Accuracy of S2 Alar-Iliac Screw Placement Under the Guidance of a 3D-Printed Surgical Guide Template

Zhao, Yonghui; Luo, Haotian; Ma, Yue; Liang, Jinlong; Han, Gonghai; Xu, Yongqing; Lu, Sheng

doi:10.1016/j.wneu.2020.10.063

Cited by 9 publications

(13 citation statements)

References 33 publications

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“… 2021 Zhao Y et al. [ 10 ] World Neurosurg 27 S2AI screw for degenerative scoliosis, revision surgery, spondylolisthesis, and lumbar stenosis S2AI screw placement assisted by a 3D-printed surgical guide is safe and accurate. 2021 Liang W et al.…”

Section: Basic Types and Clinical Applications Of Orthopedic 3d Print...mentioning

confidence: 99%

“…Sacral fractures are a common clinical disease. In the placement of S2 Alar-Iliac (S2AI) screws, many surgeons used a 3D printing surgical guide [ 10 , 104 ]. Compared to the freehand screw placement group, it showed a higher accuracy rate with the use of a guide template.…”

Section: Basic Types and Clinical Applications Of Orthopedic 3d Print...mentioning

confidence: 99%

“…The 3D surgical templates are instruments that are used to guide the placement of internal fixations such as screws, assist in bone repositioning, and aid in determining the extent of osteotomy [ 7 ]. During cadaver research as well as clinical studies, the template has attracted increasing attention from clinicians because of its position-independent character and the reduction of surgical procedures [ [8] , [9] , [10] ]. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure [ 5 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical applications and prospects of 3D printing guide templates in orthopaedics

Meng

Wang

Sun

et al. 2022

Journal of Orthopaedic Translation

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Section: Basic Types and Clinical Applications Of Orthopedic 3d Print...mentioning

confidence: 99%

Section: Basic Types and Clinical Applications Of Orthopedic 3d Print...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical applications and prospects of 3D printing guide templates in orthopaedics

Meng

Wang

Sun

et al. 2022

Journal of Orthopaedic Translation

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“…A similar result was found by Zhao et al, who utilized bilateral S2AI placement under guidance of a 3D printed surgical template for 27 patients in a retrospective clinical study in which placement of the screw was postoperatively graded on a scale ranging from grade 0(screw fully surrounded by bone) to grade 3(severe, breakthrough distance >6 mm), with the breakthrough distance defined as the shortest distance from the furthest end of the penetrating screw to the adjacent cortical bone. 18 During the operation, all screws were successfully placed in the ilium, except for 2 screws that slightly invaded the medial cortical bone (grade 1). Therefore, the results from studies regarding screw misplacement yield the conclusion that small variations in angulation can produce potential breaches, and that although such breaches may or may not result in complications, they can occur relatively frequently.…”

Section: Complications In Freehand S2 Alar Iliac Techniquesmentioning

confidence: 99%

Challenges and Complications in Freehand S2-Alar-Iliac Spinopelvic Fixation and the Potential for Robotics to Enhance Patient Safety

Arora

Berven

2022

Global Spine Journal

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Study Design: Narrative Summary Review for Navigation & Robotics Focus Issue. Objective: To discuss the challenges and complications of S2-Alar-Iliac (S2AI) spinopelvic fixation using freehand techniques, and to introduce the utility of navigation & robotics to enhance patient safety. Methods: This study involved search of literature using the PubMed database, including retrospective clinical studies, anatomic reports, and surgical reports. The intention was to find literature that discussed complications regarding screw malfunction from manual S2AI placement, anatomical complexity of the sacroiliac joint, and outcomes of S2AI procedures conducted with robotic guidance systems. Results: The sacroiliac joint presents numerous complexities that can lead to challenges in free-hand placement of the S2-alar-iliac screw. Anatomic considerations of the S2AI screw involve close proximity to vital neurovascular structures, including: superior gluteal vessels, external iliac vessels, pudendal vessels, superior gluteal nerves, sciatic nerve, sympathetic chain ganglia, and pudendal nerves. The complications associated with manual S2AI screw installation include screw misplacement, breach of cortical bone, and injury to neurovascular structures. Robotic techniques for establishing S2AI screws involve greater accuracy of screw placement and reduced complications. Conclusions: Accurate placement of S2AI screws is compromised by variation in pelvic anatomy and by a pathway that traverses dense cortical bone of the sacroiliac joint. Accurate placement of S2AI screws is important for patient safety regarding neurovascular structures, and for effective, stable fixation across the SI joint. Robotic navigation of S2AI fixation offers significant utility in improving the accuracy of screw placement and patient safety.

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“…Высокая точность транспедикулярной имплантации при использовании персонифицированных навигационных шаблонов подтверждается многочисленными современными исследованиями [1][2][3][4][5]. Изготовление таких шаблонов требует определенных финансовых, технических и временных ресурсов [6][7][8][9]. Особое значение они имеют при планировании протяженной фиксации с многочисленными опорными элементами, при этом логично их изготавливать только для тех зон позвоночника, в которых установка транспедикулярных винтов может представлять техническую сложность.…”

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Selective application of navigation templates in idiopathic scoliosis: technical and hronometric features

et al. 2022

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Objective. To evaluate short-term result of selective navigation templates application in idiopathic scoliosis surgery.Material and Methods. A total of 12 patients aged 14–17 years with idiopathic scoliosis were included in the study. Group A included 6 patients treated with selective application of navigation templates for pedicle screws insertion in the most difficult zones. Group B (control) included 6 patients in whom all the pedicle screws were placed with free-hand technique. Number of screws inserted was 16–20 per patient. There was no significant difference between the groups in sex, age, Cobb angle, number of vertebrae instrumented, number of pedicle screws and laminar hooks. Surgery duration, blood loss, absolute and relative correction were compared. In Group A, duration of the 3D-objects fabrication and printing, as well as pedicle screw accuracy based on 2-mm increment grading system were evaluated.Results. Selective application of navigation templates as compared with total free hand screws placement significantly reduced surgery duration. Difference in blood loss and deformity correction was not significant. A total of 107 pedicle screws were placed in Group A, 48 of them with navigation templates and 59 by free-hand technique. Average pedicle width in screw installation with navigation templates was 4.28 ± 1.43 mm, and in that with free-hand technique 6.53 ± 1.72 mm, with significant difference. Accurate screw placement with navigation templates and by free-hand technique were 93.7 % and 88.0 %, respectively, with no significant difference. Duration of 3D-objects manufacturing was 1419 ± 190 minutes. Active operator’s involvement was required in about 10 % of the while.Conclusion. Selective application of a pair of two-level navigation templates for most difficult pedicles in idiopathic scoliosis significantly reduces surgery duration. Difference in blood loss and deformity correction is insignificant. Refusal of total templates usage for combination of navigation templates for selected difficult pedicles and free-hand technique for the rest is an option for shortening the preoperative preparation, but provides screw placement accuracy comparable with total templates usage (92.5–97.6 % as reported).

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Accuracy of S2 Alar-Iliac Screw Placement Under the Guidance of a 3D-Printed Surgical Guide Template

Cited by 9 publications

References 33 publications

Clinical applications and prospects of 3D printing guide templates in orthopaedics

Clinical applications and prospects of 3D printing guide templates in orthopaedics

Challenges and Complications in Freehand S2-Alar-Iliac Spinopelvic Fixation and the Potential for Robotics to Enhance Patient Safety

Selective application of navigation templates in idiopathic scoliosis: technical and hronometric features

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