Application of a novel 3D drill template for cervical pedicle screw tunnel design: a cadaveric study

Zhou, Yu; Zhang, Guodong; Chen, Xuanhuang; Xu, Chen; Wu, Changfu; Lin, Yijun; Huang, Wenhua; Lin, Hua

doi:10.1007/s00586-017-5118-3

Cited by 27 publications

(26 citation statements)

References 29 publications

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“…Pedicle screws show an improved biomechanical stability over lateral mass screws, allowing for shorter instrumentations with improved reposition capacities 5,6 . However, safety concerns regarding injury to the vertebral artery, spinal cord or nerve root have been reported 7,8 . Furthermore, cervical pedicle diameters are smaller than those in the thoracic or lumbar spine, increasing its technical difficulty.…”

Section: Introductionmentioning

confidence: 99%

Precision and safety of Multilevel Cervical Transpedicular Screw Fixation with 3D Patient-Specific Guides; A Cadaveric Study

Sallent

Ramírez

Català³

et al. 2019

Sci Rep

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The aim is to design a patient-specific instrument (PSI) for multilevel cervical pedicle screw placement from C2 to C7, as well as verifying reliability and reproducibility. Computed tomography (CT) scans were obtained from 7 cadaveric cervical spines. Using Mimics software, semiautomatic segmentation was performed for each cervical spine, designing a 3D cervical spine bone model in order to plan transpedicular screw fixation. A PSI was designed according to the previously cited with two cannulated chimneys to guide the drill. The guides were 3D printed and surgeries performed at the laboratory. Postoperative scans were obtained to study screw placement. Sixty-eight transpedicular screws were available for study. 61.8% of all screws were within the pedicle or partially breached <4 mm. No differences were observed between cervical levels. None of these screws had neurovascular injury. Of the 27 screws with a grade 3 (screw outside the pedicle; 39.7%), only 2 had perforation of the transverse foramen and none of them would have caused a neural injury. In conclusion, multilevel PSI for cervical pedicle screw is a promising technology that despite showing improvements regarding free-hand technique requires further studies to improve the positioning of the PSI and their accuracy.

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Section: Introductionmentioning

confidence: 99%

Precision and safety of Multilevel Cervical Transpedicular Screw Fixation with 3D Patient-Specific Guides; A Cadaveric Study

Sallent

Ramírez

Català³

et al. 2019

Sci Rep

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“…Recently, according to the reports of relevant clinical experiments, the drill guide template has been successfully applied in the placement of pedicle screws in spine surgeries [7][8][9]. Some studies have shown that patientspecific drilling guidance templates can reduce the incidence of pedicle screw misplacement and decrease the operative time and intraoperative blood loss; however, most of these studies involved animal experiments and cadaver specimen experiments [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

Xie

et al. 2020

J Orthop Surg Res

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Background: Many surgeons believe that the use of a 3D-printed drill guide template shortens operative time and reduces intraoperative blood loss compared with those of the free-hand technique. In this study, we investigated the effects of a drill guide template on the accuracy of pedicle screw placement (the screw placed completely in the pedicle), operative time, and intraoperative blood loss. Materials/Methods: We systematically searched the major databases, such as Medline via PubMed, EMBASE, Ovid, Cochrane Library, and Google Scholar, regarding the accuracy of pedicle screw placement, operative time, and intraoperative blood loss. The χ 2 test and I 2 statistic were used to examine heterogeneity. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the accuracy rate of pedicle screw placement, and weighted mean differences (WMDs) with 95% CIs were utilized to express operative time and intraoperative blood loss. Results: This meta-analysis included 13 studies (seven randomized controlled trials and six prospective cohort studies) involving 446 patients and 3375 screws. The risk of research bias was considered moderate. Operative time (WMD = − 20.75, 95% CI − 33.20~− 8.29, P = 0.001) and intraoperative blood loss (WMD = − 106.16, 95% CI − 185.35 − 26.97, P = 0.009) in the thoracolumbar vertebrae, evaluated by a subgroup analysis, were significantly different between groups. The 3D-printed drill guide template has advantages over the free-hand technique and improves the accuracy of pedicle screw placement (OR = 2.88; 95% CI, 2.39~3.47; P = 0.000). Conclusion: The 3D-printed drill guide template can improve the accuracy rate of pedicle screw placement, shorten operative time, and reduce intraoperative blood loss.

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“…Therefore, compared with traditional C2 pedicle screw placement, the 2 methods can accurately set the placement point and direction of the C2 pedicle screw and effectively increase the accuracy of C2 pedicle screw placement. Yu et al [21] proved the safety and effectiveness of 3D-printed navigation templates based on 3D models of the cervical spine through cadaver studies, and this technology can achieve accurate C2 pedicle screw placement. Singh et al [22] showed that intraoperative navigation significantly improved the accuracy of C2 pedicle screw placement.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of C2 Pedicle or Pars Screw Placement with Assistance from a 3-Dimensional (3D)-Printed Navigation Template versus C-Arm Based Navigation

et al. 2019

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Background: Since C2 is adjacent to important nerves and blood vessels, the implantation risk of C2 internal fixation in this area is high and requires high accuracy. This study mainly discussed the application value of 3-dimensional (3D)-printed navigation template in C2 screw placement. Material/Methods: A retrospective study compared 3D-printed navigation template-assisted screw placement (group A, n=32) and the C-arm based navigation-assisted screw placement group (group B, n=32). Group A was divided into 2 subgroups: A1 (C2 pedicle screw placement) and A2 (C2 pars screw placement); group B was divided into B1 (C2 pedicle screw placement) and B2 (C2 pars screw placement). The accuracy and safety of screw placement and clinical outcomes were evaluated. Results: There were 64 C2 screws placed in group A, and 95.31% achieved a grade A accuracy rating, including 52 screws in group A1 (96.15% grade A) and 12 screws in group A2 (91.67% grade A). A total of 64 C2 screws were placed in group B, and 84.38% achieved a grade A accuracy rating, including 50 screws in group B1 (84.00% grade A) and 14 screws in group B2 (85.71% grade A). The accuracy of screw placement differed significantly between groups A and B (P=0.041) and between groups A1 and B1 (P=0.039) but not between groups A2 and B2 (P=0.636). The postoperative efficacy of the 2 groups was satisfactory. And there were no complications of blood vessels or nerves related to screw placement in either group. Conclusions: Although 3D-printed navigation template-assisted and C-arm based navigation-assisted C2 pedicle and pars screw placement provided similar safety and clinical efficacy, 3D-printed navigation template technology achieved more accurate C2 pedicle screw placement.

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Application of a novel 3D drill template for cervical pedicle screw tunnel design: a cadaveric study

Abstract: The 3D CT reconstructive rapid prototyping drill template combined with the screw tunnel design based on 3D cutting technique can help facilitate accurate cervical pedicle screw insertion.

Cited by 27 publications

References 29 publications

Precision and safety of Multilevel Cervical Transpedicular Screw Fixation with 3D Patient-Specific Guides; A Cadaveric Study

Precision and safety of Multilevel Cervical Transpedicular Screw Fixation with 3D Patient-Specific Guides; A Cadaveric Study

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

A Comparative Study of C2 Pedicle or Pars Screw Placement with Assistance from a 3-Dimensional (3D)-Printed Navigation Template versus C-Arm Based Navigation

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