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Objective. To analyze the advantages of additive technologies and 3D modeling in surgery for severe congenital spinal deformities caused by mixed and non-classified developmental anomalies, including assessing the quality of transpedicular screws. Material and Methods. A total of 20 patients with complex spinal anatomy caused by congenital vertebral anomalies were treated. Nine patients had complex unclassifiable anomalies of the spine, 11 had mixed anomalies, 3 of them had aplasia of the structures of the spinal column. In order to assess the results, patients were divided into two groups of 10 people. In Group I, standard preoperative preparation was performed according to X-ray, CT and MRI data. In Group II, preoperative preparation was accompanied by the use of a prefabricated 3D model of the patient's spine. CT data were used to create STL-models which were printed using 3D printer. To analyze the effectiveness of 3D prototyping in preoperative planning, a survey among surgeons specializing in pathology of the spine was conducted. Results. Survey results demonstrated that there were cases of changes in surgical treatment tactics after the 2nd stage of the survey, based on the results of applying standard methods of radiation diagnostics and 3D model of the entire spine with prototyping of the thoracic, lumbar, and sacral spine. In 25.3 % of cases, tactics were changed. Significant improvement in surgical treatment results were observed in Group II with preoperative 3D modeling (94.9 % without screw malposition), compared to Group I in which surgical correction was performed using standard methods of imaging (78.1 % without screw malposition). Цель исследования. Анализ преимуществ аддитивных технологий и 3D-моделирования при хирургии тяжелых врожденных деформаций позвоночника, вызванных смешанными и неклассифицируемыми аномалиями развития, включая оценку качества проведения транспедикулярных винтов. Материал и методы. Проведено лечение 20 пациентов со сложной анатомией позвоночника, вызванной врожденными аномалиями развития позвонков. У 9 пациентов имелись сложные неклассифицируемые аномалии развития позвоночника, у 11-смешанные аномалии, у 3 из них-аплазия структур позвоночного столба. С целью оценки результатов пациентов разделили на две группы по 10 человек. В группе I проводили стандартную предоперационную подготовку по данным рентгенограмм, КТ и МРТ. В группе II предоперационная подготовка сопровождалась использованием предварительно изготовленной 3D-модели позвоночника пациента. За основу взяты данные КТ позвоночника, которые преобразовывали в stl-модель. Печать модели осуществляли с применением 3D-принтера. Провели анкетирование врачей, специализирующихся в патологии позвоночника, для оценки эффективности применения 3D-моделирования в предоперационном планировании. Результаты. При анкетировании хирургов отмечены случаи изменения тактики хирургического лечения после 2-го этапа опроса, основанные на применении стандартных методов лучевой диагностики и 3D-модели всего позвоночника пациента с прототипирова...
Objective. To analyze the advantages of additive technologies and 3D modeling in surgery for severe congenital spinal deformities caused by mixed and non-classified developmental anomalies, including assessing the quality of transpedicular screws. Material and Methods. A total of 20 patients with complex spinal anatomy caused by congenital vertebral anomalies were treated. Nine patients had complex unclassifiable anomalies of the spine, 11 had mixed anomalies, 3 of them had aplasia of the structures of the spinal column. In order to assess the results, patients were divided into two groups of 10 people. In Group I, standard preoperative preparation was performed according to X-ray, CT and MRI data. In Group II, preoperative preparation was accompanied by the use of a prefabricated 3D model of the patient's spine. CT data were used to create STL-models which were printed using 3D printer. To analyze the effectiveness of 3D prototyping in preoperative planning, a survey among surgeons specializing in pathology of the spine was conducted. Results. Survey results demonstrated that there were cases of changes in surgical treatment tactics after the 2nd stage of the survey, based on the results of applying standard methods of radiation diagnostics and 3D model of the entire spine with prototyping of the thoracic, lumbar, and sacral spine. In 25.3 % of cases, tactics were changed. Significant improvement in surgical treatment results were observed in Group II with preoperative 3D modeling (94.9 % without screw malposition), compared to Group I in which surgical correction was performed using standard methods of imaging (78.1 % without screw malposition). Цель исследования. Анализ преимуществ аддитивных технологий и 3D-моделирования при хирургии тяжелых врожденных деформаций позвоночника, вызванных смешанными и неклассифицируемыми аномалиями развития, включая оценку качества проведения транспедикулярных винтов. Материал и методы. Проведено лечение 20 пациентов со сложной анатомией позвоночника, вызванной врожденными аномалиями развития позвонков. У 9 пациентов имелись сложные неклассифицируемые аномалии развития позвоночника, у 11-смешанные аномалии, у 3 из них-аплазия структур позвоночного столба. С целью оценки результатов пациентов разделили на две группы по 10 человек. В группе I проводили стандартную предоперационную подготовку по данным рентгенограмм, КТ и МРТ. В группе II предоперационная подготовка сопровождалась использованием предварительно изготовленной 3D-модели позвоночника пациента. За основу взяты данные КТ позвоночника, которые преобразовывали в stl-модель. Печать модели осуществляли с применением 3D-принтера. Провели анкетирование врачей, специализирующихся в патологии позвоночника, для оценки эффективности применения 3D-моделирования в предоперационном планировании. Результаты. При анкетировании хирургов отмечены случаи изменения тактики хирургического лечения после 2-го этапа опроса, основанные на применении стандартных методов лучевой диагностики и 3D-модели всего позвоночника пациента с прототипирова...
Objective. To assess efficacy and safety of using a three-level navigation template in the surgical treatment of congenital spinal deformities. Material and Methods. Three-level navigation templates were used in surgical treatment of four consecutively operated 10-17-year-old patients with congenital scoliosis associated with thoracic hemivertebrae. The correctness of screw position was evaluated according to CT data using a 2-mm increment method: class 0-intraosseous screw position; class 1-the screw extends beyond the pedicle cortex by less than 2 mm; class 2-by 2-4 mm; and class 3-by more than 4 mm. Preoperative DICOM data were processed with free software. The model of target zone and navigation template were 3D printed and used in surgery. Results. Four of 16 (25 %) pedicles were narrower than 4.35 mm and were estimated as difficult for implantation with a planned violation of the integrity of the endplate. Perforation of the outer cortical layer took place in all these cases, and screw position corresponded to class 2 only in pedicle width of 1.9 mm. In pedicles wider than 4.35 mm, 11 of 12 (91.7 %) screws were implanted intraosseously. One screw extended beyond the pedicle cortex by 0.8 mm (class 1). Conclusion. Three-level navigation template can be considered as an effective means of positioning transpedicular screws in secondarily changed segments adjacent to anomalous one and confounding implantation. Free software is sufficient for preparing 3D-model of target zone and navigation template, and such a model is a highly informative reference object that is convenient to use during the operation.
BACKGROUND: The choice of techniques for the treatment of children with congenital spinal deformities remains one of the most significant problems of spinal surgery. This topic is relevant given the peculiarities of the disease course, severity and rigidity of deformities, their steady and rapid progression, formation of compensatory curvature, and a significant decrease in the quality and life expectancy of patients. AIM: To compare screw misposition, adverse outcomes, intraoperative blood loss, and time required for pedicle screw placement with further deformity correction under computed tomography (CT) guidance with intraoperative navigation versus fluoroscopy. MATERIALS AND METHODS: This single-center, prospective comparative study was conducted from 2019 to 2022 at the National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov. Patient demographics and surgical outcomes were obtained from the medical records. All patients underwent a comprehensive clinical and radiological examination before surgery, after surgery, and at the stages of dynamic observation. Data of patients with congenital malformations of the spine were analyzed. The study involved 42 patients aged 318 years with congenital kyphoscoliosis of the thoracic and/or lumbar spine. The patients were divided into two groups according to the method of surgical correction used: the O-arm navigation group and the C-arm group. RESULTS: Data of patients who underwent surgery for congenital scoliosis of the spine were analyzed. The patients were divided into the O-arm navigation group, which included patients who underwent surgery using the O-arm mobile intraoperative CT with the seventh-generation Stealth Station navigation system in combination with intraoperative neuromonitoring, and the C-arm group, which included patients who underwent surgery under the control of the intraoperative C-arm. In both groups, 364 screws were placed, of which 189 screws were placed under neuronavigation, and 175 screws were placed using the C-arm. The effectiveness of the intraoperative neuronavigation system in combination with neuromonitoring showed 97.11% correct placement (grades A and B) of pedicle screws. The use of an intraoperative C-arm showed 89.63% (grades A and B) correctness. The proportion of misplaced screws corresponding to GertzbeinRobbins classes CE was higher in the C-arm group (10.37%) than in the navigation group (1.49%) (p 0.005). No severe neurological disorders, postoperative infection, or adverse clinical outcomes were observed in both groups. CONCLUSIONS: The installation of pedicle screws using CT-guided navigation (O-arm) did not prolong the operation time, did not increase blood loss, and reduced the risk of screw mispositioning compared with freehand and fluoroscopy pedicle screw placement.
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