Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis

Abstract

Introduction There was a lack of attention to the screw placement techniques for surgical treatment of scoliosis in children and adolescents. This meta-analysis aims to compare the accuracy and safety of pedicle screw placement between 3D-printed navigation template technique and free-hand technique during corrective surgery for scoliosis in children and adolescents. Methods A comprehensive search was conducted for relevant articles up to December 2021 in databases including PubMed, Embase, MEDLINE, Cochrane, and Web of Science. The systematic meta-analysis compared the efficacy of pedicle screw placement between the two techniques, including accuracy of pedicle screw placement, complication rate, operation time, blood loss, mean place time per screw, and mean times for fluoroscopy. Results The seven studies involved 229 patients altogether. A total of 2805 pedicle screws were placed by two methods. Our results revealed that the 3D-printed guide template technique was more accurate than the free-hand technique in pedicle screw placement (OR=2.96; 95% CI, 2.24~3.91, P˂ 0.000) with a lower complication rate (OR=0.21; 95% CI, 0.06~0.78, P=0.02). The operation time (MD= -34.37, 95% CI, -67.47~-1.28, P=0.04) and mean place time per screw (MD= -3.11, 95% CI, -6.13~-0.09, P=0.04) and mean times for fluoroscopy (MD= -6.60, 95% CI, -8.66~-4.55, P<0.000) significantly decreased among patients in the 3D-printed navigation template group compared with those in the free-hand technique group. In addition, the two techniques had no significant statistical difference in blood loss. Conclusions Compared with the traditional free-hand technique, the 3D-printed guide template is a promising technique with higher accuracy and safety in screw placement for the surgical treatment of scoliosis in children and adolescents and is worth popularizing and validating by more prospective clinical studies.

A Meta-Review about Medical 3D Printing

“…The pathologies included cancer [21, 25, 42-44, 46, 55, 77, 83, 130], COVID-19 [26], craniofacial defects [47,48,53,56], different fracture types [57,58,63,67,73,132], ear and hearing disorders [78], musculoskeletal malformations [21,67,68,133], neurologic disorders [21,25,38], respiratory disorders [21,79,85], spinal disorders [59,68,92,128,129,134] and tooth loss [126,127]. Procedures include brachytherapy [44,46], cereberovascular surgery [38], colorectal surgery techniques, such as transanal total mesorectal excision, total mesorectal excision, laparoscopic resection [42], craniomoaxillofacial surgery [20, 48-50, 52, 53, 56, 79, 83], guides for dental implants [126], orthopedic procedures on the musculoskeletal system [25,47,55,57,58,63,67,73,…”

“…Regarding time, a reduction in operating time of 10 minutes to 258 minutes was reported [59,132] and a reported production time range of 5 hours to 5 days [68]. These studies conducted an additional Meta-Analysis [53,56,57,78,[128][129][130][131]134]. The included papers by the authors in this section ranged from 6 -350.…”

“…Table 3 is sorted according to the medical field (n = 42). The medical fields are dentistry [126, 127], general surgery [20, 21, 24, 25] health care engineering [26], neurosurgery [38, 128–131], oncology [42, 43], oral and maxillofacial surgery [47–50, 52, 53, 55, 56], orthopedics [57–59, 63, 67, 68, 73, 77, 132–134], otorhinolaryngology [78, 79, 83], pediatrics [85, 89, 90, 92] and radiation oncology [44, 46].…”

“…The affected organs or body parts are the brain [38], cardiothoracic system [89], central nervous system [89], cranium [25, 48–50, 52, 53, 55, 56, 78, 83, 132], ear [78, 79, 132], eye [132], female internal genitals [44, 46], gastrointestinal system [89], genitourinary tract [89], jaw [25, 47–50, 56, 126], liver [25, 44], musculoskeletal system [20, 21, 24, 25, 43, 57, 58, 63, 67, 73, 90, 133], neck [44, 78, 83, 132], rectum [42], soft tissue [24, 25, 44], spine [25, 38, 59, 68, 77, 92, 128–131, 134], teeth [21, 126, 127] and upper and lower respiratory tract [85].…”

“…The pathologies included cancer [21, 25, 42–44, 46, 55, 77, 83, 130], COVID-19 [26], craniofacial defects [47, 48, 53, 56], different fracture types [57, 58, 63, 67, 73, 132], ear and hearing disorders [78], musculoskeletal malformations [21, 67, 68, 133], neurologic disorders [21, 25, 38], respiratory disorders [21, 79, 85], spinal disorders [59, 68, 92, 128, 129, 134] and tooth loss [126, 127].…”