Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement

Lu, Sheng; Xu, Yong; Chen, Guo P.; Zhang, Yuan Z.; Lu, Da; Chen, Yu B.; Shi, Ji H.; Xu, Xing

doi:10.3109/10929088.2011.605173

Cited by 92 publications

(88 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The concept of personalized image-based 3D templates was first described by Berry et al 4 Owen et al and Ryken and colleagues followed the concept with their cadaveric studies, 25,29,30 and then Lu and colleagues [16][17][18] and Kawaguchi et al 12 applied the templates for clinical use as drill guide templates. However, these templates were only used as a drilling guide.…”

Section: Discussionmentioning

confidence: 99%

A novel screw guiding method with a screw guide template system for posterior C-2 fixation

Kaneyama

Sugawara²,

Sumi³

et al. 2014

SPI

View full text Add to dashboard Cite

Object Accurate insertion of C-2 cervical screws is imperative; however, the procedures for C-2 screw insertion are technically demanding and challenging, especially in cases of C-2 vertebral abnormality. The purpose of this study is to report the effectiveness of the tailor-made screw guide template (SGT) system for placement of C-2 screws, including in cases with abnormalities. Methods Twenty-three patients who underwent posterior spinal fusion surgery with C-2 cervical screw insertion using the SGT system were included. The preoperative bone image on CT was analyzed using multiplanar imaging software. The trajectory and depth of the screws were designed based on these images, and transparent templates with screw guiding cylinders were created for each lamina. During the operation, after templates were engaged directly to the laminae, drilling, tapping, and screwing were performed through the templates. The authors placed 26 pedicle screws, 12 pars screws, 6 laminar screws, and 4 C1–2 transarticular screws using the SGT system. To assess the accuracy of the screw track under this system, the deviation of the screw axis from the preplanned trajectory was evaluated on postoperative CT and was classified as follows: Class 1 (accurate), a screw axis deviation less than 2 mm from the planned trajectory; Class 2 (inaccurate), 2 mm or more but less than 4 mm; and Class 3 (deviated), 4 mm or more. In addition, to assess the safety of the screw insertion, malpositioning of the screws was also evaluated using the following grading system: Grade 0 (containing), a screw is completely within the wall of the bone structure; Grade 1 (exposure), a screw perforates the wall of the bone structure but more than 50% of the screw diameter remains within the bone; Grade 2 (perforation), a screw perforates the bone structures and more than 50% of the screw diameter is outside the pedicle; and Grade 3 (penetration), a screw perforates completely outside the bone structure. Results In total, 47 (97.9%) of 48 screws were classified into Class 1 and Grade 0, whereas 1 laminar screw was classified as Class 3 and Grade 2. Mean screw deviations were 0.36 mm in the axial plane (range 0.0–3.8 mm) and 0.30 mm in the sagittal plane (range 0.0–0.8 mm). Conclusions This study demonstrates that the SGT system provided extremely accurate C-2 cervical screw insertion without configuration of reference points, high-dose radiation from intraoperative 3D navigation, or any registration or probing error evoked by changes in spinal alignment during surgery. A multistep screw placement technique and reliable screw guide cylinders were the key to accurate screw placement using the SGT system.

show abstract

Section: Discussionmentioning

confidence: 99%

A novel screw guiding method with a screw guide template system for posterior C-2 fixation

Kaneyama

Sugawara²,

Sumi³

et al. 2014

SPI

View full text Add to dashboard Cite

show abstract

“…Numerous studies demonstrated that the guides help to lower operation time, with Deng et al (37) suggesting this may decrease complications related to operative time (e.g., infection) (30,35,37,43). Other benefits include decreased intra-operative radiation, simplicity of use, elimination of procedural subjectivity, enhanced pre-operative planning and moderate cost in comparison with other techniques (30,(32)(33)(34)(35)(36)(37)(38)42,43).…”

Section: Surgical Guidesmentioning

confidence: 99%

“…In the cervical spine, asymmetry, vast inter-patient differences such as anomalous vertebral artery course, and the sensitive nature of surrounding tissues make procedural success more difficult to achieve, and hence able to benefit from individualised guides (30,31,33,34,37,38,40,43,56). Otsuki et al (41) demonstrated that 3DP guides provide an extra benefit in revision surgery, where screw insertion is more difficult due to morphology changes caused by the first operation.…”

Section: Surgical Guidesmentioning

confidence: 99%

“…The use of intra-operative imaging increases harmful radiation exposure for both doctors and patients (30,(34)(35)(36). 3DP guides may offer an alternative as a simple, convenient, low cost and complexequipment free way to improve the accuracy of pedicle screw placement (30)(31)(32)(33)(34)(35)(36)(37)(39)(40)(41)(42)(43).…”

Section: Surgical Guidesmentioning

confidence: 99%

“…Next, a 3D model is generated by specialist software from which the optimal screw trajectory and size can be determined, often in consultation with the surgeon. Finally, a navigational template is designed and built with optimal screw trajectory, the surface of which is the inverse of the posterior vertebral surface to ensure a good fit and accuracy of screw insertion (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)55). Numerous studies demonstrated that the guides help to lower operation time, with Deng et al (37) suggesting this may decrease complications related to operative time (e.g., infection) (30,35,37,43).…”

Section: Surgical Guidesmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of 3D printing in spinal surgery: the current state of play

et al. 2017

View full text Add to dashboard Cite

Three-dimensional printing (3DP), also known as "Additive Manufacturing", is a rapidly growing industry, particularly in the area of spinal surgery. Given the complex anatomy of the spine and delicate nature of surrounding structures, 3DP has the potential to aid surgical planning and procedural accuracy. We perform a systematic review of current literature on the applications of 3DP in spinal surgery. Six electronic databases were searched for original published studies reporting cases or outcomes for 3DP surgical models, guides or implants for spinal surgery. The findings of these studies were synthesized and summarized. These searches returned a combined 2,411 articles. Of these, 54 were included in this review. 3DP is currently used for surgical planning, intra-operative surgical guides, customised prostheses as well as "Off-the-Shelf" implants. The technology has the potential for enhanced implant properties, as well as decreased surgical time and better patient outcomes. The majority of the data thus far is from low-quality studies with inherent biases linked with the excitement of a new field. As the body of literature continues to expand, larger scale studies to evaluate advantages and disadvantages, and longer-term follow up will enhance our knowledge of the effect 3DP has in spinal surgery. In addition, issues such as financial impact, time to design and print, materials selection and bio-printing will evolve as this rapidly expanding field matures.

show abstract

Novel design for a customized, 3D‐printed surgical template for thoracic spinal arthrodesis

Naddeo

Fontana

Naddeo

et al. 2019

Robotics Computer Surgery

View full text Add to dashboard Cite

Background The integration of computer‐aided design/computer‐aided manufacturing (CAD/CAM) tools and medicine is rapidly developing for designing medical devices. A novel design for a 3D‐printed patient‐specific surgical template for thoracic pedicle screw insertion, using a procedure based on reverse engineering, is presented. Methods The surgeon chooses the entry point on the vertebra. The optimal insertion direction and the size of the screws are defined via an algorithm on the basis of a patient‐specific vertebra CAD model. The template features an innovative shape for a comfortable and univocal placement and a novel disengaging device. Results Three spinal fusions were performed to test the template. Excellent results were achieved in terms of the accuracy of the screw positioning, reduction in surgery duration, and number of X‐rays. Conclusions A novel design for a customized, 3D‐printed surgical template for thoracic spinal arthrodesis was presented, and improvements in terms of precision, duration, and safety were achieved without changing the standard procedure.

show abstract

Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement

Cited by 92 publications

References 32 publications

A novel screw guiding method with a screw guide template system for posterior C-2 fixation

A novel screw guiding method with a screw guide template system for posterior C-2 fixation

Systematic review of 3D printing in spinal surgery: the current state of play

Novel design for a customized, 3D‐printed surgical template for thoracic spinal arthrodesis

Contact Info

Product

Resources

About