Individual Navigation Templates for Subcortical Screw Placement in Lumbar Spine

Abstract

Subcortical screw placement is currently performed using frontal view fluoroscopy or intraoperative O-arm navigation system. The emergence of a novel technique for spinal navigation based on individual navigation templates created using 3D printing technology determines the need to study their safety and effectiveness in subcortical implantation. The aim of the study was to evaluate and compare the efficacy of subcortical implantation of pedicle screws in the lumbar spine using individual navigation templates versus intraoperative fluoroscopy. Materials and Methods The study was based on the analysis of treatment results in 39 patients who underwent surgery with subcortical implantation of 130 screws using the MidLIF technique. In group 1, navigation templates were used, in group 2 — intraoperative fluoroscopic control. Comparative analysis of implantation correctness and time, the total operation time, and radiation load was performed. Results The mean distance between the screw and the cortical plate recorded in the groups ranged within 1.20–3.97 mm, without statistically significant difference (p>0.05). The mean time of pedicle screw implantation was 137.0 [115.25; 161.50] s in group 1 and 314.0 [183.50; 403.25] s in group 2. The total operation time was reduced from 173.0 [155.0; 192.25] min in group 2 to 119.0 [108.0; 128.75] min in group 1. The average of 1.0 [1.0; 2.0] X-ray image was performed to place one screw in group 1, while it was 12.0 [10.0; 13.25] in group 2. The differences between the groups in terms of implantation time and radiation load were statistically significant (p<0.05). Conclusion Compared with intraoperative fluoroscopy, the use of individual navigation templates for subcortical implantation of pedicle screws provides their correct positioning with a significant reduction in both operation time and radiation load at similar safety.

Individualized 3D-printed navigation template-assisted tension band wiring for olecranon fractures

“…Re-adjust the position of the K-wire will increase the fluoroscopy times; however, to minimize the holding force and stability of the K-wire, repeated attempts should be abandoned. Kovalenko et al [ 24 ] reported that the use of individual navigation templates for pedicle screw placement could significantly reduce the times of intraoperative fluoroscopy. In a study by Hu et al [ 25 ], PVP with 3D-printed navigation templates could reduce fluoroscopy shot times and fluoroscopy dosage during surgery.…”

Application of the cortical bone trajectory technique in posterior lumbar fixation

“…In this original procedure, single segment spinal canal decompression, discectomy, interbody fusion and cortical screw fixation are all completed through a small midline incision, minimizing the injury related to the approach and providing another choice of fusion internal fixation for the clinical treatment of lumbar diseases. Over time, surgeons have applied CBT screws through a middle incision to fix two or more levels, which, combined with transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF), has also been defined as MIDLIF[ 11 - 13 ]. Although many researchers have described techniques with names such as CBT-PLIF or CBT-TLIF, they were in fact instances of MIDLIF[ 14 - 18 ].…”