Dataset Information

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

ABSTRACT:

Purpose

Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine.

Methods

Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is <1 mm, but with good internal fixation stability and no need to renovate; Type III, degree of pedicle cortex perforation is >1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable.

Results

A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group.

Conclusion

The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery.

SUBMITTER: Guo F

PROVIDER: S-EPMC5289602 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

Guo Fei F Dai Jianhao J Zhang Junxiang J Ma Yichuan Y Zhu Guanghui G Shen Junjie J Niu Guoqi G

PloS one 20170202 2

<h4>Purpose</h4>Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine.<h4>Methods</h4>Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixa ...[more]

PMID: 28152039

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Project description:OBJECTIVE:To design and evaluate the accuracy of a novel navigation template suitable for posterior cervical screw placement surgery by using 3D printing technology to improve the existing guiding template design. METHODS:The researchers (including spine surgeons and technicians) used CT to perform thin-slice scanning on 12 cases of normal upper cervical vertebral specimens and defined the screw channels that were completely located in the pedicle without penetrating the cortex as ideal screw channels, then designed the ideal channel of the upper cervical vertebral (atlantoaxial) pedicle screw by computer software which was regarded as the preset values, and recorded the screw entrance point, transverse angle and sagittal angle of the ideal channel. Then, researchers designed the novel navigation templates for placement pedicle screw according to the ideal screw channel preset values and manufactured them with one for every single vertebra by 3D printer. A senior spine surgeon performed the posterior surgery to implant pedicle screw on the specimens by the novel navigation templates, then performed CT thin-slice scanning on the specimens again after removing the screws, and reconstructed the actual screws channel by computer software, recorded the screw entrance point, transverse angle and sagittal angle of the actual channels which were defined as the actual values and evaluated them according to Kawaguchi's pedicle screw evaluation standard finally. The differences between the preoperative preset values of ideal screw channel and the postoperative actual values of actual screw channel were compared by a nonparametric paired rank test. RESULTS:48 screws were placed on 12 cases of upper cervical vertebral specimens in total. It showed that the grade 0, I, II, III channels in this study were 47, 1, 0, 0, respectively. The grade 0 channels accounted for 97.92% of the total number of channels. There was no significant difference with regard to the screw entrance point, the transverse angle, and the sagittal angle between the preoperative preset values of ideal screw channels and the postoperative actual values of actual screw channels. CONCLUSION:To implant pedicle screw assisted with the novel individually navigation template designed by 3D printed in the posterior cervical surgery can improve accuracy of pedicle screw placement and safety of the surgery.

Project description:INTRODUCTION:The most common surgical treatment of traumatic spine fractures is through a posterior approach using pedicle screws and rods. Postoperative treatment protocols including the use of postoperative orthoses however differ between hospitals and surgeons. A three-point hyperextension orthosis is designed to support proper posture and unload the anterior column. Some motion remains when wearing an orthosis, and its main value in postoperative treatment is therefore believed to be pain relief and patient confidence. This could consequently shorten recovery time. On the other hand, an orthosis could also lead to muscle weakness and slow down recovery. Any orthosis-related complications might also be avoided. Additionally, recent studies on conservative fracture treatment show no difference in radiological outcomes with or without an orthosis. To date, no randomised studies have been performed on the use of postoperative orthoses. METHODS AND ANALYSIS:Patients undergoing posterior fixation with pedicle screws for a traumatic thoracolumbar fracture (T7-L4) will be included in this randomised controlled multicentre non-inferiority trial. Forty-six patients will be randomised 1:1 to one of the two parallel groups; one group will wear a postoperative orthosis for 6?weeks followed by 6?weeks of weaning and one group will not wear an orthosis. The primary outcome is pain at 6?weeks reported on the Numerical Rating Scale. Secondary outcomes consist of pain on other moments, analgesic use, complications and length of hospital stay, quality of life (EuroQuol 5 Dimensions), back pain-related function (Oswestry Disability Index) and radiological outcomes with a follow-up of 1?year. Orthosis compliance is monitored weekly in the orthosis group. ETHICS AND DISSEMINATION:The institutional review board (METc VUmc) approved this study on 11 October 2016 under case number 2016.389. After completion of the trial, the results will be offered to an international scientific journal for peer-reviewed publication. TRIAL REGISTRATION NUMBER:NCT03097081 and NTR6285; Pre-results.

Dataset Information

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

Purpose

Methods

Results

Conclusion

Publications

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

Similar Datasets

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