Abstract
Transpedicular transdiscal screw fixation is an alternative technique used in lumbar spine fixation; however, it requires an accurate screw trajectory. The aim of this study is to design a novel 3D-printed custom drill guide and investigate its accuracy to guide the trajectory of transpedicular transdiscal (TPTD) lumbar screw fixation. Dicom images of thirty lumbar functional segment units (FSU, two segments) of L1–L4 were acquired from the PACS system in our hospital (patients who underwent a CT scan for other abdomen diseases and had normal spine anatomy) and imported into reverse design software for three-dimensional reconstructions. Images were used to print the 3D lumbar models and were imported into CAD software to design an optimal TPTD screw trajectory and a matched custom drill guide. After both the 3D printed FSU models and 3D-printed custom drill guide were prepared, the TPTD screws will be guided with a 3D-printed custom drill guide and introduced into the 3D printed FSU models. No significant statistical difference in screw trajectory angles was observed between the digital model and the 3D-printed model (P > 0.05). Our present study found that, with the help of CAD software, it is feasible to design a TPTD screw custom drill guide that could guide the accurate TPTD screw trajectory on 3D-printed lumbar models.
Highlights
Bilateral pedicle screw (BPS) fixation was recognized as the ‘‘gold standard’’ surgical technique for spinal arthrodesis (Boos & Webb, 1997; Suk et al, 2012; Umeta & Avanzi, 2011); it still had some disadvantages, such as extensive paraspinal dissection and blood loss, significant cost and surgical wound infection (Adogwa et al, 2011; Koutsoumbelis et al, 2011; Rajaee, Kanim & Bae, 2014), which prompted researchers and surgeons to develop alternative, less invasive techniques
As reported in a previous study (Wu et al, 2013), we simulated the transpedicular transdiscal (TPTD) screw trajectory (Diameter: 5.5 mm (L1–L2), and 6.0 mm (L2–L4) in CAD software, as placed at the central axis of the pedicle with a maximum upward tilt while remaining within the pedicle throughout (Fig. 1)
All TPTD screws were successfully introduced into the 3D-printed model guided by our novel TPTD screw custom drill guide
Summary
Bilateral pedicle screw (BPS) fixation was recognized as the ‘‘gold standard’’ surgical technique for spinal arthrodesis (Boos & Webb, 1997; Suk et al, 2012; Umeta & Avanzi, 2011); it still had some disadvantages, such as extensive paraspinal dissection and blood loss, significant cost and surgical wound infection (Adogwa et al, 2011; Koutsoumbelis et al, 2011; Rajaee, Kanim & Bae, 2014), which prompted researchers and surgeons to develop alternative, less invasive techniques. One of the alternative techniques developed in recent years was transpedicular transdiscal (TPTD) oblique lumbar fixation, first described by Abdu, Wilber & Emery (1994) and Grob, Humke & Dvorak (1996). Wu et al. How to cite this article Shao et al (2017), Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computerassisted 3D-printed custom drill guide. (2013) and Aghayev et al (2014) described the feasibility of TPTD screw fixation for use in non-spondylolisthesis patients, but Wu et al emphasized that the optimal trajectory of the TPTD screw was more difficult to achieve than with BPS. (2013) and Aghayev et al (2014) described the feasibility of TPTD screw fixation for use in non-spondylolisthesis patients, but Wu et al emphasized that the optimal trajectory of the TPTD screw was more difficult to achieve than with BPS. Birkenmaier et al (2010) suggested the use of a robotic-assisted navigation system to help introduce the TPTD screw percutaneously
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