Posterior First and Second Cervical Vertebrae Fusion by Screw Fixation Technique using the Modern Pre-fabricated Template Method on Cadaver Samples

Golbakhsh Mr,Mirbolook A,Paydarniya P,Komlakh K,Azarhomayoun A,Ahmadi A,Athari M

doi:10.5704/moj.2111.009

Abstract

Introduction:C1 lateral mass and C2 pedicular screws insertion are used for C1-C2 posterior fusion. Fluoroscopy Guided technique is routinely used for screw placement but it is associated with risk of injury to spinal cord and vertebral artery. 3D printing has developed rapidly in the fields of medicine. It is helpful in improving precise treatment and used for instrumentation in spine. We want to evaluate the accuracy of C1 lateral mass screws and C2 pedicle screws insertion by Pre-Fabricated Template made by three-dimensional (3D) printing.Materials and methods:Five cervical samples were obtained from cadavers. Based on fine-cut CT scan 3D-images reconstructed and the path of the screws designed by special software. A template produced by 3D-printer from 3D images. After printing the templates, they were fixed on the relevant vertebra in the operation room and based on the template path, C1 lateral mass screw and C2 pedicular screws were inserted. Placement of the screws was evaluated using CT scans post-operatively.Results:A total of 14 screws were inserted by above-mentioned method. After evaluation with CT scans none of the screws were entered in the spinal canal. Two screws had vertebral artery canal perforation with less than 50% breach. Violation was judged as noncritical and would probably not have resulted in injury to vertebral artery.Conclusions:The accuracy of C1 lateral mass screw and C2 pedicle screw insertion is acceptable with pre-fabricated template and can provide a useful aid for screw placement.

Highlights

C1 lateral mass and C2 pedicular screws insertion are used for C1-C2 posterior fusion
Three-dimensional Template for C1-C2 Fusion this study is to investigate the screw fixation technique for a C1 lateral mass screw and a pedicle screw in the second vertebra through pre-fabricated templates on cadaver samples
The path for each cylinder was followed in all cuts of axial, coronal and sagittal planes of the CT scan, where each path of the cylinder was in its correct path

Summary

Introduction

C1 lateral mass and C2 pedicular screws insertion are used for C1-C2 posterior fusion. We want to evaluate the accuracy of C1 lateral mass screws and C2 pedicle screws insertion by Pre-Fabricated Template made by threedimensional (3D) printing. They were fixed on the relevant vertebra in the operation room and based on the template path, C1 lateral mass screw and C2 pedicular screws were inserted. Conclusions: The accuracy of C1 lateral mass screw and C2 pedicle screw insertion is acceptable with pre-fabricated template and can provide a useful aid for screw placement. The surgical treatment of atlantoaxial instability is performed by fixing the first and second vertebrae using a number of different methods. Among these methods, fixing with screws has been considered in recent years. There is several anatomic variations in the general population

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Conclusion