Abstract
Background The pedicle screw is one of the main tools used in spinal deformity correction surgery. Robotic and navigated surgeries are usually used, and they provide superior accuracy in pedicle screw placement than free-hand and fluoroscopy-guided techniques. However, their high cost and space limitation are problematic. We provide a new solution using 3D printing technology to facilitate spinal deformity surgery. Methods A workflow was developed to assist spinal deformity surgery using 3D printing technology. The trajectory and profile of pedicle screws were determined on the image system by the surgical team. The engineering team designed drill templates based on the bony surface anatomy and the trajectory of pedicle screws. Their effectiveness and safety were evaluated during a preoperative simulation surgery. The surgery consisted in making a pilot hole through the drill template on a computed tomography- (CT-) based, full-scale 3D spine model for every planned segment. Somatosensory evoke potential (SSEP) and motor evoke potential (MEP) were used for intraoperative neurophysiological monitoring. Postoperative CT was obtained 6 months after the correction surgery to confirm the screw accuracy. Results From July 2015 to November 2016, we performed 10 spinal deformity surgeries with 3D printing technology assistance. In total, 173 pedicle screws were implanted using drill templates. No notable change in SSEP and MEP or neurologic deficit was noted. Based on postoperative CT scans, the acceptable rate was 97.1% (168/173). We recorded twelve pedicle screws with medial breach, six with lateral breach, and five with inferior breach. Medial breach (12/23) was the main type of penetration. Lateral breach occurred mostly in the concave side (5/6). Most penetrations occurred above the T8 level (69.6%, 16/23). Conclusion 3D printing technology provides an effective alternative for spinal deformity surgery when expensive medical equipment, such as intraoperative navigation and robotic systems, is unavailable.
Highlights
Background. e pedicle screw is one of the main tools used in spinal deformity correction surgery
A workflow was developed to assist spinal deformity surgery using ree-dimensional CT (3D) printing technology. e trajectory and profile of pedicle screws were determined on the image system by the surgical team. e engineering team designed drill templates based on the bony surface anatomy and the trajectory of pedicle screws. eir effectiveness and safety were evaluated during a preoperative simulation surgery. e surgery consisted in making a pilot hole through the drill template on a computed tomography- (CT-) based, full-scale 3D spine model for every planned segment
A systematic review in 2012 reported that in studies using free-hand technique, the accuracy ranged from 69% to 94%; with the aid of fluoroscopy, it ranged from 28% to 85% [4]
Summary
Background. e pedicle screw is one of the main tools used in spinal deformity correction surgery. E pedicle screw is one of the main tools used in spinal deformity correction surgery. Robotic and navigated surgeries are usually used, and they provide superior accuracy in pedicle screw placement than free-hand and fluoroscopy-guided techniques. Their high cost and space limitation are problematic. A workflow was developed to assist spinal deformity surgery using 3D printing technology. 3D printing technology provides an effective alternative for spinal deformity surgery when expensive medical equipment, such as intraoperative navigation and robotic systems, is unavailable. E technique employs 3D printing technology to assist in spinal deformity surgery and applies drill templates to increase the accuracy of pedicle screw placement. We developed a technique to overcome the limitations of the aforementioned techniques. e technique employs 3D printing technology to assist in spinal deformity surgery and applies drill templates to increase the accuracy of pedicle screw placement. e causes of inaccurate placement with this technique were analysed
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