Abstract
This study assessed the utility of three-dimensional preoperative image reconstruction as digital virtual templating for junior surgeons in placing a pedicle screw (PS) in the lumbar spine. Twenty-three patients of lumbar disease were operated on with bilateral PS fixation in our hospital. The two sides of lumbar pedicles were randomly divided into “hand-free group” (HFG) and “digital virtual template group” (DVTG) in each patient. Two junior surgeons preoperatively randomly divided into these two groups finished the placement of PSs. The accuracy of PS and the procedure time of PS insertion were recorded. The accuracy of PS in DVTG was 91.8% and that in HFG was 87.7%. The PS insertion procedure time of DVTG was 74.5 ± 8.1 s and that of HFG was 90.9 ± 9.9 s. Although no significant difference was reported in the accurate rate of PS between the two groups, the PS insertion procedure time was significantly shorter in DVTG than in HFG (P < 0.05). Digital virtual template is simple and can reduce the procedure time of PS placement.
Highlights
Because of its anchoring in all three columns, pedicle screws (PSs) are commonly used in rigid fixation in the thoracolumbar spine
The evaluation of the postoperative computed tomography (CT) revealed that four PSs in the digital template group and six PSs in the hand-free group” (HFG) group were displaced out of pedicle
This study assessed the utility of a digital virtual template for junior surgeons in PS placement in the lumbar spine
Summary
Because of its anchoring in all three columns, pedicle screws (PSs) are commonly used in rigid fixation in the thoracolumbar spine. The majority of cortical violations are found to be clinically silent depending on the location and length of penetration [3, 4]. Instability of a biomechanical construct and reduced fusion rates may occur due to these initially silent violations [5]. PS insertion with the hand-free technique under fluoroscopy supervision is a popular method. It is generally safe for experienced surgeons, and its accuracy is high; it may be difficult for junior surgeons, and the learning curve is slow [6]. A clinical study reported that the asymptote of the hand-free technique for an inexperienced spinal surgery fellow started after inserting about 80 screws in the learning curve [6]
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