scholarly journals Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Chengqiang Yu ◽  
Yufu Ou ◽  
Chengxin Xie ◽  
Yu Zhang ◽  
Jianxun Wei ◽  
...  
Keyword(s):  
Blood Loss ◽  
Pedicle Screw ◽  
Operative Time ◽  
Meta Analysis ◽  
Screw Placement ◽  
Intraoperative Blood Loss ◽  
Pedicle Screw Placement ◽  
Drill Guide ◽  
3D Printed ◽  
Drill Guide Template

Abstract Background Many surgeons believe that the use of a 3D-printed drill guide template shortens operative time and reduces intraoperative blood loss compared with those of the free-hand technique. In this study, we investigated the effects of a drill guide template on the accuracy of pedicle screw placement (the screw placed completely in the pedicle), operative time, and intraoperative blood loss. Materials/Methods We systematically searched the major databases, such as Medline via PubMed, EMBASE, Ovid, Cochrane Library, and Google Scholar, regarding the accuracy of pedicle screw placement, operative time, and intraoperative blood loss. The χ2 test and I2 statistic were used to examine heterogeneity. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the accuracy rate of pedicle screw placement, and weighted mean differences (WMDs) with 95% CIs were utilized to express operative time and intraoperative blood loss. Results This meta-analysis included 13 studies (seven randomized controlled trials and six prospective cohort studies) involving 446 patients and 3375 screws. The risk of research bias was considered moderate. Operative time (WMD = − 20.75, 95% CI − 33.20 ~ − 8.29, P = 0.001) and intraoperative blood loss (WMD = − 106.16, 95% CI − 185.35 ~ − 26.97, P = 0.009) in the thoracolumbar vertebrae, evaluated by a subgroup analysis, were significantly different between groups. The 3D-printed drill guide template has advantages over the free-hand technique and improves the accuracy of pedicle screw placement (OR = 2.88; 95% CI, 2.39~3.47; P = 0.000). Conclusion The 3D-printed drill guide template can improve the accuracy rate of pedicle screw placement, shorten operative time, and reduce intraoperative blood loss.

scholarly journals CLINICAL APPLICATION OF A DRILL GUIDE TEMPLATE FOR PEDICLE SCREW PLACEMENT IN SEVERE SCOLIOSIS

2017 ◽  
Vol 25 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Xin Li ◽  
Yaoshen Zhang ◽  
Qiang Zhang ◽  
Changsong Zhao ◽  
Kun Liu
Keyword(s):  
Blood Loss ◽  
Ct Scan ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Severe Scoliosis ◽  
Drill Guide ◽  
Multi Level ◽  
Drill Guide Template

ABSTRACT Objective: To evaluate the accuracy and the effect of drill guide template for pedicle screw placement in severe scoliosis. Method: Eight patients with rigid scoliosis were enrolled, five males and three females, ranging from nine to 23 years old. A three-dimensional CT scan of the spine was performed and saved as a DICOM file type. The multi-level template was designed by Mimics software and manufactured according to the part of the most severe deformity. The drill template was placed on the corresponding vertebral surface. Pedicle screws were carefully inserted across the trajectory of the template. Postoperatively, the positions of the pedicle screws were evaluated by CT scan and graded for validation. Results: No spinal cord injury or nerve damage occurred. All patients had satisfactory outcomes. The abnormalities and the measures observed during operation were the same as those found in the preoperative period. The position of the pedicle screws was accurate, according to the postoperative X-ray and CT scan. The rate of scoliosis correction was 60%. Compared with controls, surgery time, blood loss and radiation were significantly lower. Conclusion: With the application of multi-level template, the placement of pedicle screws shows high accuracy in scoliosis with shorter surgical time, less blood loss and less radiation exposure. Level of Evidence III, Retrospective Comparative Study.

scholarly journals A Modified Personalized Image-Based Drill Guide Template for Atlantoaxial Pedicle Screw Placement: A Clinical Study

2017 ◽  
Vol 23 ◽  
pp. 1325-1333 ◽  
Author(s):  
Lianghai Jiang ◽  
Liang Dong ◽  
Mingsheng Tan ◽  
Yingna Qi ◽  
Feng Yang ◽  
...  
Keyword(s):  
Clinical Study ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Drill Guide ◽  
Drill Guide Template

scholarly journals Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis

2022 ◽  
Vol 52 (1) ◽  
pp. E10
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Operative Time ◽  
Meta Analysis ◽  
Screw Placement ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Training Requirements ◽  
3D Fluoroscopy ◽  
Placement Accuracy

OBJECTIVE Several approaches have been studied for internal fixation of the spine using pedicle screws (PSs), including CT navigation, 2D and 3D fluoroscopy, freehand, and robotic assistance. Robot-assisted PS placement has been controversial because training requirements, cost, and previously unclear benefits. This meta-analysis compares screw placement accuracy, operative time, intraoperative blood loss, and overall complications of PS insertion using traditional freehand, navigated, and robot-assisted methods. METHODS A systematic review was performed of peer-reviewed articles indexed in several databases between January 2000 and August 2021 comparing ≥ 2 PS insertion methods with ≥ 10 screws per treatment arm. Data were extracted for patient outcomes, including PS placement, misplacement, and accuracy; operative time, overall complications, intraoperative blood loss, postoperative hospital length of stay, postoperative Oswestry Disability Index (ODI) score, and postoperative visual analog scale (VAS) score for back pain. Risk of bias was assessed using the Newcastle-Ottawa score and Cochrane tool. A network meta-analysis (NMA) was performed to estimate PS placement accuracy as the primary outcome. RESULTS Overall, 78 studies consisting of 6262 patients and > 31,909 PSs were included. NMA results showed that robot-assisted and 3D-fluoroscopy PS insertion had the greatest accuracy compared with freehand (p < 0.01 and p < 0.001, respectively), CT navigation (p = 0.02 and p = 0.04, respectively), and 2D fluoroscopy (p < 0.01 and p < 0.01, respectively). The surface under the cumulative ranking (SUCRA) curve method further demonstrated that robot-assisted PS insertion accuracy was superior (S = 0.937). Optimal screw placement was greatest in robot-assisted (S = 0.995) placement, and misplacement was greatest with freehand (S = 0.069) approaches. Robot-assisted placement was favorable for minimizing complications (S = 0.876), while freehand placement had greater odds of complication than robot-assisted (OR 2.49, p < 0.01) and CT-navigation (OR 2.15, p = 0.03) placement. CONCLUSIONS The results of this NMA suggest that robot-assisted PS insertion has advantages, including improved accuracy, optimal placement, and minimized surgical complications, compared with other PS insertion methods. Limitations included overgeneralization of categories and time-dependent effects.

A low invasiveness patient’s specific template for spine surgery

2016 ◽  
Vol 231 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Farhad Azimifar ◽  
Kamran Hassani ◽  
Amir Hossein Saveh ◽  
Farhad Tabatabai Ghomshe
Keyword(s):  
Pedicle Screw ◽  
Digital Technology ◽  
Screw Placement ◽  
Patient Specific ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
New Approach ◽  
Additive Manufacturing Technology ◽  
Drill Guide ◽  
Drill Guide Template

Free-hand pedicle screw placement is still conventional in surgery, although it has potentially high risks. The surgical procedures such as pedicle screw placement are usually designed based on medical imaging, but during surgery, the procedures are not normally followed due to the fact that some points are missed in two-dimensional images and seen only during surgery. In this regards, some highly accurate computer-assisted systems have been proposed and are currently used. Moreover, it is possible to reduce or completely avoid hand working by applying modern digital technology. Therefore, using these technologies has remarkable advantages. In this study, we have presented a new approach of pedicle screw placement in the lumbar and sacral regions using a specific drill guide template. The template was created by additive manufacturing technology and was verified in a clinical study as well. The main aim of this research includes the following: design, analyze, manufacture and evaluate the accuracy of a new patient-specific drill guide template, for lumbar pedicle screw placement, and compare the template to the free-hand technique under fluoroscopy supervision. Our results show that the incidence of cortex perforation is substantially reduced compared to existing methods. Finally, we believe that this approach remarkably lowers the incidence of cortex perforation and could be potentially used in clinical applications, particularly in certain selected cases.

Sign in / Sign up

Export Citation Format

Share Document