The three-dimensional printed template guided technique for S2AI screw placement and a comparison with freehand technique

2020 ◽  
Author(s):  
Zhenhai Zhou ◽  
Zhimin Zeng ◽  
Honggui Yu ◽  
Jiachao Xiong ◽  
Zhiming Liu ◽  
...  
Keyword(s):  
Adult Spinal Deformity ◽  
Three Dimensional ◽  
Deformity Correction ◽  
Asian Population ◽  
Screw Placement ◽  
Asian Patients ◽  
Sacropelvic Fixation ◽  
Freehand Technique ◽  
Group 3 ◽  
Adult Volunteers

Abstract Background Sacropelvic fixation continues to present challenges when involved in the adult spinal deformity correction. The S2 alar iliac (S2AI) fixation is commonly used in sacropelvic fixation. Several techniques, including intraoperative navigation and freehand technique, were used for S2AI screws placement. The aim of this study is to analyze the anatomic parameters for S2AI screw trajectory in Asian population and introduce a novel technique described as three-dimensional printed template guided technique (TGT). Meanwhile, the accuracy and safety of this technique were compared with conventional freehand technique. Methods The S2AI trajectory parameters were measured in100 Asian adult volunteers. Parameters were compared between different genders. Forty-eight adult patients who underwent S2AI screw placement were reviewed, 28 patients received freehand technique and 20 patients received TGT technique. Postoperative CT was used to assess the accuracy of screw trajectory and cortex violation related complications were recorded. Results The cephalocaudal angles (CA), maximal length of screw pathway (ML), narrowest width of pathway within the iliar teardrop (NW), distance from the center of teardrop to sciatic notch(SD) and distance of the start point distal to S1 dorsal foramen(DD) showed significant gender-related difference (p<0.05). All 48 patients were placed S2AI screws bilaterally (40 screws in TGT vs 56 screws in freehand). One screw penetrated iliac cortex in TGT group but 10 screws penetrated iliac cortex in freehand group (3% vs 17.9%) (p<0.05). Conclusion Approximately 30-35° of cephalocaudal angle and 39°mediolateral angle are appropriate for S2AI screw placement in Asian patients. Either freehand or TGT technique is safe for S2AI screw placement. TGT technique is more accurate compared with conventional freehand technique. Trial registration This is a retrospective study. Key words Sacropelvic fixation, Second sacral alar iliac (S2AI) screw, three-dimensional printed template, freehand technique

scholarly journals The three-dimensional printed template guided technique for S2 alar iliac screw placement and a comparison with freehand technique

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096711
Author(s):  
Zhenhai Zhou ◽  
Zhimin Zeng ◽  
Honggui Yu ◽  
Jiachao Xiong ◽  
Zhiming Liu ◽  
...  
Keyword(s):  
Adult Spinal Deformity ◽  
Three Dimensional ◽  
Deformity Correction ◽  
Asian Population ◽  
Screw Placement ◽  
Asian Patients ◽  
Sacropelvic Fixation ◽  
Freehand Technique ◽  
Iliac Screw ◽  
Group 3

Purpose: Sacropelvic fixation continues to present challenges when involved in the adult spinal deformity correction. The S2 alar iliac (S2AI) fixation is commonly used in sacropelvic fixation. Several techniques, including intraoperative navigation and freehand technique, were used for S2AI screws placement. The aim of this study is to analyze the anatomic parameters for S2AI screw trajectory in Asian population and introduce a novel technique described as a three-dimensional printed template guided technique (TGT). Meanwhile, the accuracy and safety of this technique were compared with the conventional freehand technique. Methods: The S2AI trajectory parameters were measured in 100 Asian adult volunteers. Parameters were compared between different genders. Forty-eight adult patients who underwent S2AI screw placement were reviewed: 28 patients received freehand technique and 20 patients received TGT technique. Postoperative computed tomography was used to assess the accuracy of screw trajectory and cortex violation-related complications were recorded. Results: The cephalocaudal angles (CAs), maximal length of screw pathway, narrowest width of pathway within the iliar teardrop, distance from the center of teardrop to sciatic notch, and distance of the start point distal to S1 dorsal foramen showed significant gender-related difference ( p < 0.05). All 48 patients were placed S2AI screws bilaterally (40 screws in TGT vs. 56 screws in freehand). One screw penetrated iliac cortex in the TGT group but 10 screws penetrated iliac cortex in the freehand group (3% vs. 17.9%) ( p < 0.05). Conclusion: Approximately 30–35° of CA and 39° mediolateral angle are appropriate for S2AI screw placement in Asian patients. Either freehand or TGT technique is safe for S2AI screw placement. TGT technique is more accurate compared with the conventional freehand technique. Trial registration: This is a retrospective study.

scholarly journals Three-Dimensional Printing for Preoperative Planning and Pedicle Screw Placement in Adult Spinal Deformity: A Systematic Review

2020 ◽  
pp. 219256822094417
Author(s):  
Cesar D. Lopez ◽  
Venkat Boddapati ◽  
Nathan J. Lee ◽  
Marc D. Dyrszka ◽  
Zeeshan M. Sardar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Three Dimensional ◽  
Deformity Correction ◽  
Screw Placement ◽  
Spinal Deformities ◽  
Three Dimensional Printing ◽  
Significant Difference ◽  
Dimensional Printing

Study Design: Systematic review. Objectives: This current systematic review seeks to identify current applications and surgical outcomes for 3-dimensional printing (3DP) in the treatment of adult spinal deformity. Methods: A comprehensive search of publications was conducted through literature databases using relevant keywords. Inclusion criteria consisted of original studies, studies with patients with adult spinal deformities, and studies focusing on the feasibility and/or utility of 3DP technologies in the planning or treatment of scoliosis and other spinal deformities. Exclusion criteria included studies with patients without adult spinal deformity, animal subjects, pediatric patients, reviews, and editorials. Results: Studies evaluating the effect of 3DP drill guide templates found higher screw placement accuracy in the 3DP cohort (96.9%), compared with non-3DP cohorts (81.5%, P < .001). Operative duration was significant decreased in 3DP cases (378 patients, 258 minutes) relative to non-3DP cases (301 patients,272 minutes, P < .05). The average deformity correction rate was 72.5% in 3DP cases (245 patients). There was no significant difference in perioperative blood loss between 3DP (924.6 mL, 252 patients) and non-3DP cases (935.6 mL, 177 patients, P = .058). Conclusions: Three-dimensional printing is currently used for presurgical planning, patient and trainee communication and education, pre- and intraoperative guides, and screw drill guides in the treatment of scoliosis and other adult spinal deformities. In adult spinal deformity, the usage of 3DP guides is associated with increased screw accuracy and favorable deformity correction outcomes; however, average costs and production lead time are highly variable between studies.

scholarly journals Negative Sagittal Balance Following Adult Spinal Deformity Surgery

2017 ◽  
Vol 8 (2) ◽  
pp. 149-155
Author(s):  
Robert K. Merrill ◽  
Jun S. Kim ◽  
Ian T. McNeill ◽  
Samuel C. Overley ◽  
James E. Dowdell ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sagittal Balance ◽  
Adult Spinal Deformity ◽  
Univariate Analysis ◽  
Deformity Correction ◽  
Sagittal Vertical Axis ◽  
Spinal Deformity Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Study Design: Retrospective cohort study. Objective: Elucidate negative sagittal balance following adult spinal deformity surgery. Methods: We conducted a retrospective review of adult spinal deformity patients who underwent long fusion (>5 levels) to the sacrum by a single surgeon at a single institution between 2011 and 2015. Patients were divided into cohorts of postoperative sagittal vertical axis (SVA) <−10 mm, between −10 and +10 mm, or >+10 mm, denoted as groups 1, 2, and 3, respectively. Univariate analysis compared preoperative factors between the groups, and a multivariable logistic regression model was used to determine independent risk factors for developing a negative sagittal balance (SVA<−10 mm) following adult spinal deformity correction. Results: We reviewed 8 patients in group 1, 9 patients in group 2, and 25 patients in group 3. The average postoperative SVA for group 1, group 2, and group 3 were −30.99, +3.67, and +55.56 mm, respectively. There was a trend toward higher upper-instrumented vertebra (UIV) in group 1 (T2) compared with group 2 (T10) and group 3 (T9) ( P = .05). A trend toward lower preoperative SVA in groups 1 and 2 compared with group 3 was also seen (+53.36 vs +71.73 vs +122.80 mm) ( P = .06). Finally, we found a trend toward lower body mass index in group 1 compared with groups 2 and 3 (24.71 vs 25.92 vs 29.33 kg/m2) ( P = .07). Based on multivariable regression, higher UIV was found to be a statistically significant independent predictor for developing a postoperative negative sagittal balance of <−10 mm ( P = .02, odds ratio = 0.67). Conclusions: Our results demonstrate that a higher UIV may predispose patients undergoing adult spinal deformity correction to have a postoperative negative sagittal balance.

Three-dimensional Printed Drill Guides Versus Fluoroscopic-guided Freehand Technique for Pedicle Screw Placement

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nicholas Wallace ◽  
Bilal B. Butt ◽  
Ilyas Aleem ◽  
Rakesh Patel
Keyword(s):  
Pedicle Screw ◽  
Three Dimensional ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Freehand Technique

Identification of High-risk Patients for Implantable Cardioverter–Defibrillator Therapy in Asia

2011 ◽  
Vol 3 (1) ◽  
pp. 77
Author(s):  
Cyril YK Ko ◽  
Jeffrey WH Fung ◽  
◽  
Keyword(s):  
Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Asian Population ◽  
Structural Heart Disease ◽  
Medical Problem ◽  
Western World ◽  
Asian Countries ◽  
Cardioverter Defibrillator ◽  
Asian Patients ◽  
Risk Patients

Sudden cardiac death (SCD) is a serious medical problem worldwide. Multiple landmark studies have demonstrated the benefit of implantable cardioverter–defibrillator (ICD) therapy in preventing SCD in at-risk patients. Although the data available in Asia are limited, the disease pattern seems to be different from that in the western world. The Asian population seems to have a lower incidence of SCD. Coronary heart disease, which is the major underlying cause of SCD in the west, may play a less important role in Asian countries. In addition, non-structural heart disease seems to be a more prevalent cause of SCD in Asia. It is thus questionable whether the results of ICD trials can be applied directly to Asian countries, as most of these trials seldom recruited Asian patients. This article will review SCD in Asia, focusing on the epidemiology and risk factors for SCD in Asia and highlighting some unique features that may be different from those seen in the western world.

Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis

2019 ◽  
Vol 30 (6) ◽  
pp. 822-832
Author(s):  
Cecilia L. Dalle Ore ◽  
Christopher P. Ames ◽  
Vedat Deviren ◽  
Darryl Lau
Keyword(s):  
Rheumatoid Arthritis ◽  
Spinal Deformity ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Vena Cava ◽  
Deformity Correction ◽  
Perioperative Outcomes ◽  
Medical Complications ◽  
Filter Placement ◽  
Estimated Blood Loss

OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.

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