3D Printed Templates Improve the Accuracy and Safety of Pedicle Screw Placement in the Treatment of Pediatric Congenital Scoliosis

Abstract Background Three-dimensional (3-D) printed guidance templates are being increasingly used in spine surgery. The purpose of this study was to determine if 3D printed navigation templates can improve the accuracy of pedicle screw placement and decrease the complication rate compared to freehand screw placement in the treatment of children with congenital scoliosis. Methods The records of pediatric patients with congenital scoliosis treated at our hospital from January 2017 to January 2019 were retrospectively reviewed. Patients were divided into those where a 3D printed guidance templated was used and those in which the freehand method was used for pedicle screw placement. The accuracy rate of pedicle screw placement, surgical outcomes, and complications were compared between groups. Results A total of 67 children with congenital scoliosis were included (43 males and 24 females; mean age of 4.13 ± 2.66 years; range, 2–15 years). There were 34 children in the template-assisted group and 33 in the freehand group. The excellent accuracy rate of pedicle screw placement was significantly higher in the template-assisted group (96.10% vs. 88.64%, P = 0.007). The main Cobb angle and kyphosis angle were similar between the 2 groups preoperatively and postoperatively (all, P > 0.05), and in both groups both angles were significantly decreased after surgery as compared to the preoperative values (all, P < 0.001). The degree of change of the Cobb angle of the main curve and kyphosis angle were not significantly different between the 2 groups. There were no postoperative complications in the template group and 4 in the freehand group (0% vs. 12.12%; P = 0.009). All 4 patients with complications required revision surgery.

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3D Printed Templates Improve the Accuracy and Safety of Pedicle Screw Placement in the Treatment of Pediatric Congenital Scoliosis

10.21203/rs.3.rs-850871/v1 ◽

2021 ◽

Author(s):

Jun Cao ◽

Xuejun Zhang ◽

Haonan Liu ◽

Ziming Yao ◽

Yunsong Bai ◽

...

Keyword(s):

Cobb Angle ◽

Pedicle Screw ◽

Three Dimensional ◽

Congenital Scoliosis ◽

Screw Placement ◽

Accuracy Rate ◽

Kyphosis Angle ◽

Pedicle Screw Placement ◽

3D Printed ◽

Main Curve

Abstract Background: Three-dimensional (3-D) printed guidance templates are being increasingly used in spine surgery. The purpose of this study was to determine if 3D printed navigation templates can improve the accuracy of pedicle screw placement and decrease the complication rate compared to freehand screw placement in the treatment of children with congenital scoliosis. Methods: The records of pediatric patients with congenital scoliosis treated at our hospital from January 2017 to January 2019 were retrospectively reviewed. Patients were divided into those where a 3D printed guidance templated was used and those in which the freehand method was used for pedicle screw placement. The accuracy rate of pedicle screw placement, surgical outcomes, and complications were compared between groups.Results: A total of 67 children with congenital scoliosis were included (43 males and 24 females; mean age of 4.13 ± 2.66 years; range, 2-15 years). There were 34 children in the template-assisted group and 33 in the freehand group. The excellent accuracy rate of pedicle screw placement was significantly higher in the template-assisted group (96.10% vs. 88.64%, P = 0.007). The main Cobb angle and kyphosis angle were similar between the 2 groups preoperatively and postoperatively (all, P > 0.05), and in both groups both angles were significantly decreased after surgery as compared to the preoperative values (all, P < 0.001). The degree of change of the Cobb angle of the main curve and kyphosis angle were not significantly different between the 2 groups. There were no postoperative complications in the template group and 4 in the freehand group (0% vs. 12.12%; P = 0.009). All 4 patients with complications required revision surgery.

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The 3D Printed Template Assists Accuracy and Safety of Screw Placement in the Treatment of Pediatric Congenital Scoliosis: A Case Control Retrospective Study

10.21203/rs.3.rs-344986/v1 ◽

2021 ◽

Author(s):

Jun Cao ◽

Xuejun Zhang ◽

Haonan Liu ◽

Ziming Yao ◽

Yunsong Bai ◽

...

Keyword(s):

Postoperative Complications ◽

Pedicle Screw ◽

Three Dimensional ◽

Congenital Scoliosis ◽

Screw Placement ◽

Accuracy Rate ◽

Pedicle Screw Placement ◽

3D Printed ◽

Cobb’S Angle ◽

Excellent Accuracy

Abstract Background: Three-dimensional (3-D) printed templates are increasingly applied in spinal surgery, but are rarely used in the treatment of congenital scoliosis. This study aimed to evaluate the accuracy and safety of 3D printed template-assisted screw placement in the treatment of congenital scoliosis.Methods: A total of 67 patients with congenital scoliosis treated in our hospital between January 2017 to January 2019 were retrospectively included (mean age= 4.13±2.66 years, range: 2-15) and divided into the template-assistant group (n=34) and the freehand group (n=33) according to the screw placement method. The accuracy rate of pedicle screw placement, surgical outcomes, and incidence of complications were compared between groups.Results: Although the good accuracy (grade 0+ grade 1) rate of pedicle screw placement was comparable between the two groups, the excellent accuracy (grade 0) rate was significantly higher in the template-assistant group than in the freehand group (96.10% vs. 88.64%, P=0.007). The main curve Cobb's angle and Kyphosis' angle significantly decreased after surgery in both groups but without a significant intergroup difference. The template-assistant group had a significantly lower postoperative complication rate than the freehand group (0% vs. 18.18%; P=0.009). The 4 patients with postoperative complications in the freehand group all received revision surgery.Conclusion: The 3D printed templates can improve the excellent accuracy rate of screw placement and reduce postoperative complications in the treatment of congenital scoliosis, thereby improving the therapeutic efficacy.

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Does Three-dimensional Printing Plus Pedicle Guider Technology in Severe Congenital Scoliosis Facilitate Accurate and Efficient Pedicle Screw Placement?

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000000739 ◽

2019 ◽

Vol 477 (8) ◽

pp. 1904-1912 ◽

Cited By ~ 2

Author(s):

Ming Luo ◽

Wengang Wang ◽

Ningning Yang ◽

Lei Xia

Keyword(s):

Pedicle Screw ◽

Three Dimensional ◽

Congenital Scoliosis ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Three Dimensional Printing ◽

Dimensional Printing

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Spinal Neuronavigation and 3D-Printed Tubular Guide for Pedicle Screw Placement: A Really New Tool to Improve Safety and Accuracy of the Surgical Technique?

Journal of Spine ◽

10.4172/2165-7939.1000e118 ◽

2015 ◽

Vol 04 (05) ◽

Cited By ~ 2

Author(s):

Alessandro Landi Cristina Mancarella ◽

Fabrizio Gregori Roberto Delfini

Keyword(s):

Surgical Technique ◽

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

3D Printed

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Design and basic research on accuracy of a novel individualized three-dimensional printed navigation template in atlantoaxial pedicle screw placement

PLoS ONE ◽

10.1371/journal.pone.0214460 ◽

2019 ◽

Vol 14 (4) ◽

pp. e0214460 ◽

Cited By ~ 1

Author(s):

Xiao-Long Chen ◽

Ya-Fen Xie ◽

Jian-Xin Li ◽

Wu Wu ◽

Guan-Nan Li ◽

...

Keyword(s):

Pedicle Screw ◽

Three Dimensional ◽

Basic Research ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Navigation Template

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Comparison of Radiation Exposure in Lumbar Pedicle Screw Placement With Fluoroscopy Vs Computer-Assisted Image Guidance With Intraoperative Three-Dimensional Imaging

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2008.11753648 ◽

2008 ◽

Vol 31 (5) ◽

pp. 532-537 ◽

Cited By ~ 96

Author(s):

Harvey Smith ◽

Matthew Welsch ◽

Hatice Ugurlu ◽

Rick Sasso ◽

Alexander Vaccaro

Keyword(s):

Radiation Exposure ◽

Pedicle Screw ◽

Image Guidance ◽

Three Dimensional ◽

Screw Placement ◽

Computer Assisted ◽

Pedicle Screw Placement ◽

Three Dimensional Imaging ◽

Computer Assisted Image ◽

Lumbar Pedicle

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Accuracy of upper thoracic pedicle screw placement using three-dimensional image guidance

The Spine Journal ◽

10.1016/j.spinee.2009.06.014 ◽

2009 ◽

Vol 9 (10) ◽

pp. 817-821 ◽

Cited By ~ 56

Author(s):

Jonathan M. Bledsoe ◽

Doug Fenton ◽

Jeremy L. Fogelson ◽

Eric W. Nottmeier

Keyword(s):

Pedicle Screw ◽

Image Guidance ◽

Three Dimensional ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Dimensional Image ◽

Thoracic Pedicle Screw ◽

Upper Thoracic

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Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement

Journal of Neurosurgery Spine ◽

10.3171/2010.5.spine09993 ◽

2010 ◽

Vol 13 (5) ◽

pp. 606-611 ◽

Cited By ~ 75

Author(s):

Yoshimoto Ishikawa ◽

Tokumi Kanemura ◽

Go Yoshida ◽

Zenya Ito ◽

Akio Muramoto ◽

...

Keyword(s):

Pedicle Screw ◽

Three Dimensional ◽

Screw Placement ◽

Computer Assisted ◽

Pedicle Screw Placement ◽

Cervical Pedicle Screw ◽

Retrospective Clinical Study ◽

Significant Difference ◽

Cervical Pedicle ◽

Grade 3

Object The authors performed a retrospective clinical study to evaluate the feasibility and accuracy of cervical pedicle screw (CPS) placement using 3D fluoroscopy-based navigation (3D FN). Methods The study involved 62 consecutive patients undergoing posterior stabilization of the cervical spine between 2003 and 2008. Thirty patients (126 screws) were treated using conventional techniques (CVTs) with a lateral fluoroscopic view, whereas 32 patients (150 screws) were treated using 3D FN. Screw positions were classified into 4 grades based on the pedicle wall perforations observed on postoperative CT. Results The prevalence of perforations in the CVT group was 27% (34 screws): 92 (73.0%), 12 (9.5%), 6 (4.8%), and 16 (12.7%) for Grade 0 (no perforation), Grade 1 (perforation < 1 mm), Grade 2 (perforation ≥ 1 and < 2 mm), and Grade 3 (perforation ≥ 2 mm), respectively. In the 3D FN group, the prevalence of perforations was 18.7% (28 screws): 122 (81.3%), 17 (11.3%), 6 (4%), and 5 (3.3%) for Grades 0, 1, 2, and 3, respectively. Statistical analysis showed no significant difference in the prevalence of Grade 1 or higher perforations between the CVT and 3D FN groups. A higher prevalence of malpositioned CPSs was seen in Grade 2 or higher (17.5% vs 7.3%, p < 0.05) in the 3D FN group and Grade 3 (12.7% vs 7.3%, p < 0.05) perforations in the CVT group. The ORs for CPS malpositioning in the CVT group were 2.72 (95% CI 1.16–6.39) in Grade 2 or higher perforations and 3.89 (95% CI 1.26–12.02) in Grade 3 perforations. Conclusions Three-dimensional fluoroscopy-based navigation can improve the accuracy of CPS insertion; however, severe CPS malpositioning that causes injury to the vertebral artery or neurological complications can occur even with 3D FN. Advanced techniques for the insertion of CPSs and the use of modified insertion devices can reduce the risk of a malpositioned CPS and provide increased safety.

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