COMPUTER 3D-MODELING OF PATIENT-SPECIFIC NAVIGATIONAL TEMPLATE FOR CERVICAL SCREW INSERTION
https://doi.org/10.14531/ss2018.2.33-38
Abstract
Objective. To prove the effectiveness of 3D computer modeling and printing of patient-specific templates for cervical spine screw fixation.
Materials and Methods. Based on the MSCT data of three patients, 3D models of cervical vertebrae and guiding templates were produced. The screws were inserted transpedicularly into 3D-printed models of C2–C7 vertebrae and C1 lateral masses using standard cervical instrumentation. This technology was then clinically tested in a patient with C2 tumor, in whom posterior stabilization of C1–C3 vertebrae was performed using guiding templates. In the postoperative period, MSCT was performed to monitor the position of screws.
Results. When implanting screws into 3D-models, technical difficulties were not revealed. After insertion of screws, a visual assessment of the 3D vertebra model was made. Malpositions in models were not detected. Based on the proven technique, a clinical approbation was performed in a patient with normal cervical spine pattern. MSCT study revealed the deviation of screws relative to the planned trajectory by no more than 2 mm, with no malpositions.
Conclusion. The first domestic description of the technique of navigation using guiding templates is presented. Of all the existing methods, this is the most reliable way of screw positioning in the cervical spine. The possible insertion error does not affect the quality of positioning.
About the Authors
A. V. Burtsev
Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
Russian Federation
Russian Federation
Aleksandr Vladimirovich Burtsev - MD, PhD, surgeon, orthopedist-vertebrologist, researcher, Laboratory of Axial Skeletal Pathology and Neurosurgery.
M. Ulyanovoy str., 640014, Kurgan
O. M. Pavlova
Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
Russian Federation
Russian Federation
Olga Mikhailovna Pavlova - neurosurgeon, orthopedist-traumatologist, junior researcher in the Laboratory of Axial Skeletal Pathology and Neurosurgery.
M. Ulyanovoy str., 640014, Kurgan
S. O. Ryabykh
Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
Russian Federation
Russian Federation
Sergey Olegovich Ryabykh, DMSc, pediatric surgeon, orthopedist-traumatologist, vertebrologist, Head of the Clinic of Spine Pathology and Rare Diseases.
M. Ulyanovoy str., 640014, Kurgan
A. V. Gubin
Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
Russian Federation
Russian Federation
Alexandr Vadimovich Gubin, DMSc, orthopedist-traumatologist, Director.
M. Ulyanovoy str., 640014, Kurgan
References
1. Berry E, Cuppone M, Porada S, Millner PA, Rao A, Chiverton N, Seedhom BB. Personalised image-based templates for intra-operative guidance. Proc Inst Mech Eng H. 2005;219:111–118. DOI: 10.1243/095441105X9273.
2. Birnbaum K, Schkommodau E, Decker N, Prescher A, Klapper U, Radermacher K. Computer-assisted orthopedic surgery with individual templates and comparison to conventional operation method. Spine. 2001;26:365–370. DOI: 10.1097/00007632-200102150-00012.
3. D’ Urso PS, Williamson OD, Thompson RG. Biomodeling as an aid to spinal instrumentation. Spine. 2005;30:2841–2845. DOI: 10.1097/01.brs.0000190886.56895.3d.
4. Hu Y, Yuan ZS, Spiker WR, Albert TJ, Dong WX., Xie H, Yuan JB, Wang CT. Deviation analysis of C2 translaminar screw placement assisted by a novel rapid prototyping drill template: a cadaveric study. Eur Spine J. 2013;22:2770–2776. DOI: 10.1007/s00586-013-2993-0.
5. Kaneyama S, Sugawara T, Sumi M, Higashiyama N, Takabatake M, Mizoi K. A novel screw guiding method with a screw guide template system for posterior C2 fixation: clinical article. J Neurosurg Spine. 2014;21:231–238. DOI: 10.3171/2014.3.SPINE13730.
6. Kaneyama S, Sugawara T, Sumi M. Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system. Spine. 2015;40:E341–E348. DOI: 10.1097/BRS.0000000000000772.
7. Lu S, Xu YQ, Chen GP, Zhang YZ, Lu D, Chen YB, Shi JH, Xu XM. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement. Comput Aided Surg. 2011;16:240–248. DOI: 10.3109/10929088.2011.605173.
8. Lu S, Xu YQ, Lu WW, Ni GX, Li YB, Shi JH, Li DP, Chen GP, Chen YB, Zhang YZ. A novel patient-specific navigational template for cervical pedicle screw placement. Spine. 2009;34:E959–E966. DOI: 10.1097/BRS.0b013e3181c09985.
9. Lu S, Xu YQ, Zhang YZ, Xie L, Guo H, Li DP. A novel computer-assisted drill guide template for placement of C2 laminar screws. Eur Spine J. 2009;18:1379–1385. DOI: 10.1007/s00586-009-1051-4.
10. Lu S, Zhang YZ, Wang Z, Shi JH, Chen YB, Xu XM, Xu YQ. Accuracy and efficacy of thoracic pedicle screws in scoliosis with patient-specific drill template. Med Biol Eng Comput. 2012;50:751–758. DOI: 10.1007/s11517-012-0900-1.
11. Mobbs RJ, Coughlan M, Thompson R, Sutterlin CE 3rd, Phan K. The utility of 3D printing for surgical planning and patient-specific implant design for complex spinal pathologies: case report. J Neurosurg Spine. 2017;26:513–518. DOI: 10.3171/2016.9.SPINE16371.
12. Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G, Staudte HW. Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res. 1998;(354):28–38.
13. Ryken TC, Owen BD, Christensen GE, Reinhardt JM. Image-based drill templates for cervical pedicle screw placement. J Neurosurg Spine. 2009;10:21–26. DOI: 10.3171/2008.9.SPI08229.
14. Sugawara T, Higashiyama N, Kaneyama S, Sumi M. Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C1–C2 fixation. Spine. 2017;42:E340–E346. DOI: 10.1097/BRS.0000000000001807.
15. Sugawara T, Higashiyama N, Kaneyama S, Takabatake M, Watanabe N, Uchida F, Sumi M, Mizoi K. Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine: clinical article. J Neurosurg Spine. 2013;19:185–190. DOI: 10.3171/2013.4.SPINE121059.
16. Takemoto M, Fujibayashi S, Ota E, Otsuki B, Kimura H, Sakamoto T, Kawai T, Futami T, Sasaki K, Matsushita T, Nakamura T, Neo M, Matsuda S. Additivemanufactured patient-specific titanium templates for thoracic pedicle screw placement: novel design with reduced contact area. Eur Spine J. 2016;25:1698–1705. DOI: 10.1007/s00586-015-3908-z.
Review
For citations:
Burtsev A.V., Pavlova O.M., Ryabykh S.O., Gubin A.V. COMPUTER 3D-MODELING OF PATIENT-SPECIFIC NAVIGATIONAL TEMPLATE FOR CERVICAL SCREW INSERTION. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2018;15(2):33-38. https://doi.org/10.14531/ss2018.2.33-38
Email this article 