Analysis of the 3D prototyping in the surgical correction of congenital kyphoscoliosis
https://doi.org/10.14531/ss2020.1.42-53
Abstract
Objective. To analyze the advantages of additive technologies and 3D modeling in surgery for severe congenital spinal deformities caused by mixed and non-classified developmental anomalies, including assessing the quality of transpedicular screws.
Material and Methods. A total of 20 patients with complex spinal anatomy caused by congenital vertebral anomalies were treated. Nine patients had complex unclassifiable anomalies of the spine, 11 had mixed anomalies, 3 of them had aplasia of the structures of the spinal column. In order to assess the results, patients were divided into two groups of 10 people. In Group I, standard preoperative preparation was performed according to X-ray, CT and MRI data. In Group II, preoperative preparation was accompanied by the use of a prefabricated 3D model of the patient’s spine. CT data were used to create STL-models which were printed using 3D printer. To analyze the effectiveness of 3D prototyping in preoperative planning, a survey among surgeons specializing in pathology of the spine was conducted.
Results. Survey results demonstrated that there were cases of changes in surgical treatment tactics after the 2nd stage of the survey, based on the results of applying standard methods of radiation diagnostics and 3D model of the entire spine with prototyping of the thoracic, lumbar, and sacral spine. In 25.3 % of cases, tactics were changed. Significant improvement in surgical treatment results were observed in Group II with preoperative 3D modeling (94.9 % without screw malposition), compared to Group I in which surgical correction was performed using standard methods of imaging (78.1 % without screw malposition).
Conclusion. 3D modeling allows increasing the accuracy of the placement of transpedicular screws and reducing the risk of malposition, which favorably affects the biomechanical properties of the instrumentation and reduces the risk of damage to neural structures. The use of 3D modeling can statistically significantly reduce the time taken to install one screw, and the number of x-rays required. Reducing the number of images allows you to reduce radiation exposure not only to the patient, but also to the staff of the department.
Material and Methods. A total of 20 patients with complex spinal anatomy caused by congenital vertebral anomalies were treated. Nine patients had complex unclassifiable anomalies of the spine, 11 had mixed anomalies, 3 of them had aplasia of the structures of the spinal column. In order to assess the results, patients were divided into two groups of 10 people. In Group I, standard preoperative preparation was performed according to X-ray, CT and MRI data. In Group II, preoperative preparation was accompanied by the use of a prefabricated 3D model of the patient’s spine. CT data were used to create STL-models which were printed using 3D printer. To analyze the effectiveness of 3D prototyping in preoperative planning, a survey among surgeons specializing in pathology of the spine was conducted.
Results. Survey results demonstrated that there were cases of changes in surgical treatment tactics after the 2nd stage of the survey, based on the results of applying standard methods of radiation diagnostics and 3D model of the entire spine with prototyping of the thoracic, lumbar, and sacral spine. In 25.3 % of cases, tactics were changed. Significant improvement in surgical treatment results were observed in Group II with preoperative 3D modeling (94.9 % without screw malposition), compared to Group I in which surgical correction was performed using standard methods of imaging (78.1 % without screw malposition).
Conclusion. 3D modeling allows increasing the accuracy of the placement of transpedicular screws and reducing the risk of malposition, which favorably affects the biomechanical properties of the instrumentation and reduces the risk of damage to neural structures. The use of 3D modeling can statistically significantly reduce the time taken to install one screw, and the number of x-rays required. Reducing the number of images allows you to reduce radiation exposure not only to the patient, but also to the staff of the department.
About the Authors
A. A. Snetkov
N.N. Priorov Central Institute of Traumatology and Orthopedics
Russian Federation
Russian Federation
Aleksandr Andreyevich Snetkov, MD, PhD, surgeon in the Spinal Pathology Department
10 Priorova str., Moscow 127299, Russia
D. S. Gorbatyuk
N.N. Priorov Central Institute of Traumatology and Orthopedics
Russian Federation
Russian Federation
Dmitry Sergeyevich Gorbatyuk, junior researcher, Organizational Methodological Department
10 Priorova str., Moscow 127299, Russia
A. A. Panteleyev
N.N. Priorov Central Institute of Traumatology and Orthopedics
Russian Federation
Russian Federation
Andrey Andreyevich Panteleyev, surgeon in the Spinal Pathology Department
10 Priorova str., Moscow 127299, Russia
N. A. Eskin
N.N. Priorov Central Institute of Traumatology and Orthopedics
Russian Federation
Russian Federation
Nikolay Aleksandrovich Eskin, DMSc, Prof., Deputy Director for science
10 Priorova str., Moscow 127299, Russia
S. V. Kolesov
N.N. Priorov Central Institute of Traumatology and Orthopedics
Russian Federation
Russian Federation
Sergey Vasilyevich Kolesov, DMSc, orthopedic traumatologist, Head of the Spinal Pathology Department
10 Priorova str., Moscow 127299, Russia
References
1. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine. 1990;15:11–14. DOI: 10.1097/00007632-199001000-00004.
2. Wilcox B, Mobbs RJ, Wu AM, Phan K. Systematic review of 3D printing in spinal surgery: the current state of play. J Spine Surg. 2017;3:433–443. DOI: 10.21037/jss.2017.09.01.
3. Cho W, Job AV, Chen J, Hwan BJ. A review of current clinical applications of threedimensional printing in spine surgery. Asian Spine J. 2018;12:171–177. DOI: 10.4184/asj.2018.12.1.171.
4. Chhabra S, Chopra S, Kataria R, Sinha VD. Use of 3D printer model to study vertebral artery anatomy and variations in developmental craniovertebral junction anomalies and as a preoperative tool – an institutional experience. J Spine Surg. 2017;3:572–579. DOI: 10.21037/jss.2017.10.07.
5. Hsu MR, Haleem MS, Hsu W. 3D printing applications in minimally invasive spine surgery. Min Invas Surg. 2018;2018:ID 4760769. DOI: 10.1155/2018/4760769.
6. Tan LA, Yerneni K, Tuchman A, Li XJ, Cerpa M, Lehman RA Jr, Lenke LG. Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction. J Spine Surg. 2018;4:319–327. DOI: 10.21037/jss.2018.05.16.
7. Yang M, Zhang N, Shi H, Li H, Liu S, Song Z, Shan L, Wu Q, Hao D. Three-dimensional printed model-assisted screw installation in treating posterior atlantoaxial internal fixation. Sci Rep. 2018;8:11026. DOI: 10.1038/s41598-018-29426-2.
8. Fan Y, Du J, Zhang J, Liu S, Xue X, Huang Y, Zhang J, Hao D. Comparison of accuracy of pedicle screw insertion among 4 guided technologies in spine surgery. Med Sci Monit. 2017;23:5960–5968. DOI: 10.12659/msm.905713.
9. Karlin L, Weinstock P, Hedequist D, Prabhu SP. The surgical treatment of spinal deformity in children with myelomeningocele: the role of personalized threedimensional printed models. J Pediatr Orthop B. 2017;26:375–382. DOI: 10.1097/BPB.0000000000000411.
10. Wang YT, Yang XJ, Yan B, Zeng TH, Qiu YY, Chen SJ. Clinical application of threedimensional printing in the personalized treatment of complex spinal disorders. Chin J Traumatol. 2016;19:31–34. DOI: 10.1016/j.cjtee.2015.09.009.
11. Park HJ, Wang C, Choi KH, Kim HN. Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training. J Orthop Surg Res. 2018;13:86. DOI: 10.1186/s13018-018-0788-z.
12. Kuklo TR, Lenke LG, O’Brien MF, Lehman RA Jr, Polly DW Jr, Schroeder TM. Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees. Spine. 2005;30:222–226. DOI: 10.1097/01.brs.0000150482.26918.d8.
13. Complications of Pediatric and Adult Spinal Surgery, ed. by Vaccaro AR, Regan JJ, Crawford AH, Benzel EC, Anderson DG. N. Y.: Marcel Dekker, 2004. DOI: 10.1201/b14827.
14. O`Brien MF, Lenke LG, Mardjetko S, Lowe TG, Kong Y, Eck K, Smith D. Pedicle morphology in thoracic adolescent idiopathic scoliosis: is pedicle fixation an anatomically viable technique? Spine. 2000;25:2285–2293. DOI: 10.1097/00007632-200009150-00005.
15. Rampersaud YR, Pik JH, Salonen D, Faroog S. Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: a CT analysis. Spine. 2005;30:E183–E190. DOI: 10.1097/01.brs.0000157490.65706.38.
16. Kokushin DN, Vissarionov SV, Baindurashvili AG, Ovechkina AV, Poznovich MS. Comparative analysis of pedicle screw placement in children with congenital scoliosis: freehand technique (in vivo) and guide templates (in vitro). Traumatology and Orthopedics of Russia. 2018;24(4):53–63. In Russian. DOI: 10.21823/2311-2905-2018-24-4-53-63.
17. De Blas G, Barrios C, Regidor I, Montes E, Burgos J, Pizá-Vallespir G, Hevia E. Safe pedicle screw placement in thoracic scoliotic curves using t-EMG: stimulation threshold variability at concavity and convexity in apex segments. Spine. 2012;37:E387–E395. DOI: 10.1097/BRS.0b013e31823b077b.
18. Samdani AF, Tantorski M, Cahill PJ, Ranade A, Koch S, Clements DH, Betz RR, Asghar J. Triggered electromyography for placement of thoracic pedicle screws: is it reliable? Eur Spine J. 2011;20:869–874. DOI: 10.1007/s00586-010-1653-x.
19. Vissarionov SV, Drozdetsky AP, Kokushin DN, Belyanchikov SM. Correction of idiopathic scoliosis under 3D-CT navigation in children. Hir. Pozvonoc. 2012;(2):30–36. In Russian. DOI: 10.14531/ss2012.2.30-36.
20. Vissarionov SV. Approaches to spinal deformity correction using transpedicular systems in children with idiopathic scoliosis. Hir. Pozvonoc. 2013;(1):21–27. In Russian. DOI: 10.14531/ss2013.1.21-27.
Review
For citations:
Snetkov A.A., Gorbatyuk D.S., Panteleyev A.A., Eskin N.A., Kolesov S.V. Analysis of the 3D prototyping in the surgical correction of congenital kyphoscoliosis. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2020;17(1):42-53. https://doi.org/10.14531/ss2020.1.42-53
Email this article 