A novel computer-assisted drill guide template for placement of C2 laminar screws

Lu, Sheng; Xu, Yong; Zhang, Yuan Z.; Xie, Le; Guo, Hai; Li, Dong P.

doi:10.1007/s00586-009-1051-4

Cited by 91 publications

(90 citation statements)

References 31 publications

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“…The data from general population may not apply to patients with OO. In addition, the use of C2 laminar screws in atlantoaxial fixation in attempt to reduce the risk for the vertebral artery (VA), was first reported by Wright et al [36] in 2004 and since became popular [18,19,38]. For OO patients, however, a couple of questions arise: can C2 pedicle screw be safely placed in every OO patient?…”

Section: Introductionmentioning

confidence: 99%

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

Meng

2011

Eur Spine J

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Introduction Patients with os odontoideum always present instability in atlantoaxial joint and need atlantoaxial fixation. C2 pedicle or laminar screws fixation has proven to be efficient and reliable for atlantoaxial instability. However, os odontoideum is a congenital or developmental disease, featured with anomalous bony anatomies. The anatomic measurements and guidelines for C2 pedicle screw placement in general population tends to differ with those of os odontoideum patients, for whom C2 pedicle screws are often needed. The option and techniques of C2 fixation are still challenging and yet to be fully explored. Material and methods We recruited 29 adult patients with os odontoideum and measured the dimension of C2 pedicle and lamina for each patient to examine how well do they match with the screws anatomically. In order to access the intra-observer reliability and inter-observer repeatability of the measurements, the intraclass correlation coefficient (ICC) was also calculated. Results The results for reliability of the CT measurements showed excellent intraobserver (ICC = 0.95 and 0.96) and interobserver correlation coefficient (ICC = 0.93). The diameter and length of C2 pedicle were found to be 6.06 ± 1.37 and 24.05 ± 2.54 mm, while the corresponding figures of C2 laminar were 6.95 ± 0.82 and 25.60 ± 2.18 mm, respectively. In the measurements, all 29 cases had suitable diameter (larger than 5.5 mm) for C2 laminar screw (the laminar diameters ranged from 5.52 to 8.82 mm). In C2 pedicle measurements, the diameters of the 29 cases were from 3.50 to 9.86 mm, while 20 pedicles (34.5%) in 14 cases were less than 5.5 mm in diameter. Six had bilateral small pedicles where the diameter was less than 5.5 mm. Conclusion Anatomically, we found laminar screw is a better match in comparison with pedicle screw for C2 fixation in os odontoideum. The options for C2 fixation should be made based on careful preoperative imaging and thorough consideration. Preoperative reconstructive CT scan can offer great assistance for the choice of fixation in os odontoideum by revealing the anatomy of the C2 pedicles in detail.

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Section: Introductionmentioning

confidence: 99%

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

Meng

2011

Eur Spine J

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“…The concept of personalized image-based 3D templates was first described by Berry et al 4 Owen et al and Ryken and colleagues followed the concept with their cadaveric studies, 25,29,30 and then Lu and colleagues [16][17][18] and Kawaguchi et al 12 applied the templates for clinical use as drill guide templates. However, these templates were only used as a drilling guide.…”

Section: Discussionmentioning

confidence: 99%

A novel screw guiding method with a screw guide template system for posterior C-2 fixation

Kaneyama

Sugawara²,

Sumi³

et al. 2014

SPI

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Object Accurate insertion of C-2 cervical screws is imperative; however, the procedures for C-2 screw insertion are technically demanding and challenging, especially in cases of C-2 vertebral abnormality. The purpose of this study is to report the effectiveness of the tailor-made screw guide template (SGT) system for placement of C-2 screws, including in cases with abnormalities. Methods Twenty-three patients who underwent posterior spinal fusion surgery with C-2 cervical screw insertion using the SGT system were included. The preoperative bone image on CT was analyzed using multiplanar imaging software. The trajectory and depth of the screws were designed based on these images, and transparent templates with screw guiding cylinders were created for each lamina. During the operation, after templates were engaged directly to the laminae, drilling, tapping, and screwing were performed through the templates. The authors placed 26 pedicle screws, 12 pars screws, 6 laminar screws, and 4 C1–2 transarticular screws using the SGT system. To assess the accuracy of the screw track under this system, the deviation of the screw axis from the preplanned trajectory was evaluated on postoperative CT and was classified as follows: Class 1 (accurate), a screw axis deviation less than 2 mm from the planned trajectory; Class 2 (inaccurate), 2 mm or more but less than 4 mm; and Class 3 (deviated), 4 mm or more. In addition, to assess the safety of the screw insertion, malpositioning of the screws was also evaluated using the following grading system: Grade 0 (containing), a screw is completely within the wall of the bone structure; Grade 1 (exposure), a screw perforates the wall of the bone structure but more than 50% of the screw diameter remains within the bone; Grade 2 (perforation), a screw perforates the bone structures and more than 50% of the screw diameter is outside the pedicle; and Grade 3 (penetration), a screw perforates completely outside the bone structure. Results In total, 47 (97.9%) of 48 screws were classified into Class 1 and Grade 0, whereas 1 laminar screw was classified as Class 3 and Grade 2. Mean screw deviations were 0.36 mm in the axial plane (range 0.0–3.8 mm) and 0.30 mm in the sagittal plane (range 0.0–0.8 mm). Conclusions This study demonstrates that the SGT system provided extremely accurate C-2 cervical screw insertion without configuration of reference points, high-dose radiation from intraoperative 3D navigation, or any registration or probing error evoked by changes in spinal alignment during surgery. A multistep screw placement technique and reliable screw guide cylinders were the key to accurate screw placement using the SGT system.

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“…The use of intra-operative imaging increases harmful radiation exposure for both doctors and patients (30,(34)(35)(36). 3DP guides may offer an alternative as a simple, convenient, low cost and complexequipment free way to improve the accuracy of pedicle screw placement (30)(31)(32)(33)(34)(35)(36)(37)(39)(40)(41)(42)(43).…”

Section: Surgical Guidesmentioning

confidence: 99%

“…Next, a 3D model is generated by specialist software from which the optimal screw trajectory and size can be determined, often in consultation with the surgeon. Finally, a navigational template is designed and built with optimal screw trajectory, the surface of which is the inverse of the posterior vertebral surface to ensure a good fit and accuracy of screw insertion (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)55). Numerous studies demonstrated that the guides help to lower operation time, with Deng et al (37) suggesting this may decrease complications related to operative time (e.g., infection) (30,35,37,43).…”

Section: Surgical Guidesmentioning

confidence: 99%

“…Numerous studies demonstrated that the guides help to lower operation time, with Deng et al (37) suggesting this may decrease complications related to operative time (e.g., infection) (30,35,37,43). Other benefits include decreased intra-operative radiation, simplicity of use, elimination of procedural subjectivity, enhanced pre-operative planning and moderate cost in comparison with other techniques (30,(32)(33)(34)(35)(36)(37)(38)42,43).…”

Section: Surgical Guidesmentioning

confidence: 99%

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Systematic review of 3D printing in spinal surgery: the current state of play

et al. 2017

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Three-dimensional printing (3DP), also known as "Additive Manufacturing", is a rapidly growing industry, particularly in the area of spinal surgery. Given the complex anatomy of the spine and delicate nature of surrounding structures, 3DP has the potential to aid surgical planning and procedural accuracy. We perform a systematic review of current literature on the applications of 3DP in spinal surgery. Six electronic databases were searched for original published studies reporting cases or outcomes for 3DP surgical models, guides or implants for spinal surgery. The findings of these studies were synthesized and summarized. These searches returned a combined 2,411 articles. Of these, 54 were included in this review. 3DP is currently used for surgical planning, intra-operative surgical guides, customised prostheses as well as "Off-the-Shelf" implants. The technology has the potential for enhanced implant properties, as well as decreased surgical time and better patient outcomes. The majority of the data thus far is from low-quality studies with inherent biases linked with the excitement of a new field. As the body of literature continues to expand, larger scale studies to evaluate advantages and disadvantages, and longer-term follow up will enhance our knowledge of the effect 3DP has in spinal surgery. In addition, issues such as financial impact, time to design and print, materials selection and bio-printing will evolve as this rapidly expanding field matures.

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A novel computer-assisted drill guide template for placement of C2 laminar screws

Cited by 91 publications

References 31 publications

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

A novel screw guiding method with a screw guide template system for posterior C-2 fixation

Systematic review of 3D printing in spinal surgery: the current state of play

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