Are computer numerical control (CNC)-manufactured patient-specific metal templates available for posterior thoracic pedicle screw insertion? Feasibility and accuracy evaluation

Abstract

CNC-manufactured PDTs are viable for assisting in PTPI with good feasibility and accuracy.

Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes

“…Posterior vertebral instrumentation, which consists of inserting screws through the selected pedicles into the corresponding vertebral bodies and attaching rods posteriorly on top of the inserted screws, 1 is currently the most widely used stabilization technique in spine surgery. 2,3 It is used in daily surgical practice to treat various pathologies of the spine, such as scoliosis, fractures, tumors, and other degenerations. 2,4,5 Due to the vicinity of the spinal cord, aorta, and viscera, as well as the fact that the pedicles represent the narrowest region of the vertebral anatomy, 6 pedicle screw misplacement can result in a perforation of the pedicle or cortical wall of the vertebral body, which represents a risk for serious neurologic, vascular, or pulmonary complications.…”

“…9 Moreover, pedicle screw misplacement can result in a loss of fixation, and therefore, the accuracy of pedicle screw placement is an important aspect of vertebral instrumentation, with two types of techniques established in clinical practice: the free-hand and the image-guided. 2,3,10,11 Both approaches require a steep learning curve for less-experienced spine surgeons, 3,12 nevertheless, image-guided techniques offer additional information because surgical instruments can be intraoperatively tracked and visualized, 13 and therefore assist spine surgeons toward a more accurate screw placement. 4,10 However, if an imageguided insertion technique is used or, for example, in the case of a low bone density that reduces screw fixation, 14,15 pedicle screw placement plans should be determined preoperatively.…”

“…Posterior vertebral instrumentation, which consists of inserting screws through the selected pedicles into the corresponding vertebral bodies and attaching rods posteriorly on top of the inserted screws, is currently the most widely used stabilization technique in spine surgery . It is used in daily surgical practice to treat various pathologies of the spine, such as scoliosis, fractures, tumors, and other degenerations …”

Avaliação do uso de guias para posicionamento de parafusos pediculares em cirurgias de correção de escoliose

“…Os guias específicos para pacientes destacam-se entre as novas opções técnicas para auxiliar o preparo do orifício piloto dos pedículos e melhorar a acurácia do parafuso pedicular, reduzindo a exposição do cirurgião à radiação (13,26). Em nosso meio, essa modalidade de guia foi desenvolvida e não há relatos da sua utilização em pacientes com deformidades da coluna vertebral.…”

“…Outro ponto diretamente relacionado à tentativa de se obter uma maior acurácia no posicionamento dos parafusos é o emprego excessivo de fluoroscopia durante o procedimento cirúrgico. Desse modo, outro aspecto importante a ser considerado seria a possibilidade de diminuição do tempo de uso de fluoroscopia e da dose total de radiação nos procedimentos cirúrgicos da coluna vertebral que envolvam o uso de parafusos ___________________________________________________________Introdução 29pediculares, tendo em vista o trajeto ósseo pedicular previamente planejado por estudo tomográfico e tridimensional da anatomia de cada paciente, como ferramenta auxiliar importante ao cirurgião durante a implantação dos parafusos pediculares com mínima necessidade do auxílio de fluoroscopia para o procedimento(13).…”