Clinical Application of Atlantoaxial Pedicle Screw Placement Assisted by a Modified 3D-Printed Navigation Template

Abstract

OBJECTIVES:To investigate the primary clinical value of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template.METHODS:We retrospectively analyzed the cases of 17 patients treated from June 2015 to September 2016 with atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. All procedures were performed prior to surgery, including thin-slice CT scanning, medical image sampling and computerized 3D modeling of the atlantoaxial joint, optimal pedicle screw trajectory determination, and anatomical trait acquisition for the atlantoaxial pedicle, spinous process of the axis, vertebral lamina and posterior lateral mass, and design of a reverse template. During surgery, a navigation template was tightly attached to the atlantoaxial joint to assist in pedicle screw placement. Surgeons subsequently used an electric drill to remove the template through a guide channel and then placed the atlantoaxial pedicle screw. Observed indexes included the VAS score, JOA improvement rate, surgery duration, and blood loss.RESULTS:Surgery was successful in all 17 patients, with an average operation duration of 106±25 min and an average blood loss of 220±125 ml. Three days postoperatively, the VAS score decreased from 6.42±2.21 to 3.15±1.26. Six months postoperatively, the score decreased to 2.05±1.56. The postoperative JOA score increased significantly from 7.68±2.51 to 11.65±2.72 3 d after surgery and to 13.65±2.57 after 6 months. Sixty-eight pedicle screws were inserted successfully, with 34 in the atlas and 34 in the axis. According to the Kawaguchi standard, 66 screws were in grade 0 (97.06%), and 2 were in grade 1 (2.94%). The pre- and postoperative transverse and sagittal screw angles showed no significant differences.CONCLUSIONS:Atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template is worth recommending due to the improved accuracy in screw placement, improved patient safety and beneficial clinical effects.

Clinical applications and prospects of 3D printing guide templates in orthopaedics

“… 2018 Pu X et al. [ 68 ] Clinics 17 Pedicle screw fixation in the upper cervical spine for atlantoaxial dislocation and deformity Atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template is worth recommending due to the improved accuracy in screw placement, improved patient safety, and beneficial clinical effects. 2018 Thayaparan GK et al.…”

“…The pedicle screw fixation has become the strongest and most common method of internal fixation in posterior cervical surgery due to its excellent biomechanical properties [ 8 , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] ]. However, it is difficult, inefficient, and risky to place pedicle screws.…”

Evaluation of a Three-Dimensional Printed Guide and a Polyoxymethylene Thermoplastic Regulator for Percutaneous Pedicle Screw Fixation in Patients with Thoracolumbar Fracture

“…The 3D printed personalized guide, created by preoperative computer-aided design (CAD) and simulation can improve the precision of intraoperative pedicle insertion. The 3D printed plate in auxiliary pedicle insertion increases the accuracy and safety of pedicle screw implantation and has been widely used [23,24].With the development of minimally invasive techniques, the use of a percutaneous insertion guide template is gradually applied in pedicle insertion and screw placement. Li et al [17] used preoperative CAD technology to print a personalized guide template for PKP, which improved the accuracy of pedicle insertion, effectively reduced the number of pedicle insertion procedures, fluoroscopy sessions, and the operation time, and improved the postoperative recovery of patients.…”

Application of three-level navigation template in surgery for hemivertebrae in adolescents

“…Среди обширного числа публикаций, посвященных опыту применения навигационных шаблонов в спинальной хирургии, большая часть фокусируется на установке опорных элементов в шейные позвонки у взрослых пациентов [13][14][15][16][17][18][19]. Близкое по тематике к нашему исследование Д.Н.…”