Is a patient-specific drill template via a cortical bone trajectory safe in cervical anterior transpedicular insertion?

Abstract

BackgroundThis study aimed to develop patient-specific drill templates by computer numerical control or three-dimensional printing via two cortical bone trajectories (CBTs) and to evaluate their efficacies and accuracies in cervical anterior transpedicular insertion.MethodsPreoperative CT images of 20 cadaveric cervical vertebrae (C3–C7) were obtained. After image processing, patient-specific drill templates were randomly assigned to be constructed via two CBTs (CBT0 and CBT0.7) and manufactured by two methods (computer numerical control and three-dimensional printing). Guided by patient-specific drill templates, 3.5-mm-diameter screws were inserted into the pedicles. Postoperative CT scans were performed to evaluate the screw deviation in the entry point and midpoint of the pedicle. The screw positions were also graded.ResultsComputer numerical control patient-specific drill templates had a significantly shorter manufacturing time compared to three-dimensional-printed patient-specific drill templates (p < 0.01). Absolute deviations at the entry point and midpoint of the pedicle had no significant differences on the transverse and sagittal planes (p > 0.05). There were no significant differences in screw positions (p = 0.3). However, three screw positions were in grade 3 in CBT0, while the others were in grade 1.ConclusionsCBT0.7 appears to be a safe and feasible trajectory for cervical anterior transpedicular insertion. Bio-safe computer numerical control patient-specific drill templates can facilitate cervical anterior transpedicular insertion with good feasibility and accuracy.

Patient-specific drill template for C2 transoral pedicle insertion in complete reduction of atlantoaxial dislocation: cadaveric efficacy and accuracy assessments

“…The accuracy of PDTs in facilitating C2TOPI is of vital importance. In the present study, we calculated the absolute value of the deviations from the centroids between the preoperative designs and postoperative measurements, which had been used in our previous studies [25–27] to show the actual deviations. Our study showed that the absolute deviations in the axial plane (0.79 ± 0.64 mm) and the sagittal plane (0.96 ± 0.51 mm) in the PDT group might be within an acceptable range for clinical application.…”

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

“… 2018 Peng P et al. [ 76 ] J Orthop Surg Res 4 cadaver CBT screw fixation Bio-safe drill templates can facilitate cervical anterior transpedicular insertion with good feasibility and accuracy. 2018 Krämer M et al.…”

“…On this basis, Peng et al. [ 76 ] developed a template for guiding cortical bone trajectory screws. It successfully improved the success rate of screw placement and reduced intraoperative complications.…”

A Novel Radiographic Analysis System for Subaxial Cervical Spine Pedicle Screw Placement

“…Alternatively, a guidance system such as O-arm-based three-dimensional (3D) navigation, 3D model, navigation templates, Doppler donography, robotic guidance system, [7][8][9][10][11][12] or augmented reality-based navigation [13 14] is needed to prevent placement failure. The use of these resources is limited because of their high cost and steep associated learning curve however, and they cannot be widely applied in all kinds of hospitals.…”