Design, fabrication, and evaluation of single- and multi-level 3D-printed non-covering cervical spinal fusion surgery templates
Cervical spinal fusion surgeries require accurate placement of the pedicle screws. Any misplacement/misalignment of these screws may lead to injuries to the spinal cord, arteries and other organs. Template guides have emerged as accurate and cost-effective tools for the safe and rapid insertions of...
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| Veröffentlicht in: | Frontiers in bioengineering and biotechnology Jg. 12; S. 1416872 |
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| Abstract | Cervical spinal fusion surgeries require accurate placement of the pedicle screws. Any misplacement/misalignment of these screws may lead to injuries to the spinal cord, arteries and other organs. Template guides have emerged as accurate and cost-effective tools for the safe and rapid insertions of pedicle screws.
Novel patient-specific single- and multi-level non-covering templates for cervical pedicle screw insertions were designed, 3D-printed, and evaluated.
CT scans of two patients were acquired to reconstruct their 3D spine model. Two sets of single-level (C3-C7) and multi-level (C4-C6) templates were designed and 3D-printed. Pedicle screws were inserted into the 3D
printed vertebrae by free-hand and guided techniques. For single-level templates, a total of 40 screws (2 patients × 5 vertebrae × 2 methods × 2 screws) and for multi-level templates 24 screws (2 patients × 3 vertebrae × 2 methods × 2 screws) were inserted by an experienced surgeon. Postoperative CT images were acquired to measure the errors of the entry point, 3D angle, as well as axial and sagittal plane angles of the inserted screws as compared to the initial pre-surgery designs. Accuracy of free-hand and guided screw insertions, as well as those of the single- and multi-level guides, were also compared using paired t-tests.
Despite the minimal removal of soft tissues, the 3D-printed templates had acceptable stability on the vertebrae during drillings and their utilization led to statistically significant reductions in all error variables. The mean error of entry point decreased from 3.02 mm (free-hand) to 0.29 mm (guided) using the single-level templates and from 5.7 mm to 0.76 mm using the multi-level templates. The percentage reduction in mean of other error variables for, respectively, single- and multi-level templates were as follows: axial plane angle: 72% and 87%, sagittal plane angle: 56% and 78%, and 3D angle: 67% and 83%. The error variables for the multi-level templates generally exceeded those of the single-level templates. The use of single- and multi-level templates also considerably reduced the duration of pedicle screw placements.
The novel single- and multi-level non-covering templates are valuable tools for the accurate placement of cervical pedicle screws. |
|---|---|
| AbstractList | Cervical spinal fusion surgeries require accurate placement of the pedicle screws. Any misplacement/misalignment of these screws may lead to injuries to the spinal cord, arteries and other organs. Template guides have emerged as accurate and cost-effective tools for the safe and rapid insertions of pedicle screws.
Novel patient-specific single- and multi-level non-covering templates for cervical pedicle screw insertions were designed, 3D-printed, and evaluated.
CT scans of two patients were acquired to reconstruct their 3D spine model. Two sets of single-level (C3-C7) and multi-level (C4-C6) templates were designed and 3D-printed. Pedicle screws were inserted into the 3D
printed vertebrae by free-hand and guided techniques. For single-level templates, a total of 40 screws (2 patients × 5 vertebrae × 2 methods × 2 screws) and for multi-level templates 24 screws (2 patients × 3 vertebrae × 2 methods × 2 screws) were inserted by an experienced surgeon. Postoperative CT images were acquired to measure the errors of the entry point, 3D angle, as well as axial and sagittal plane angles of the inserted screws as compared to the initial pre-surgery designs. Accuracy of free-hand and guided screw insertions, as well as those of the single- and multi-level guides, were also compared using paired t-tests.
Despite the minimal removal of soft tissues, the 3D-printed templates had acceptable stability on the vertebrae during drillings and their utilization led to statistically significant reductions in all error variables. The mean error of entry point decreased from 3.02 mm (free-hand) to 0.29 mm (guided) using the single-level templates and from 5.7 mm to 0.76 mm using the multi-level templates. The percentage reduction in mean of other error variables for, respectively, single- and multi-level templates were as follows: axial plane angle: 72% and 87%, sagittal plane angle: 56% and 78%, and 3D angle: 67% and 83%. The error variables for the multi-level templates generally exceeded those of the single-level templates. The use of single- and multi-level templates also considerably reduced the duration of pedicle screw placements.
The novel single- and multi-level non-covering templates are valuable tools for the accurate placement of cervical pedicle screws. BackgroundCervical spinal fusion surgeries require accurate placement of the pedicle screws. Any misplacement/misalignment of these screws may lead to injuries to the spinal cord, arteries and other organs. Template guides have emerged as accurate and cost-effective tools for the safe and rapid insertions of pedicle screws.Questions/PurposesNovel patient-specific single- and multi-level non-covering templates for cervical pedicle screw insertions were designed, 3D-printed, and evaluated.MethodsCT scans of two patients were acquired to reconstruct their 3D spine model. Two sets of single-level (C3-C7) and multi-level (C4-C6) templates were designed and 3D-printed. Pedicle screws were inserted into the 3D-printed vertebrae by free-hand and guided techniques. For single-level templates, a total of 40 screws (2 patients × 5 vertebrae × 2 methods × 2 screws) and for multi-level templates 24 screws (2 patients × 3 vertebrae × 2 methods × 2 screws) were inserted by an experienced surgeon. Postoperative CT images were acquired to measure the errors of the entry point, 3D angle, as well as axial and sagittal plane angles of the inserted screws as compared to the initial pre-surgery designs. Accuracy of free-hand and guided screw insertions, as well as those of the single- and multi-level guides, were also compared using paired t-tests.ResultsDespite the minimal removal of soft tissues, the 3D-printed templates had acceptable stability on the vertebrae during drillings and their utilization led to statistically significant reductions in all error variables. The mean error of entry point decreased from 3.02 mm (free-hand) to 0.29 mm (guided) using the single-level templates and from 5.7 mm to 0.76 mm using the multi-level templates. The percentage reduction in mean of other error variables for, respectively, single- and multi-level templates were as follows: axial plane angle: 72% and 87%, sagittal plane angle: 56% and 78%, and 3D angle: 67% and 83%. The error variables for the multi-level templates generally exceeded those of the single-level templates. The use of single- and multi-level templates also considerably reduced the duration of pedicle screw placements.ConclusionThe novel single- and multi-level non-covering templates are valuable tools for the accurate placement of cervical pedicle screws. BackgroundCervical spinal fusion surgeries require accurate placement of the pedicle screws. Any misplacement/misalignment of these screws may lead to injuries to the spinal cord, arteries and other organs. Template guides have emerged as accurate and cost-effective tools for the safe and rapid insertions of pedicle screws.Questions/PurposesNovel patient-specific single- and multi-level non-covering templates for cervical pedicle screw insertions were designed, 3D-printed, and evaluated.MethodsCT scans of two patients were acquired to reconstruct their 3D spine model. Two sets of single-level (C3-C7) and multi-level (C4-C6) templates were designed and 3D-printed. Pedicle screws were inserted into the 3D - printed vertebrae by free-hand and guided techniques. For single-level templates, a total of 40 screws (2 patients × 5 vertebrae × 2 methods × 2 screws) and for multi-level templates 24 screws (2 patients × 3 vertebrae × 2 methods × 2 screws) were inserted by an experienced surgeon. Postoperative CT images were acquired to measure the errors of the entry point, 3D angle, as well as axial and sagittal plane angles of the inserted screws as compared to the initial pre-surgery designs. Accuracy of free-hand and guided screw insertions, as well as those of the single- and multi-level guides, were also compared using paired t-tests.ResultsDespite the minimal removal of soft tissues, the 3D-printed templates had acceptable stability on the vertebrae during drillings and their utilization led to statistically significant reductions in all error variables. The mean error of entry point decreased from 3.02 mm (free-hand) to 0.29 mm (guided) using the single-level templates and from 5.7 mm to 0.76 mm using the multi-level templates. The percentage reduction in mean of other error variables for, respectively, single- and multi-level templates were as follows: axial plane angle: 72% and 87%, sagittal plane angle: 56% and 78%, and 3D angle: 67% and 83%. The error variables for the multi-level templates generally exceeded those of the single-level templates. The use of single- and multi-level templates also considerably reduced the duration of pedicle screw placements.ConclusionThe novel single- and multi-level non-covering templates are valuable tools for the accurate placement of cervical pedicle screws. Cervical spinal fusion surgeries require accurate placement of the pedicle screws. Any misplacement/misalignment of these screws may lead to injuries to the spinal cord, arteries and other organs. Template guides have emerged as accurate and cost-effective tools for the safe and rapid insertions of pedicle screws.BackgroundCervical spinal fusion surgeries require accurate placement of the pedicle screws. Any misplacement/misalignment of these screws may lead to injuries to the spinal cord, arteries and other organs. Template guides have emerged as accurate and cost-effective tools for the safe and rapid insertions of pedicle screws.Novel patient-specific single- and multi-level non-covering templates for cervical pedicle screw insertions were designed, 3D-printed, and evaluated.Questions/PurposesNovel patient-specific single- and multi-level non-covering templates for cervical pedicle screw insertions were designed, 3D-printed, and evaluated.CT scans of two patients were acquired to reconstruct their 3D spine model. Two sets of single-level (C3-C7) and multi-level (C4-C6) templates were designed and 3D-printed. Pedicle screws were inserted into the 3D-printed vertebrae by free-hand and guided techniques. For single-level templates, a total of 40 screws (2 patients × 5 vertebrae × 2 methods × 2 screws) and for multi-level templates 24 screws (2 patients × 3 vertebrae × 2 methods × 2 screws) were inserted by an experienced surgeon. Postoperative CT images were acquired to measure the errors of the entry point, 3D angle, as well as axial and sagittal plane angles of the inserted screws as compared to the initial pre-surgery designs. Accuracy of free-hand and guided screw insertions, as well as those of the single- and multi-level guides, were also compared using paired t-tests.MethodsCT scans of two patients were acquired to reconstruct their 3D spine model. Two sets of single-level (C3-C7) and multi-level (C4-C6) templates were designed and 3D-printed. Pedicle screws were inserted into the 3D-printed vertebrae by free-hand and guided techniques. For single-level templates, a total of 40 screws (2 patients × 5 vertebrae × 2 methods × 2 screws) and for multi-level templates 24 screws (2 patients × 3 vertebrae × 2 methods × 2 screws) were inserted by an experienced surgeon. Postoperative CT images were acquired to measure the errors of the entry point, 3D angle, as well as axial and sagittal plane angles of the inserted screws as compared to the initial pre-surgery designs. Accuracy of free-hand and guided screw insertions, as well as those of the single- and multi-level guides, were also compared using paired t-tests.Despite the minimal removal of soft tissues, the 3D-printed templates had acceptable stability on the vertebrae during drillings and their utilization led to statistically significant reductions in all error variables. The mean error of entry point decreased from 3.02 mm (free-hand) to 0.29 mm (guided) using the single-level templates and from 5.7 mm to 0.76 mm using the multi-level templates. The percentage reduction in mean of other error variables for, respectively, single- and multi-level templates were as follows: axial plane angle: 72% and 87%, sagittal plane angle: 56% and 78%, and 3D angle: 67% and 83%. The error variables for the multi-level templates generally exceeded those of the single-level templates. The use of single- and multi-level templates also considerably reduced the duration of pedicle screw placements.ResultsDespite the minimal removal of soft tissues, the 3D-printed templates had acceptable stability on the vertebrae during drillings and their utilization led to statistically significant reductions in all error variables. The mean error of entry point decreased from 3.02 mm (free-hand) to 0.29 mm (guided) using the single-level templates and from 5.7 mm to 0.76 mm using the multi-level templates. The percentage reduction in mean of other error variables for, respectively, single- and multi-level templates were as follows: axial plane angle: 72% and 87%, sagittal plane angle: 56% and 78%, and 3D angle: 67% and 83%. The error variables for the multi-level templates generally exceeded those of the single-level templates. The use of single- and multi-level templates also considerably reduced the duration of pedicle screw placements.The novel single- and multi-level non-covering templates are valuable tools for the accurate placement of cervical pedicle screws.ConclusionThe novel single- and multi-level non-covering templates are valuable tools for the accurate placement of cervical pedicle screws. |
| Author | Khalaf, K. Safahieh, A. H. Nazemi, H. Arjmand, N. Azimi, P. |
| Author_xml | – sequence: 1 givenname: A. H. surname: Safahieh fullname: Safahieh, A. H. – sequence: 2 givenname: H. surname: Nazemi fullname: Nazemi, H. – sequence: 3 givenname: N. surname: Arjmand fullname: Arjmand, N. – sequence: 4 givenname: P. surname: Azimi fullname: Azimi, P. – sequence: 5 givenname: K. surname: Khalaf fullname: Khalaf, K. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39070162$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1177/21925682231196456 10.1016/j.nec.2023.11.005 10.1093/neuros/nyy630 10.1016/j.injury.2018.02.011 10.1093/ons/opab060 10.1016/j.wneu.2018.05.188 10.1007/s00586-008-0795-6 10.31616/asj.2021.0362 10.1016/j.jcot.2018.07.010 10.1177/1556331621996331 10.1007/s00586-020-06601-6 10.14245/ns.2244554.277 10.6061/clinics/2015(02)08 10.1007/s11548-021-02516-9 10.1016/j.spinee.2018.05.001 10.1016/j.spinee.2013.03.046 10.1186/s13018-015-0157-0 10.1186/s13018-024-04712-0 10.1227/neu.0b013e3181fdfaf4 10.1097/brs.0000000000001807 10.4184/asj.2017.11.1.4 10.1097/brs.0000000000004684 10.1007/s00586-016-4926-1 10.35787/jimdc.v12i2.934 10.6061/clinics/2018/e259 10.21037/jss.2019.11.01 10.5435/jaaos-d-21-00710 10.1016/j.wneu.2020.05.055 10.3171/2021.5.focus21209 10.1371/journal.pone.0171509 10.1007/s00402-013-1755-0 10.1007/s00402-011-1383-5 10.1016/j.media.2023.103027 10.1016/j.wneu.2023.05.020 10.2217/3dp-2021-0002 10.12659/msm.918440 10.1080/24699322.2016.1236146 10.1097/00007632-200010150-00016 10.5137/1019-5149.JTN.40449-22.2 10.1016/j.wneu.2022.12.091 10.31616/asj.2018.0243 10.1243/095441105x9273 10.1097/bsd.0000000000000151 10.21203/rs.3.rs-3223961/v1 10.1097/00007632-199001000-00004 10.3171/2017.4.spine16831 10.1097/md.0000000000013769 10.1007/s00586-019-05978-3 10.1016/j.wneu.2022.03.114 10.1016/j.spinee.2020.09.007 10.7759/cureus.53861 10.1186/s12938-017-0421-0 10.3171/2014.3.spine13730 10.14444/8113 |
| ContentType | Journal Article |
| Copyright | Copyright © 2024 Safahieh, Nazemi, Arjmand, Azimi and Khalaf. 2024. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Keywords | pedicle screws drilling fusion surgery cervical spine 3D-printing template guides |
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| SubjectTerms | 3D-printing Accuracy Arteries Back surgery cervical spine Computed tomography Design drilling fusion surgery Injuries Medical imaging Patients pedicle screws Registration Soft tissues Spinal cord injuries Statistical analysis Surgeons Surgery template guides Trauma Vertebrae |
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