Accuracy of cervical pedicle screw placement with four different designs of rapid prototyping navigation templates: a human cadaveric study.

IF 1.5 4区医学 Q3 SURGERY

Computer Assisted Surgery Pub Date : 2021-12-01 DOI:10.1080/24699322.2021.1919210

Zhijing Wen, Teng Lu, Xijing He, Jialiang Li, Quanjin Zang, Yibin Wang, Zhengchao Gao, Pengzhen Gu

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引用次数: 2

Abstract

Purpose: Due to the high perforation rate of cervical pedicle screw placement, we have designed four different types of rapid prototyping navigation templates to enhance the accuracy of cervical pedicle screw placement.

Methods: Fifteen human cadaveric cervical spines from C2 to C7 were randomly divided into five groups, with three specimens in each group. The diameter of pedicle screw used in this study was 3.5 mm. Groups 1-4 were assisted by the two-level template, one-level bilateral template, one-level unilateral template and one-level point-contact template, respectively. Group 5 was without any navigation template. After the surgery, the accuracy of screw placement in the five groups was evaluated using postoperative computed tomographic scans to observe whether the screw breached the pedicle cortex.

Results: A total of 180 pedicle screws were inserted without any accidents. The accuracy rate was 75%, 100%, 100%, 91.7%, and 63.9%, respectively, from Groups 1 to 5. All the template groups were significantly higher than Group 5, though the two-level navigation template group was significantly lower than the other three template groups. The operation time was 4.72 ± 0.28, 4.81 ± 0.29, 5.03 ± 0.35, 8.42 ± 0.36, and 10.05 ± 0.52 min, respectively, from Groups 1 to 5. The no template and point-contact procedures were significantly more time-consuming than the template procedures.

Conclusion: This study demonstrated that four different design types of navigation templates achieved a higher accuracy in assisting cervical pedicle screw placement than no template insertion. However, the two-level template's accuracy was the lowest compared to the other three templates. Meanwhile, these templates avoided fluoroscopy during the surgery and decreased the operation time. It is always very challenging to translate cadaveric studies to clinical practice. Hence, the one-level bilateral, unilateral, and point-contact navigation templates designed by us need to be meticulously tested to verify their accuracy and safety.

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四种不同设计快速原型导航模板的颈椎椎弓根螺钉置入精度:人体尸体研究。

目的:针对颈椎椎弓根螺钉置入穿孔率高的问题，我们设计了四种不同类型的快速原型导航模板，以提高颈椎椎弓根螺钉置入的准确性。方法:取15例人体C2 ~ C7颈椎标本，随机分为5组，每组3例。本研究使用的椎弓根螺钉直径为3.5 mm。1 ~ 4组分别采用二级模板、一级双侧模板、一级单侧模板和一级点接触模板辅助。第5组没有任何导航模板。手术后，通过术后计算机断层扫描评估五组螺钉放置的准确性，观察螺钉是否破坏椎弓根皮质。结果:共钉入椎弓根螺钉180枚，无意外发生。1 ~ 5组的准确率分别为75%、100%、100%、91.7%、63.9%。所有模板组均显著高于第5组，但二级导航模板组显著低于其他3个模板组。1 ~ 5组手术时间分别为4.72±0.28 min、4.81±0.29 min、5.03±0.35 min、8.42±0.36 min、10.05±0.52 min。无模板和点接触程序明显比模板程序更费时。结论:本研究表明，四种不同设计类型的导航模板在辅助颈椎椎弓根螺钉置入方面比不植入模板具有更高的准确性。然而，与其他三个模板相比，二级模板的准确性是最低的。同时，这些模板避免了术中透视检查，缩短了手术时间。将尸体研究转化为临床实践总是非常具有挑战性的。因此，我们设计的一级双侧、单侧和点接触导航模板需要经过细致的测试，以验证其准确性和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Computer Assisted Surgery Medicine-Surgery

CiteScore

2.30

自引率

0.00%

发文量

审稿时长

10 weeks

期刊介绍： omputer Assisted Surgery aims to improve patient care by advancing the utilization of computers during treatment; to evaluate the benefits and risks associated with the integration of advanced digital technologies into surgical practice; to disseminate clinical and basic research relevant to stereotactic surgery, minimal access surgery, endoscopy, and surgical robotics; to encourage interdisciplinary collaboration between engineers and physicians in developing new concepts and applications; to educate clinicians about the principles and techniques of computer assisted surgery and therapeutics; and to serve the international scientific community as a medium for the transfer of new information relating to theory, research, and practice in biomedical imaging and the surgical specialties. The scope of Computer Assisted Surgery encompasses all fields within surgery, as well as biomedical imaging and instrumentation, and digital technology employed as an adjunct to imaging in diagnosis, therapeutics, and surgery. Topics featured include frameless as well as conventional stereotactic procedures, surgery guided by intraoperative ultrasound or magnetic resonance imaging, image guided focused irradiation, robotic surgery, and any therapeutic interventions performed with the use of digital imaging technology.