Rafael Augusto Azuero Gonzalez , Fabio Alexander Diaz Otero , Felipe Ramirez-Velandia , Orielson Cruz Amaya , Andres Felipe Hortua Moreno , Ramon Elias Patiño Guerrero , Ivan Dario Ramirez Giraldo
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We share our experience using a surgical planning and support system with 3D printed patient-specific guides that utilize a locking screw, highlighting the advantages of incorporating it into complex spine surgeries.</p></div><div><h3>Materials and Methods</h3><p>The surgical planning and support system is composed of six phases: (1) spine digitization, (2) segmental analysis and vertebral characterization, (3) planning of angulation, depth, and diameter of transpedicular screws, (4) 3D printing of the spine model, and the locking single level drill guides, (5) selection of surgical instruments, and (6) surgery.</p></div><div><h3>Illustrative cases</h3><p>High resolution tomographic images of two 15-year-old females and one 16-year-old male were processed through software analysis for segmental analysis and vertebral characterization. This process aimed to propose the most suitable plan in a multidisciplinary meeting. Sterilized 3D-printed patient-specific locking spine drill guide models were utilized for the spinal instrumentation.</p></div><div><h3>Conclusions</h3><p> <!-->Multiple countries are now developing 3D printed drill guides for screw fixation in severe scoliosis.<!--> <!-->Our guide represents the first one using a transitory locking mechanism to improve accuracy of fixation. The 3D printed locking drill guides enabled accurate insertion and direction of the transpedicular screw, resulting in improvements in sagittal and coronal balance, and all screws classified as accurately placed and with minimal difference with the planned trajectory. Additional outcomes such as surgical time, intraoperative bleeding, radiation exposure, hospital stay, and postoperative complications should also be considered for further studies in this area.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"36 ","pages":"Article 101956"},"PeriodicalIF":0.4000,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000021/pdfft?md5=e546cf2bc85ab127e569798d9f9025e5&pid=1-s2.0-S2214751924000021-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis\",\"authors\":\"Rafael Augusto Azuero Gonzalez , Fabio Alexander Diaz Otero , Felipe Ramirez-Velandia , Orielson Cruz Amaya , Andres Felipe Hortua Moreno , Ramon Elias Patiño Guerrero , Ivan Dario Ramirez Giraldo\",\"doi\":\"10.1016/j.inat.2024.101956\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p> <!-->The preparation of the pedicle and the insertion of a transpedicular screw is a high-risk procedure during spine surgeries. To avoid pedicle screw misplacement in posterior spinal deformity surgery, patient specific 3D‐printed guides can be used but technical issues reported in 17% of screw fixations. To address this concern, our team has developed single-level guide templates and a locking screw mechanism. We share our experience using a surgical planning and support system with 3D printed patient-specific guides that utilize a locking screw, highlighting the advantages of incorporating it into complex spine surgeries.</p></div><div><h3>Materials and Methods</h3><p>The surgical planning and support system is composed of six phases: (1) spine digitization, (2) segmental analysis and vertebral characterization, (3) planning of angulation, depth, and diameter of transpedicular screws, (4) 3D printing of the spine model, and the locking single level drill guides, (5) selection of surgical instruments, and (6) surgery.</p></div><div><h3>Illustrative cases</h3><p>High resolution tomographic images of two 15-year-old females and one 16-year-old male were processed through software analysis for segmental analysis and vertebral characterization. This process aimed to propose the most suitable plan in a multidisciplinary meeting. Sterilized 3D-printed patient-specific locking spine drill guide models were utilized for the spinal instrumentation.</p></div><div><h3>Conclusions</h3><p> <!-->Multiple countries are now developing 3D printed drill guides for screw fixation in severe scoliosis.<!--> <!-->Our guide represents the first one using a transitory locking mechanism to improve accuracy of fixation. The 3D printed locking drill guides enabled accurate insertion and direction of the transpedicular screw, resulting in improvements in sagittal and coronal balance, and all screws classified as accurately placed and with minimal difference with the planned trajectory. 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引用次数: 0
摘要
导言：在脊柱手术中，准备椎弓根和插入经椎弓根螺钉是一项高风险手术。为避免脊柱后畸形手术中椎弓根螺钉错位，可使用针对患者的 3D 打印导板，但据报道，17% 的螺钉固定存在技术问题。为了解决这个问题，我们的团队开发了单层导板模板和锁定螺钉机制。我们分享了使用三维打印患者特异性导板和锁定螺钉的手术规划和支持系统的经验，强调了将其应用于复杂脊柱手术的优势。材料和方法手术规划和支持系统由六个阶段组成：（1）脊柱数字化；（2）节段分析和椎体特征描述；（3）经椎螺钉的角度、深度和直径规划；（4）脊柱模型和锁定单层钻导的三维打印；（5）手术器械的选择；（6）手术。 示例病例通过软件分析处理了两名 15 岁女性和一名 16 岁男性的高分辨率断层扫描图像，进行了节段分析和椎体特征描述。这一过程旨在通过多学科会议提出最合适的方案。结论 目前，多个国家正在开发用于严重脊柱侧凸螺钉固定的 3D 打印钻导器。我们的导板是首个使用过渡锁定机制来提高固定精确度的导板。三维打印的锁定钻导器能够准确插入经椎螺钉并确定其方向，从而改善矢状面和冠状面的平衡，所有螺钉都被归类为放置准确，与计划轨迹差异最小。该领域的进一步研究还应考虑其他结果，如手术时间、术中出血、辐射暴露、住院时间和术后并发症等。
Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis
Introduction
The preparation of the pedicle and the insertion of a transpedicular screw is a high-risk procedure during spine surgeries. To avoid pedicle screw misplacement in posterior spinal deformity surgery, patient specific 3D‐printed guides can be used but technical issues reported in 17% of screw fixations. To address this concern, our team has developed single-level guide templates and a locking screw mechanism. We share our experience using a surgical planning and support system with 3D printed patient-specific guides that utilize a locking screw, highlighting the advantages of incorporating it into complex spine surgeries.
Materials and Methods
The surgical planning and support system is composed of six phases: (1) spine digitization, (2) segmental analysis and vertebral characterization, (3) planning of angulation, depth, and diameter of transpedicular screws, (4) 3D printing of the spine model, and the locking single level drill guides, (5) selection of surgical instruments, and (6) surgery.
Illustrative cases
High resolution tomographic images of two 15-year-old females and one 16-year-old male were processed through software analysis for segmental analysis and vertebral characterization. This process aimed to propose the most suitable plan in a multidisciplinary meeting. Sterilized 3D-printed patient-specific locking spine drill guide models were utilized for the spinal instrumentation.
Conclusions
Multiple countries are now developing 3D printed drill guides for screw fixation in severe scoliosis. Our guide represents the first one using a transitory locking mechanism to improve accuracy of fixation. The 3D printed locking drill guides enabled accurate insertion and direction of the transpedicular screw, resulting in improvements in sagittal and coronal balance, and all screws classified as accurately placed and with minimal difference with the planned trajectory. Additional outcomes such as surgical time, intraoperative bleeding, radiation exposure, hospital stay, and postoperative complications should also be considered for further studies in this area.
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