Rakesh Kumar, Jean-Christophe Leveque, Philip K Louie, Rajiv Sethi, Venu M Nemani
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This study aims to evaluate the safety and efficacy of 3DPSG in ASD patients with Watanabe types C and D pedicles, where the safe corridor for screw placement is limited.</p><p><strong>Methods: </strong>3DPSG were designed using fine cut (≤1.25 mm) computed tomography scans. Preoperative screw trajectory planning and guide manufacturing were conducted using computer-aided design software (Mighty Oak Medical, Englewood, CO). Four ASD surgeons with varying experience levels placed the guides. Data on patient demographics, pedicle morphology, number of levels instrumented, and implant-related complications were collected.</p><p><strong>Results: </strong>The study included 115 patients (median age 67, range 18-81 years) with 2210 screws placed from T1 to L5. The median number of levels instrumented per case was 11 (range 7-12). Diagnoses included adult degenerative scoliosis (<i>n</i> = 62), adult idiopathic scoliosis (<i>n</i> = 30), Scheuermann's kyphosis (<i>n</i> = 2), and other complex conditions (<i>n</i> = 21). The overall accuracy rate for pedicle screw placement was 99.5%, with a 0% malposition rate in type C and D pedicles. No vascular or neurological complications or reoperations related to screw placement were reported.</p><p><strong>Conclusion: </strong>3DPSG facilitates safe and accurate pedicle screw placement regardless of pedicle morphology in ASD surgeries. This includes the challenging Watanabe types C and D pedicles, typically found at curve apices, enabling surgeons to achieve high implant density and optimal spinal fixation in ASD patients.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"18 S1","pages":"S50-S56"},"PeriodicalIF":1.7000,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483462/pdf/","citationCount":"0","resultStr":"{\"title\":\"Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? 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This study aims to evaluate the safety and efficacy of 3DPSG in ASD patients with Watanabe types C and D pedicles, where the safe corridor for screw placement is limited.</p><p><strong>Methods: </strong>3DPSG were designed using fine cut (≤1.25 mm) computed tomography scans. Preoperative screw trajectory planning and guide manufacturing were conducted using computer-aided design software (Mighty Oak Medical, Englewood, CO). Four ASD surgeons with varying experience levels placed the guides. Data on patient demographics, pedicle morphology, number of levels instrumented, and implant-related complications were collected.</p><p><strong>Results: </strong>The study included 115 patients (median age 67, range 18-81 years) with 2210 screws placed from T1 to L5. The median number of levels instrumented per case was 11 (range 7-12). Diagnoses included adult degenerative scoliosis (<i>n</i> = 62), adult idiopathic scoliosis (<i>n</i> = 30), Scheuermann's kyphosis (<i>n</i> = 2), and other complex conditions (<i>n</i> = 21). The overall accuracy rate for pedicle screw placement was 99.5%, with a 0% malposition rate in type C and D pedicles. No vascular or neurological complications or reoperations related to screw placement were reported.</p><p><strong>Conclusion: </strong>3DPSG facilitates safe and accurate pedicle screw placement regardless of pedicle morphology in ASD surgeries. 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引用次数: 0
摘要
背景：成人脊柱畸形（ASD）手术通常涉及使用各种方法放置椎弓根螺钉，包括徒手技术、透视引导和计算机辅助术中导航，每种方法都有明显的局限性。尤其具有挑战性的是对具有小松质骨通道或无松质骨通道的椎弓根（Watanabe C 和 D 型椎弓根）进行器械植入，这种椎弓根常见于大弯的顶点，精确的螺钉植入对于有效矫正畸形至关重要。三维打印椎弓根螺钉钻导器（3DPSG）可帮助精确放置椎弓根螺钉，同时最大限度地减少对标准 ASD 手术工作流程的干扰。本研究旨在评估3DPSG在渡边C型和D型椎弓根ASD患者中的安全性和有效性，在这些患者中，螺钉置入的安全通道有限。使用计算机辅助设计软件（Mighty Oak Medical, Englewood, CO）进行术前螺钉轨迹规划和导板制造。四名具有不同经验水平的 ASD 外科医生负责放置导板。收集了有关患者人口统计学、椎弓根形态、植入器械的层数以及植入物相关并发症的数据：研究共纳入 115 名患者（中位年龄 67 岁，18-81 岁不等），从 T1 到 L5 共植入 2210 枚螺钉。每个病例植入的螺钉数量中位数为 11 个（7-12 个不等）。诊断包括成人退行性脊柱侧凸（62 例）、成人特发性脊柱侧凸（30 例）、Scheuermann 脊柱侧凸（2 例）和其他复杂情况（21 例）。椎弓根螺钉置入的总体准确率为99.5%，C型和D型椎弓根螺钉置入不良率为0%。结论：在 ASD 手术中，无论椎弓根形态如何，3DPSG 都有助于安全、准确地放置椎弓根螺钉。结论：无论 ASD 手术中的椎弓根形态如何，3DPSG 都有助于安全、准确地放置椎弓根螺钉，包括具有挑战性的渡边 C 型和 D 型椎弓根，它们通常位于曲线顶端，使外科医生能够在 ASD 患者中实现高植入密度和最佳脊柱固定：4:
Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? A 5-Year, Single-Center Experience With 2210 Screws Placed for Adult Spinal Deformity Reconstruction.
Background: Adult spinal deformity (ASD) surgery often involves the placement of pedicle screws using various methods, including freehand technique, fluoroscopic guidance, and computer-assisted intraoperative navigation, each with distinct limitations. Particularly challenging is the instrumentation of pedicles with small or absent cancellous channels (Watanabe types C and D pedicles), commonly found at the apex of large curves where precise screw placement is crucial for effective deformity correction. 3D-printed pedicle screw drill guides (3DPSG) may assist in accurately placing pedicle screws while minimally disrupting the standard ASD surgery workflow. This study aims to evaluate the safety and efficacy of 3DPSG in ASD patients with Watanabe types C and D pedicles, where the safe corridor for screw placement is limited.
Methods: 3DPSG were designed using fine cut (≤1.25 mm) computed tomography scans. Preoperative screw trajectory planning and guide manufacturing were conducted using computer-aided design software (Mighty Oak Medical, Englewood, CO). Four ASD surgeons with varying experience levels placed the guides. Data on patient demographics, pedicle morphology, number of levels instrumented, and implant-related complications were collected.
Results: The study included 115 patients (median age 67, range 18-81 years) with 2210 screws placed from T1 to L5. The median number of levels instrumented per case was 11 (range 7-12). Diagnoses included adult degenerative scoliosis (n = 62), adult idiopathic scoliosis (n = 30), Scheuermann's kyphosis (n = 2), and other complex conditions (n = 21). The overall accuracy rate for pedicle screw placement was 99.5%, with a 0% malposition rate in type C and D pedicles. No vascular or neurological complications or reoperations related to screw placement were reported.
Conclusion: 3DPSG facilitates safe and accurate pedicle screw placement regardless of pedicle morphology in ASD surgeries. This includes the challenging Watanabe types C and D pedicles, typically found at curve apices, enabling surgeons to achieve high implant density and optimal spinal fixation in ASD patients.
期刊介绍：
The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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