Relation between the length of navigation pipe and accuracy of screw placement in cervical pedicle screw placement assisted by 3D printed navigation template_West China Medical Journal

Authors：

DENG Jiayan ¹ ,  WU Chao ^1,2 , SHEN Danwei ¹ , ZENG Bofang ² , TAN Lun ²

1. Digital Medical Center, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;
2. Department of Orthopedics, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

WU Chao, Email: flightiness@163.com

Keywords：

Cervical spinal fracture and dislocation; Pedicle screw; 3D printing; Individualized design; Accuracy analysis

DOI：

10.7507/1002-0179.202108051

Video：

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Objective To evaluate the deviation between actual and simulated screw placement after cervical pedicle screw placement assisted by 3D printed navigation template, and analyze the correlation between screw placement deviation and navigation pipe length. Methods A total of 40 patients undergoing cervical 1-7 pedicle screw insertion assisted by 3D printed navigation template in Zigong Fourth People’s Hospital between February 2018 and August 2020 were included in this prospective study. These patients were divided into 3 groups randomly, including 12 patients with a 5-mm pipe length (5 mm group), 13 patients with a 10-mm pipe length (10 mm group), and 15 patients with a 15-mm pipe length (15 mm group). Three-dimensional modeling was performed on preoperative cervical CT images of these patients and simulated pedicle screw was placed. Individualized pedicle screw navigation templates were designed according to the position and direction of simulated pedicle screws, and 3D printing was performed on the cervical model and navigation templates. Preoperative 3D printed model and navigation templates were used to simulate the surgical process to confirm the safety of screws. During the operation, pedicle screw placement was performed according to the preoperative design and simulated surgical process. The postoperative CT images were registered with the preoperative CT images in 3D model. The safety of screw placement was evaluated by the postoperative screw placement Grade, and the accuracy of screw placement was evaluated by measuring the deviation of screw placement point and the deviation of screw placement direction in horizontal plane (inclination angle) and sagittal plane (head inclination angle). The influence of different navigation pipe lengths on the safety and accuracy of screw placement was analyzed. Results A total of 164 pedicle screws were inserted with navigation template assistance, including 48 screws (38 in Grade 0 and 10 in Grade 1) in the 5 mm group, 52 screws in the 10 mm group (all in Grade 0), and 64 screws (52 in Grade 0 and 12 in Grade 1) in the 15 mm group, and the difference in the grade among the three groups was statistically significant (P<0.05). When the navigation pipe length was 5, 10, and 15 mm, respectively, the screw entry point deviation was (1.87±0.63), (1.44±0.63), and (1.66±0.54) mm, respectively, the inclination angle deviation was (2.72±0.25), (0.90±0.21), and (1.84±0.35)°, respectively, and the head inclination angle deviation was (8.63±1.83), (7.15±1.38), and (8.24±1.52)°, respectively. The deviations in the 10 mm group were all significantly less than those in the other two groups (P<0.05). Conclusions In the cervical pedicle screw placement assisted by navigation template, all the screws were Grade 0 or Grade 1, with high safety. The mean deviation of the screw entry point is within 2 mm, with high accuracy. When the length of navigation pipe is 10 mm, the safety and accuracy of screw placement can be fully guaranteed.

Citation： DENG Jiayan, WU Chao, SHEN Danwei, ZENG Bofang, TAN Lun. Relation between the length of navigation pipe and accuracy of screw placement in cervical pedicle screw placement assisted by 3D printed navigation template. West China Medical Journal, 2021, 36(10): 1349-1354. doi: 10.7507/1002-0179.202108051 Copy

1.	Ma XY, Yin QS, Wu ZH, et al. C1 pedicle screws versus C1 lateral mass screws: comparisons of pullout strengths and biomechanical stabilities. Spine (Phila Pa 1976), 2009, 34(4): 371-377.
2.	Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976), 2012, 37(5): E349-E356.
3.	Chin KR, Mills MV, Seale J, et al. Ideal starting point and trajectory for C2 pedicle screw placement: a 3D computed tomography analysis using perioperative measurements. Spine J, 2014, 14(4): 615-618.
4.	El Hawary MA. Determining optimal C2 pedicle screw placement and length in patients with axis traumatic spondylolisthesis: a case series. Global Spine J, 2013, 3(2): 63-68.
5.	Patkar SV. New entry point for C2 screw, in posterior C1-C2 fixation (Goel-Harm’s technique) significantly reducing the possibility of vertebral artery injury. Neurol Res, 2016, 38(2): 93-97.
6.	Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-E120.
7.	Sugawara T, Higashiyama N, Kaneyama S, et al. Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C1-C2 fixation. Spine (Phila Pa 1976), 2017, 42(6): E340-E346.
8.	吴超, 邓佳燕, 罗敏, 等. 3D打印逐级导板辅助椎弓根钉固定下颈椎骨折脱位. 中国矫形外科杂志, 2019, 470(12): 1132-1136.
9.	邓佳燕, 吴超, 林旭, 等. 3D导航模板在治疗寰枢椎骨折辅助置钉中的应用. 实用骨科杂志, 2018, 24(4): 350-353.
10.	Yu Z, Zhang G, Chen X, et al. Application of a novel 3D drill template for cervical pedicle screw tunnel design: a cadaveric study. Eur Spine J, 2017, 26(9): 2348-2356.
11.	Roberts TT, Leonard GR, Cepela DJ. Classifications in brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res, 2017, 475(5): 1499-1504.
12.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
13.	Guo F, Dai J, Zhang J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One, 2017, 12(2): e0171509.
14.	Deng T, Jiang M, Lei Q, et al. The accuracy and the safety of individualized 3D printing screws insertion templates for cervical screw insertion. Comput Assist Surg (Abingdon), 2016, 21(1): 143-149.
15.	吴超, 邓佳燕, 谭伦, 等. 逐级扩大型 3D 打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
16.	Abul-Kasim K, Strömbeck A, Ohlin A, et al. Reliability of low-radiation dose CT in the assessment of screw placement after posterior scoliosis surgery, evaluated with a new grading system. Spine (Phila Pa 1976), 2009, 34(9): 941-948.
17.	Hu Y, Dong WX, Spiker WR, et al. An anatomic study to determine the optimal entry point, medial angles, and effective length for safe fixation using posterior C1 lateral mass screws. Spine (Phila Pa 1976), 2015, 40(4): E191-E198.
18.	Oh SH, Min WK. Analysis of cervical pedicle with reconstructed computed tomography imaging in Korean population: feasibility and surgical anatomy. J Spinal Disord Tech, 2014, 27(3): E99-E103.
19.	Liu J, Napolitano JT, Ebraheim NA. Systematic review of cervical pedicle dimensions and projections. Spine (Phila Pa 1976), 2010, 35(24): E1373-E1380.
20.	Farooque K, Yadav R, Chowdhury B, et al. Computerized tomography-based morphometric analysis of subaxial cervical spine pedicle in asymptomatic Indian population. Int J Spine Surg, 2018, 12(2): 112-120.
21.	Tan M, Wang H, Wang Y, et al. Morphometric evaluation of screw fixation in Atlas via posterior arch and lateral mass. Spine (Phila Pa 1976), 2003, 28(9): 888-895.
22.	Wu C, Deng J, Wang Q, et al. Feasibility of Atlas pedicle screw fixation perpendicular to the coronal plane: a 3D anatomic analysis. Global Spine J, 2021: 2192568220980715.
23.	Wu C, Deng J, Zeng B, et al. Three-dimensional anatomic analysis and navigation templates for C1 pedicle screw placement perpendicular to the coronal plane: a retrospective study. Neurol Res, 2021: 1-9.

1. Ma XY, Yin QS, Wu ZH, et al. C1 pedicle screws versus C1 lateral mass screws: comparisons of pullout strengths and biomechanical stabilities. Spine (Phila Pa 1976), 2009, 34(4): 371-377.
2. Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976), 2012, 37(5): E349-E356.
3. Chin KR, Mills MV, Seale J, et al. Ideal starting point and trajectory for C2 pedicle screw placement: a 3D computed tomography analysis using perioperative measurements. Spine J, 2014, 14(4): 615-618.
4. El Hawary MA. Determining optimal C2 pedicle screw placement and length in patients with axis traumatic spondylolisthesis: a case series. Global Spine J, 2013, 3(2): 63-68.
5. Patkar SV. New entry point for C2 screw, in posterior C1-C2 fixation (Goel-Harm’s technique) significantly reducing the possibility of vertebral artery injury. Neurol Res, 2016, 38(2): 93-97.
6. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-E120.
7. Sugawara T, Higashiyama N, Kaneyama S, et al. Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C1-C2 fixation. Spine (Phila Pa 1976), 2017, 42(6): E340-E346.
8. 吴超, 邓佳燕, 罗敏, 等. 3D打印逐级导板辅助椎弓根钉固定下颈椎骨折脱位. 中国矫形外科杂志, 2019, 470(12): 1132-1136.
9. 邓佳燕, 吴超, 林旭, 等. 3D导航模板在治疗寰枢椎骨折辅助置钉中的应用. 实用骨科杂志, 2018, 24(4): 350-353.
10. Yu Z, Zhang G, Chen X, et al. Application of a novel 3D drill template for cervical pedicle screw tunnel design: a cadaveric study. Eur Spine J, 2017, 26(9): 2348-2356.
11. Roberts TT, Leonard GR, Cepela DJ. Classifications in brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res, 2017, 475(5): 1499-1504.
12. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
13. Guo F, Dai J, Zhang J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One, 2017, 12(2): e0171509.
14. Deng T, Jiang M, Lei Q, et al. The accuracy and the safety of individualized 3D printing screws insertion templates for cervical screw insertion. Comput Assist Surg (Abingdon), 2016, 21(1): 143-149.
15. 吴超, 邓佳燕, 谭伦, 等. 逐级扩大型 3D 打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
16. Abul-Kasim K, Strömbeck A, Ohlin A, et al. Reliability of low-radiation dose CT in the assessment of screw placement after posterior scoliosis surgery, evaluated with a new grading system. Spine (Phila Pa 1976), 2009, 34(9): 941-948.
17. Hu Y, Dong WX, Spiker WR, et al. An anatomic study to determine the optimal entry point, medial angles, and effective length for safe fixation using posterior C1 lateral mass screws. Spine (Phila Pa 1976), 2015, 40(4): E191-E198.
18. Oh SH, Min WK. Analysis of cervical pedicle with reconstructed computed tomography imaging in Korean population: feasibility and surgical anatomy. J Spinal Disord Tech, 2014, 27(3): E99-E103.
19. Liu J, Napolitano JT, Ebraheim NA. Systematic review of cervical pedicle dimensions and projections. Spine (Phila Pa 1976), 2010, 35(24): E1373-E1380.
20. Farooque K, Yadav R, Chowdhury B, et al. Computerized tomography-based morphometric analysis of subaxial cervical spine pedicle in asymptomatic Indian population. Int J Spine Surg, 2018, 12(2): 112-120.
21. Tan M, Wang H, Wang Y, et al. Morphometric evaluation of screw fixation in Atlas via posterior arch and lateral mass. Spine (Phila Pa 1976), 2003, 28(9): 888-895.
22. Wu C, Deng J, Wang Q, et al. Feasibility of Atlas pedicle screw fixation perpendicular to the coronal plane: a 3D anatomic analysis. Global Spine J, 2021: 2192568220980715.
23. Wu C, Deng J, Zeng B, et al. Three-dimensional anatomic analysis and navigation templates for C1 pedicle screw placement perpendicular to the coronal plane: a retrospective study. Neurol Res, 2021: 1-9.

West China Medical Journal

Relation between the length of navigation pipe and accuracy of screw placement in cervical pedicle screw placement assisted by 3D printed navigation template

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