Clinical application of three-dimensional printing technique combined with thoracic pedicle screw track detector in thoracic pedicle screw placement_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

NIE Hu ,  NIU Guoqi , ZHOU Gong , LIU Tao , CHEN Hui , LI Chao

Department of Orthopedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P.R.China;

Corresponding author：

NIU Guoqi, Email: sngq@163.com

Keywords：

Three-dimensional printing technique; thoracic spine; pedicle screw; screw track detector; internal fixation

DOI：

10.7507/1002-1892.202012016

Video：

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Objective To investigate the clinical application of three-dimensional (3D) printing technique combined with a new type of thoracic pedicle screw track detector in thoracic pedicle screw placement.Methods According to the characteristics of thoracic pedicle and common clinical screw placement methods, a new type of thoracic pedicle screw track detector was independently developed and designed. The clinical data of 30 patients with thoracic vertebrae related diseases who underwent posterior thoracic pedicle screw fixation between March 2017 and January 2020 were retrospectively analysed. Among them, there were 18 males and 12 females with an average age of 56.3 years (range, 32-76 years). There was 1 case of thoracic disc herniation, 4 cases of thoracic canal stenosis, 2 cases of ossification of posterior longitudinal ligament of thoracic vertebra, 16 cases of thoracic trauma, 2 cases of thoracic infection, and 5 cases of thoracic canal occupation. Three-dimensional CT of the thoracic vertebra was routinely performed preoperatively, and the model of the patient’s thoracic vertebra was reconstructed and printed out. With the assistance of the model, preoperative simulation was performed with the combination of the new type thoracic pedicle screw track detector, and detected no nails after critical cortical damage. During operation, one side was randomly selected to use traditional hand screws placement (control group), and the other side was selected to use 3D printing technique combined with new type thoracic pedicle screw track detector to assist thoracic pedicle screws placement (observation group). The single screw placement time, adjustment times of single screw, and blood loss during screw placement were compared between the two groups. The accuracy of screw placement in the two groups was evaluated according to postoperative CT imaging data.Results The single screw placement time, adjustment times of single screw, and blood loss during screw placement in the observation group were significantly less than those in the control group (P<0.05). Postoperative CT examination showed that the observation group had 87 screws of grade 1, 3 screws of grade 2, and the acceptable screw placement rate was 100% (90/90); the control group had 76 screws of grade 1, 2 screws of grade 2, 11 screws of grade 3, and 1 screw of grade 4, and the acceptable screw placement rate was 86.7% (78/90); showing significant difference in screw placement between the two groups (χ²=12.875, P=0.001). All patients were followed up 6-18 months, with an average of 11.3 months. There was no complication of vascular, nerve, spinal cord, or visceral injury, and screws or rods broken, and no patient was revised.Conclusion The 3D printing technique combined with the new type of thoracic pedicle screw track detector assisted thoracic pedicle screw placement is convenient, and significantly improves the accuracy and safety of intraoperative screw placement, and overall success rate of the surgery.

Citation： NIE Hu, NIU Guoqi, ZHOU Gong, LIU Tao, CHEN Hui, LI Chao. Clinical application of three-dimensional printing technique combined with thoracic pedicle screw track detector in thoracic pedicle screw placement. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(5): 586-592. doi: 10.7507/1002-1892.202012016 Copy

1.	Fichtner J, Hofmann N, Rienmüller A, et al. Revision rate of misplaced pedicle screws of the thoracolumbar spine-comparison of three-dimensional fluoroscopy navigation with freehand placement: A systematic analysis and review of the literature. World Neurosurg, 2018, 109: e24-e32.
2.	Zhao Q, Zhang H, Hao D, et al. Complications of percutaneous pedicle screw fixation in treating thoracolumbar and lumbar fracture. Medicine (Baltimore), 2018, 97(29): e11560.
3.	Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-120.
4.	李超, 牛国旗, 蒋维利, 等. 个体化 3D 打印导向模板辅助胸腰椎椎弓根螺钉置入在强直性脊柱炎中的应用研究. 中国骨伤, 2020, 33(7): 649-654.
5.	Aoude AA, Fortin M, Figueiredo R, et al. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. Eur Spine J, 2015, 24(5): 990-1004.
6.	Chen H, Guo K, Yang H, et al. Thoracic pedicle screw placement guide plate produced by three-dimensional (3-D) laser printing. Med Sci Monit, 2016, 22: 1682-1686.
7.	Nevzati E, Marbacher S, Soleman J, et al. Accuracy of pedicle screw placement in the thoracic and lumbosacral spine using a conventional intraoperative fluoroscopy-guided technique: a national neurosurgical education and training center analysis of 1236 consecutive screws. World Neurosurg, 2014, 82(5): 866-871.
8.	Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
9.	Rajasekaran S, Vidyadhara S, Ramesh P, et al. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976), 2007, 32(2): E56-64.
10.	Xie CL, Huang QS, Wu L, et al. Transmuscular ultrasonography of the placement of thoracolumbar pedicle screws: A cadaveric study. World Neurosurg, 2018, 115: e360-e365.
11.	Chen X, Gao X, Zhang G, et al. Design, application, and evaluation of a novel method for determining optimal trajectory of thoracic pedicle screws. Ann Transl Med, 2020, 8(16): 1012.
12.	Xu W, Zhang X, Ke T, et al. 3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study. BMC Musculoskelet Disord, 2017, 18(1): 348.
13.	Tan LA, Yerneni K, Tuchman A, et al. Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction. J Spine Surg, 2018, 4(2): 319-327.
14.	Tu Q, Ding HW, Chen H, et al. Three-dimensional-printed individualized guiding templates for surgical correction of severe kyphoscoliosis secondary to ankylosing spondylitis: Outcomes of 9 cases. World Neurosurg, 2019, 130: e961-e970.
15.	Wang K, Zhang ZJ, Chen JX, et al. Design and application of individualized, 3-dimensional-printed navigation template for placing cortical bone trajectory screws in middle-upper thoracic spine: Cadaver research study. World Neurosurg, 2019, 125: e348-e352.
16.	吴超, 谭伦, 林旭, 等. 3D 打印个体化矢状曲度模棒及椎弓根螺钉导航模板在胸腰椎骨折脱位术中的应用. 中国修复重建外科杂志, 2015, 29(11): 1381-1388.

1. Fichtner J, Hofmann N, Rienmüller A, et al. Revision rate of misplaced pedicle screws of the thoracolumbar spine-comparison of three-dimensional fluoroscopy navigation with freehand placement: A systematic analysis and review of the literature. World Neurosurg, 2018, 109: e24-e32.
2. Zhao Q, Zhang H, Hao D, et al. Complications of percutaneous pedicle screw fixation in treating thoracolumbar and lumbar fracture. Medicine (Baltimore), 2018, 97(29): e11560.
3. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-120.
4. 李超, 牛国旗, 蒋维利, 等. 个体化 3D 打印导向模板辅助胸腰椎椎弓根螺钉置入在强直性脊柱炎中的应用研究. 中国骨伤, 2020, 33(7): 649-654.
5. Aoude AA, Fortin M, Figueiredo R, et al. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. Eur Spine J, 2015, 24(5): 990-1004.
6. Chen H, Guo K, Yang H, et al. Thoracic pedicle screw placement guide plate produced by three-dimensional (3-D) laser printing. Med Sci Monit, 2016, 22: 1682-1686.
7. Nevzati E, Marbacher S, Soleman J, et al. Accuracy of pedicle screw placement in the thoracic and lumbosacral spine using a conventional intraoperative fluoroscopy-guided technique: a national neurosurgical education and training center analysis of 1236 consecutive screws. World Neurosurg, 2014, 82(5): 866-871.
8. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
9. Rajasekaran S, Vidyadhara S, Ramesh P, et al. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976), 2007, 32(2): E56-64.
10. Xie CL, Huang QS, Wu L, et al. Transmuscular ultrasonography of the placement of thoracolumbar pedicle screws: A cadaveric study. World Neurosurg, 2018, 115: e360-e365.
11. Chen X, Gao X, Zhang G, et al. Design, application, and evaluation of a novel method for determining optimal trajectory of thoracic pedicle screws. Ann Transl Med, 2020, 8(16): 1012.
12. Xu W, Zhang X, Ke T, et al. 3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study. BMC Musculoskelet Disord, 2017, 18(1): 348.
13. Tan LA, Yerneni K, Tuchman A, et al. Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction. J Spine Surg, 2018, 4(2): 319-327.
14. Tu Q, Ding HW, Chen H, et al. Three-dimensional-printed individualized guiding templates for surgical correction of severe kyphoscoliosis secondary to ankylosing spondylitis: Outcomes of 9 cases. World Neurosurg, 2019, 130: e961-e970.
15. Wang K, Zhang ZJ, Chen JX, et al. Design and application of individualized, 3-dimensional-printed navigation template for placing cortical bone trajectory screws in middle-upper thoracic spine: Cadaver research study. World Neurosurg, 2019, 125: e348-e352.
16. 吴超, 谭伦, 林旭, 等. 3D 打印个体化矢状曲度模棒及椎弓根螺钉导航模板在胸腰椎骨折脱位术中的应用. 中国修复重建外科杂志, 2015, 29(11): 1381-1388.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of three-dimensional printing technique combined with thoracic pedicle screw track detector in thoracic pedicle screw placement

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