Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Lihang ¹ , TANG Qian ² , CHEN Qiling ¹ , LU Tingsheng ¹ , YAO Shudan ¹ , PU Xingwei ¹ , JI Linsong ¹ ,  LUO Chunshan ¹

1. Department of Spine Surgery, Beijing Jishuitan Hospital Guizhou Hospital/Guizhou Provincial Orthopedic Hospital, Guiyang Guizhou, 550004, P. R. China;
2. Department of Burn and Plastic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang Guizhou, 550004, P. R. China;

Corresponding author：

LUO Chunshan, Email: lyz8088gk@163.com

Keywords：

Scoliosis correction surgery; new point contact pedicle navigation template; three-dimensional printing technology; five-point positioning

DOI：

10.7507/1002-1892.202302089

Video：

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Objective To explore the effectiveness of a new point contact pedicle navigation template (referred to as “new navigation template” for simplicity) in assisting screw implantation in scoliosis correction surgery. Methods Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups (P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. Results Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups (P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group (P<0.05). There was no complications related to screws implantation during or after operation in the two groups. Conclusion The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.

Citation： WANG Lihang, TANG Qian, CHEN Qiling, LU Tingsheng, YAO Shudan, PU Xingwei, JI Linsong, LUO Chunshan. Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 700-705. doi: 10.7507/1002-1892.202302089 Copy

1.	Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-294.
2.	Miekisiak G, Kornas P, Lekan M, et al. Accuracy of the free-hand placement of pedicle screws in the lumbosacral spine using a universal entry point: clinical validation. J Spinal Disord Tech, 2015, 28(4): E194-E198.
3.	Liu Z, Jin M, Qiu Y, et al. The superiority of intraoperative O-arm navigation-assisted surgery in instrumenting extremely small thoracic pedicles of adolescent idiopathic scoliosis: A case-control study. Medicine (Baltimore), 2016, 95(18): e3581. doi: 10.1097/MD.0000000000003581.
4.	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.
5.	魏巍, 邢龙颜, 焦甲勋, 等. 数字化导航模板技术联合颈椎椎弓根螺钉植入的有效性及安全性: 前瞻性、单中心、自身对照临床试验方案. 中国组织工程研究, 2017, 21(35): 5644-5648.
6.	李洪珂, 董胜利, 刘帅, 等. 3D打印导航模板辅助置钉在脊柱侧弯术中的应用价值. 生物医学工程与临床, 2022, 26(3): 300-306.
7.	余城墙, 韦建勋. 3D打印技术在脊柱外科围手术期应用的研究进展. 中国脊柱脊髓杂志, 2019, 29(3): 275-278.
8.	王力航, 陈啟鸰, 陆廷盛, 等. 头盆环牵引治疗重度僵硬型脊柱侧后凸伴复杂椎管内畸形的临床研究. 中华外科杂志, 2021, 59(5): 370-377.
9.	李洪珂, 郝申申, 王鹏程, 等. 3D打印导航模板辅助特发性脊柱侧弯椎弓根螺钉置入的准确性. 中国组织工程研究, 2020, 24(30): 4757-4762.
10.	Lu C, Ma L, Wang X, et al. Comparison of 3D-printed navigation template-assisted pedicle screws versus freehand screws for scoliosis in children and adolescents: A systematic review and meta-analysis. J Neurol Surg A Cent Eur Neurosurg, 2023, 84(2): 188-197.
11.	钟远鸣, 万通, 钟锡锋, 等. 3D打印模型辅助置钉技术与传统置钉技术治疗脊柱畸形有效与安全性的Meta分析. 中国组织工程研究, 2021, 25(30): 4900-4906.
12.	曾柏方, 吴超, 李涛, 等. 3D打印皮外导板辅助微创椎弓根螺钉植入治疗多节段胸腰椎骨折. 中国修复重建外科杂志, 2021, 35(6): 742-749.
13.	闻志靖, 高正超, 卢腾, 等. 导航模板辅助脊柱椎弓根内固定术与传统椎弓根内固定术手术效果比较的Meta分析. 中国骨伤, 2018, 31(11): 1069-1076.
14.	杜心如, 赵玲秀, 张一模, 等. 胸腰椎椎弓根内径的测量及其临床意义. 中国脊柱脊髓杂志, 2001, 11(3): 162-164.
15.	史亚民, 柴伟, 侯树勋, 等. 胸椎椎弓根形态测量研究. 中国脊柱脊髓杂志, 2002, 12(3): 191-193.
16.	石锐, 刘浩, 袁元, 等. 不同节段椎弓根内部结构的测量和比较. 中国临床解剖学杂志, 2005, 23(5): 458-462.
17.	侯树勋, 史亚民. 国人下胸椎及腰椎椎弓根形态学特点及其临床意义. 中华骨科杂志, 1994, 14(4): 222-225.
18.	Modi HN, Suh SW, Fernandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
19.	Kotani Y, Abumi K, Ito M, et al. Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine (Phila Pa 1976), 2007, 32(14): 1543-1550.
20.	Rao G, Brodke DS, Rondina M, et al. Inter- and intraobserver reliability of computed tomography in assessment of thoracic pedicle screw placement. Spine (Phila Pa 1976), 2003, 28(22): 2527-2530.
21.	Fisher CG, Sahajpal V, Keynan O, et al. Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine, 2006, 5(6): 520-526.

1. Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-294.
2. Miekisiak G, Kornas P, Lekan M, et al. Accuracy of the free-hand placement of pedicle screws in the lumbosacral spine using a universal entry point: clinical validation. J Spinal Disord Tech, 2015, 28(4): E194-E198.
3. Liu Z, Jin M, Qiu Y, et al. The superiority of intraoperative O-arm navigation-assisted surgery in instrumenting extremely small thoracic pedicles of adolescent idiopathic scoliosis: A case-control study. Medicine (Baltimore), 2016, 95(18): e3581. doi: 10.1097/MD.0000000000003581.
4. 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.
5. 魏巍, 邢龙颜, 焦甲勋, 等. 数字化导航模板技术联合颈椎椎弓根螺钉植入的有效性及安全性: 前瞻性、单中心、自身对照临床试验方案. 中国组织工程研究, 2017, 21(35): 5644-5648.
6. 李洪珂, 董胜利, 刘帅, 等. 3D打印导航模板辅助置钉在脊柱侧弯术中的应用价值. 生物医学工程与临床, 2022, 26(3): 300-306.
7. 余城墙, 韦建勋. 3D打印技术在脊柱外科围手术期应用的研究进展. 中国脊柱脊髓杂志, 2019, 29(3): 275-278.
8. 王力航, 陈啟鸰, 陆廷盛, 等. 头盆环牵引治疗重度僵硬型脊柱侧后凸伴复杂椎管内畸形的临床研究. 中华外科杂志, 2021, 59(5): 370-377.
9. 李洪珂, 郝申申, 王鹏程, 等. 3D打印导航模板辅助特发性脊柱侧弯椎弓根螺钉置入的准确性. 中国组织工程研究, 2020, 24(30): 4757-4762.
10. Lu C, Ma L, Wang X, et al. Comparison of 3D-printed navigation template-assisted pedicle screws versus freehand screws for scoliosis in children and adolescents: A systematic review and meta-analysis. J Neurol Surg A Cent Eur Neurosurg, 2023, 84(2): 188-197.
11. 钟远鸣, 万通, 钟锡锋, 等. 3D打印模型辅助置钉技术与传统置钉技术治疗脊柱畸形有效与安全性的Meta分析. 中国组织工程研究, 2021, 25(30): 4900-4906.
12. 曾柏方, 吴超, 李涛, 等. 3D打印皮外导板辅助微创椎弓根螺钉植入治疗多节段胸腰椎骨折. 中国修复重建外科杂志, 2021, 35(6): 742-749.
13. 闻志靖, 高正超, 卢腾, 等. 导航模板辅助脊柱椎弓根内固定术与传统椎弓根内固定术手术效果比较的Meta分析. 中国骨伤, 2018, 31(11): 1069-1076.
14. 杜心如, 赵玲秀, 张一模, 等. 胸腰椎椎弓根内径的测量及其临床意义. 中国脊柱脊髓杂志, 2001, 11(3): 162-164.
15. 史亚民, 柴伟, 侯树勋, 等. 胸椎椎弓根形态测量研究. 中国脊柱脊髓杂志, 2002, 12(3): 191-193.
16. 石锐, 刘浩, 袁元, 等. 不同节段椎弓根内部结构的测量和比较. 中国临床解剖学杂志, 2005, 23(5): 458-462.
17. 侯树勋, 史亚民. 国人下胸椎及腰椎椎弓根形态学特点及其临床意义. 中华骨科杂志, 1994, 14(4): 222-225.
18. Modi HN, Suh SW, Fernandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
19. Kotani Y, Abumi K, Ito M, et al. Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine (Phila Pa 1976), 2007, 32(14): 1543-1550.
20. Rao G, Brodke DS, Rondina M, et al. Inter- and intraobserver reliability of computed tomography in assessment of thoracic pedicle screw placement. Spine (Phila Pa 1976), 2003, 28(22): 2527-2530.
21. Fisher CG, Sahajpal V, Keynan O, et al. Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine, 2006, 5(6): 520-526.

Chinese Journal of Reparative and Reconstructive Surgery

Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery

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