{"title":"A Novel Method to Improve the Accuracy and Stability of the 3D Guide Template Technique Applied in Upper Cervical Spine Surgery.","authors":"Zhen-Shan Yuan, Yong Hu, Wei-Xin Dong, Jianbing Zhong, Bingke Zhu, Xiao-Yang Sun","doi":"10.5137/1019-5149.JTN.40449-22.2","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the safety and accuracy of C1 and C2 pedicle screw placement using a three-dimensional (3D)-printed double template and compare them with those of the conventional method in a clinical study.</p><p><strong>Material and methods: </strong>DICOM format data from 60 cases with C1-C2 instability were obtained after computed tomography (CT) was performed. A total of 32 cases underwent surgery via the free-hand technique, whereas 28 cases underwent surgery via a 3D-printed \"pointing-drilling\" guide template. The ideal trajectory of the C1 and C2 pedicle screws was designed using a baseplate as a separate complementary template for the corresponding posterior C1-C2 anatomical surface, after which the \"pointingdrilling\" guide template was materialized using a 3D printing machine. The 3D-printed \"pointing-drilling\" guide template, which was sterilized with low-temperature plasma, was used to locate the starting point and determine the drill trajectory during surgery. The positions of the screws in the axial and sagittal planes of the CT scan were observed and categorized into four grades, after which the operative time, fluoroscopy time, and intraoperative bleeding in the two groups were compared.</p><p><strong>Results: </strong>No significant difference (p > 0.05) in each screw classification grade was observed between the free-hand and \"pointingdrilling\" template groups; however, a significant difference was observed (p=0.048) between these two groups. A significant difference (p < 0.05) in fluoroscopy times was observed between the free-hand and \"pointing-drilling\" template groups. Conversely, no significant differences were observed in bleeding (p=0.491) and operative time (p=0.309) between the free-hand and \"pointingdrilling\" template groups.</p><p><strong>Conclusion: </strong>The 3D-printed \"pointing-drilling\" guide template technique promoted more secure C1 and C2 pedicle screw placement compared with the free-hand technique in clinics.</p>","PeriodicalId":23395,"journal":{"name":"Turkish neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.9000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Turkish neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5137/1019-5149.JTN.40449-22.2","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Aim: To evaluate the safety and accuracy of C1 and C2 pedicle screw placement using a three-dimensional (3D)-printed double template and compare them with those of the conventional method in a clinical study.
Material and methods: DICOM format data from 60 cases with C1-C2 instability were obtained after computed tomography (CT) was performed. A total of 32 cases underwent surgery via the free-hand technique, whereas 28 cases underwent surgery via a 3D-printed "pointing-drilling" guide template. The ideal trajectory of the C1 and C2 pedicle screws was designed using a baseplate as a separate complementary template for the corresponding posterior C1-C2 anatomical surface, after which the "pointingdrilling" guide template was materialized using a 3D printing machine. The 3D-printed "pointing-drilling" guide template, which was sterilized with low-temperature plasma, was used to locate the starting point and determine the drill trajectory during surgery. The positions of the screws in the axial and sagittal planes of the CT scan were observed and categorized into four grades, after which the operative time, fluoroscopy time, and intraoperative bleeding in the two groups were compared.
Results: No significant difference (p > 0.05) in each screw classification grade was observed between the free-hand and "pointingdrilling" template groups; however, a significant difference was observed (p=0.048) between these two groups. A significant difference (p < 0.05) in fluoroscopy times was observed between the free-hand and "pointing-drilling" template groups. Conversely, no significant differences were observed in bleeding (p=0.491) and operative time (p=0.309) between the free-hand and "pointingdrilling" template groups.
Conclusion: The 3D-printed "pointing-drilling" guide template technique promoted more secure C1 and C2 pedicle screw placement compared with the free-hand technique in clinics.
期刊介绍：
Turkish Neurosurgery is a peer-reviewed, multidisciplinary, open access and totally free journal directed at an audience of neurosurgery physicians and scientists. The official language of the journal is English. The journal publishes original articles in the form of clinical and basic research. Turkish Neurosurgery will only publish studies that have institutional review board (IRB) approval and have strictly observed an acceptable follow-up period. With the exception of reference presentation, Turkish Neurosurgery requires that all manuscripts be prepared in accordance with the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.
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