Three-Dimensional Printing Technology Based on Digital Orthopedics: 5-Point Positioning Point-Contact Pedicle Navigation Template in the Case of Scoliosis and Complex Pedicle

Abstract

Objective: Imperfect fitting of the navigation template leads to prolonged surgery time and increased blood loss. These problems have not been effectively addressed in previous research. This study explores the efficacy of a novel 5-point positioning point-contact pedicle navigation template in complex pedicle situations in scoliosis.

Methods: This study employed a retrospective controlled design. From November 2019 to November 2023, 28 patients with scoliosis and complex pedicle were selected and underwent scoliosis correction surgery. A 5-point positioning point-contact pedicle navigation template was used intraoperatively to guide pedicle screw placement. Matched with 56 historical cases as a control group. The analysis included screw placement time, screw placement bleeding volume, fluoroscopy frequency, manual repositioning frequency, screw placement accuracy and grade, screw placement complications, and main curve correction rate. Continuous variables were compared using the independent samples t-test. Categorical data were analyzed with the chi-square test.

Results: All 28 patients successfully underwent surgery, with a total of 268 pedicle screws placed. The surgery duration ranged from 220 to 410 min, with an average of (283.16 ± 51.26) min. Intraoperative blood loss ranged from 630 to 1900 mL, with an average of (902.17 ± 361.25) mL. Pedicle screw placement time ranged from 60 to 130 min, with an average of (85.24 ± 24.65) min. Pedicle screw placement bleeding volume ranged from 40 to 180 mL, with an average of (76.47 ± 42.65) mL. Fluoroscopy frequency ranged from 3 to 7 times, with an average of (4.31 ± 1.14) times. Manual repositioning frequency ranged from 0 to 2 times, with an average of (0.46 ± 0.58) times. Pedicle screw placement grades: Grade I: 237 screws; Grade II: 25 screws; Grade III: 6 screws; Grade IV: 0 screws. There were no screw-related complications. The correction rate ranged from 46% to 68%, with an average of (55.83 ± 9.22)%. Compared to the experienced screw group, the differences in screw placement time, screw placement bleeding volume, fluoroscopy procedures, and manual redirections were statistically significant (p < 0.05).

Conclusion: The 5-point positioning point-contact pedicle navigation template features a claw-like structure that securely adapts to various deformed vertebral facet joints, avoiding drift phenomena and ensuring accurate screw placement. Its pointed contact structure with the lamina of the spine avoids extensive and complete detachment of posterior structures, reducing blood loss, surgery time, and trauma. Predesigned pedicle screw entry points and directions reduce fluoroscopy frequency and surgery time.

Keywords

3D printing / 5-point Positioning Point-Contact Navigation Template / Complex Pedicle / Pedicle Navigation Template / Scoliosis

References

[1] Samdani AF, Ranade A, Saldanha V, Yondorf MZ. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery. 2010; 66(2): 290–294. discussion 294-5.

[2] Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine. 1990; 15(1): 11–14.

[3] Miekisiak G, Kornas P, Lekan M, Dacko W, Latka D, Kaczmarczyk J. 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.

[4] Liu Z, Jin M, Qiu Y, Yan H, Han X, Zhu Z. The superiority of intraoperative O-arm navigation-assisted surgery in instrumenting extremely small thoracic pedicles of adolescent idiopathic scoliosis: a case-control study. Medicine. 2016; 95(18): e3581.

[5] Aimin W, Shao Z, Wang J, et al. The accuracy of a method for printing three-dimensional spinal models. PLoS One. 2015; 10(4): e0124291.

[6] Sugawara T, Higashiyama N, Kaneyama S, Sumi M. Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C1-C2 fixation. Spine. 2017; 42(6): E340–E346.

[7] Chengqiang Y, Wei J. Research progress on the application of 3D printing technology in spinal surgery during the perioperative period[J]. Chin J Spinal Cord. 2019; 29(3): 275–278.

[8] Wang L, Chen Q, Tingsheng L, et al. Clinical study on the treatment of severe rigid kyphoscoliosis with complex intraspinal deformities by cranio-pelvic ring traction [J]. Chin J Surg. 2021; 59(5): 370–377.

[9] Li H, Hao S, Wang P, et al. Accuracy of pedicle screw placement in idiopathic scoliosis assisted by 3D printing navigation template[J]. J Clin Rehabil Tissue Eng Res. 2020; 24(30): 4757–4762.

[10] Wei W, Longyan X, Jiaxun J, et al. Effectiveness and safety of digital navigation template technology combined with cervical pedicle screw implantation: prospective, single-center, self-controlled clinical trial protocol [J]. Chin J Tissue Eng Res. 2017; 21(35): 5644–5648.

[11] Zhang S, Chen R, Guo C, et al. Selective pedicle screw treatment of adolescent idiopathic scoliosis based on 3D printing technology[J]. J Clin Med. 2016; 20(48): 7225–7231.

[12] Wen Z, Gao Z, Teng L, et al. Meta-analysis of the surgical effects of navigation template-assisted spinal pedicle internal fixation compared with traditional spinal pedicle internal fixation[J]. Chin J Orthop Traumatol. 2018; 31(11): 1069–1076.

[13] Yan B, Sun Y, Ouyang H, et al. Application study on precise implantation of lumbar pedicle screw assisted by 3D printing navigation module[J]. Chin J Clin Anat. 2017; 35(2): 156–159.

[14] Li H, Dong S, Liu S, et al. Application value of 3D printing navigation template-assisted screw placement in scoliosis surgery[J]. Biomed Eng Clin Pract. 2022; 26(3): 300–306.

[15] Wang F, Liu Z, Zhang J, et al. Application value of 3D printing navigation template in assisting atlantoaxial pedicle screw placement[J]. Chin J Spinal Cord. 2017; 27(1): 61–68.

[16] Xinru D, Zhao L, Zhang Y, et al. Measurement of the inner diameter of thoracolumbar pedicle and its clinical significance [J]. Chin J Spine Spinal Cord. 2001; 11(3): 162–164.

[17] Shi Y, Chai W, Hou S, et al. Study on the morphology measurement of thoracic pedicle[J]. Chin J Spinal Cord. 2002; 12(3): 191–193.

[18] Shi R, Liu H, Yuan Y, et al. Measurement and comparison of internal structures of different segments of pedicle[J]. Chin J Clin Anat. 2005; 23(5): 458–462.

[19] Hou S, Shi Y. Morphological characteristics and clinical significance of the lower thoracic and lumbar vertebral pedicle in Chinese people[J]. Chin J Orthop. 1994; 14(4): 222–225.

[20] Kotani Y, Abumi K, Ito M, Takahata M, Sudo H, Ohshima S, et al. Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine. 2007; 32(14): 1543–1550.

[21] Rao G, Brodke DS, Rondina M, Bacchus K, Dailey AT. Inter-and intraobserver reliability of computed tomography in assessment of thoracic pedicle screw placement. Spine. 2003; 28(22): 2527–2530.

[22] Fisher CG, Sahajpal V, Keynan O, Boyd M, Graeb D, Bailey C, et al. Accuracy and safety of pedicle screw fixation in thoracic spine trauma.Journal of neurosurgery. Spine. 2006; 5(6): 520–526.

[23] Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine. 2004; 29(3): 333–342. discussion 342.

[24] Wang L, Tang Q, Chen Q, et al. Application study of a new point-contact pedicle navigation template in assisted screw implantation in scoliosis correction surgery [J]. Chin J Reconst Plast Surg. 2023; 37(6): 700–705.

[25] Wang L, Tingsheng L, Chen Q, et al. Application of a 5-point positioning method for point-contact pedicle navigation template in complex scoliosis with complex pedicle [J]. J Clin Rehabil Res. 2024; 28(18): 2859–2864.

[26] Wang L, Chen Q, Tingsheng L, et al. Application of a point-contact pincer-type fixed navigation template in complex pedicle screw placement in scoliosis [J]. Chin J Orthop. 2023; 43(21): 1409–1417.

RIGHTS & PERMISSIONS

2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.