Department of Spine Surgery, Balgrist University Hospital Zürich, University of Zürich, Forchstrasse 340, 8008, Zurich, CH, Switzerland.
Spine Deform. 2024 Jul;12(4):989-1000. doi: 10.1007/s43390-024-00852-9. Epub 2024 Apr 1.
Hypoplastic pedicles of the thoracolumbar spine (<5 mm diameter) are often found in syndromic deformities of the spine and pose a challenge in pedicle screw instrumentation. 3D-printed patient-specific guides might help overcome anatomical difficulties when instrumenting pedicles with screws, thereby reducing the necessity for less effective fixation methods such as hooks or sublaminar wires. In this study, the surgical feasibility and clinical outcome of patients with hypoplastic pedicles following pedicle screw instrumentation with 3D-printed patient-specific guides were assessed.
Hypoplastic pedicles were identified on preoperative computed tomography (CT) scans in six patients undergoing posterior spinal fusion surgery between 2017 and 2020. Based on these preoperative CT scans, patient-specific guides were produced to help with screw instrumentation of these thin pedicles. Postoperatively, pedicle-screw-related complications or revisions were analyzed.
93/105 (88.6%) pedicle screws placed with patient-specific guides were instrumented. 62/93 (66.7%) of these instrumented pedicles were defined as hypoplastic with a mean width of 3.07 mm (SD ±0.98 mm, 95% CI [2.82-3.32]). Overall, 6 complications in the 62 hypoplastic pedicles (9.7%) were observed and included intraoperatively managed 4 cerebrospinal fluid leaks, 1 pneumothorax and 1 delayed revision due to 2 lumbar screws (2/62, 3.3%) impinging the L3 nerve root causing a painful radiculopathy. The mean follow-up time was 26.7 (SD ±11.7) months. Complications were only noted when the pedicle-width-to-screw-diameter ratio measured less than 0.62.
Patient-specific 3D-printed guides can aid in challenging instrumentation of hypoplastic pedicles in the thoracolumbar spine, especially if the pedicle-width-to-screw-diameter ratio is greater than 0.62.
胸腰椎发育不良的椎弓根（<5mm 直径）在脊柱综合征畸形中经常发现，这给椎弓根螺钉器械固定带来了挑战。3D 打印的患者特异性引导器可以帮助克服使用螺钉固定椎弓根时的解剖学困难，从而减少使用钩或皮下线等效果较差的固定方法的必要性。在这项研究中，评估了使用 3D 打印的患者特异性引导器进行椎弓根螺钉器械固定后，患有发育不良椎弓根的患者的手术可行性和临床结果。
在 2017 年至 2020 年期间，对接受后路脊柱融合手术的 6 名患者的术前 CT 扫描中发现了发育不良的椎弓根。根据这些术前 CT 扫描，制作了患者特异性引导器，以帮助对这些细的椎弓根进行螺钉固定。术后分析了与椎弓根螺钉相关的并发症或修订。
93/105（88.6%）颗使用患者特异性引导器放置的椎弓根螺钉进行了器械固定。在这些器械固定的椎弓根中，有 62/93（66.7%）被定义为发育不良，平均宽度为 3.07mm（标准差 ±0.98mm，95%CI[2.82-3.32]）。总体而言，在 62 个发育不良的椎弓根中观察到 6 个并发症（9.7%），包括术中管理的 4 例脑脊液漏、1 例气胸和 1 例因 2 颗腰椎螺钉（2/62，3.3%）压迫 L3 神经根导致神经根痛而延迟修订。平均随访时间为 26.7（标准差±11.7）个月。只有当椎弓根宽度与螺钉直径的比值小于 0.62 时才会出现并发症。
患者特异性 3D 打印引导器可以帮助在胸腰椎发育不良的椎弓根中进行具有挑战性的器械固定，特别是当椎弓根宽度与螺钉直径的比值大于 0.62 时。
