Kumar Rakesh, Leveque Jean-Christophe, Louie Philip K, Sethi Rajiv, Nemani Venu M
Division of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Medical Center, Seattle, WA, USA.
Division of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Medical Center, Seattle, WA, USA
Int J Spine Surg. 2024 Aug 30;18(S1):S50-S56. doi: 10.14444/8641.
Adult spinal deformity (ASD) surgery often involves the placement of pedicle screws using various methods, including freehand technique, fluoroscopic guidance, and computer-assisted intraoperative navigation, each with distinct limitations. Particularly challenging is the instrumentation of pedicles with small or absent cancellous channels (Watanabe types C and D pedicles), commonly found at the apex of large curves where precise screw placement is crucial for effective deformity correction. 3D-printed pedicle screw drill guides (3DPSG) may assist in accurately placing pedicle screws while minimally disrupting the standard ASD surgery workflow. This study aims to evaluate the safety and efficacy of 3DPSG in ASD patients with Watanabe types C and D pedicles, where the safe corridor for screw placement is limited.
3DPSG were designed using fine cut (≤1.25 mm) computed tomography scans. Preoperative screw trajectory planning and guide manufacturing were conducted using computer-aided design software (Mighty Oak Medical, Englewood, CO). Four ASD surgeons with varying experience levels placed the guides. Data on patient demographics, pedicle morphology, number of levels instrumented, and implant-related complications were collected.
The study included 115 patients (median age 67, range 18-81 years) with 2210 screws placed from T1 to L5. The median number of levels instrumented per case was 11 (range 7-12). Diagnoses included adult degenerative scoliosis ( = 62), adult idiopathic scoliosis ( = 30), Scheuermann's kyphosis ( = 2), and other complex conditions ( = 21). The overall accuracy rate for pedicle screw placement was 99.5%, with a 0% malposition rate in type C and D pedicles. No vascular or neurological complications or reoperations related to screw placement were reported.
3DPSG facilitates safe and accurate pedicle screw placement regardless of pedicle morphology in ASD surgeries. This includes the challenging Watanabe types C and D pedicles, typically found at curve apices, enabling surgeons to achieve high implant density and optimal spinal fixation in ASD patients.
成人脊柱畸形（ASD）手术通常涉及使用多种方法置入椎弓根螺钉，包括徒手技术、透视引导和计算机辅助术中导航，每种方法都有明显的局限性。特别具有挑战性的是对松质骨通道较小或缺失的椎弓根（渡边C型和D型椎弓根）进行器械操作，这些椎弓根常见于大弯的顶点，精确的螺钉置入对于有效的畸形矫正至关重要。3D打印椎弓根螺钉钻孔导向器（3DPSG）可能有助于在最小程度干扰标准ASD手术流程的情况下准确置入椎弓根螺钉。本研究旨在评估3DPSG在具有渡边C型和D型椎弓根的ASD患者中的安全性和有效性，这些患者的螺钉置入安全通道有限。
使用薄层（≤1.25毫米）计算机断层扫描设计3DPSG。术前使用计算机辅助设计软件（Mighty Oak Medical，科罗拉多州恩格尔伍德）进行螺钉轨迹规划和导向器制造。四名经验水平不同的ASD外科医生置入导向器。收集患者人口统计学数据、椎弓根形态、置入器械的节段数和与植入物相关的并发症数据。
该研究纳入了115例患者（中位年龄67岁，范围18 - 81岁），从T1至L5置入了2210枚螺钉。每例置入器械的节段数中位数为11（范围7 - 12）。诊断包括成人退变性脊柱侧凸（n = 62）、成人特发性脊柱侧凸（n = 30）、休门氏驼背（n = 2）和其他复杂情况（n = 21）。椎弓根螺钉置入的总体准确率为99.5%，C型和D型椎弓根的误置率为0%。未报告与螺钉置入相关的血管或神经并发症或再次手术情况。
3DPSG有助于在ASD手术中安全、准确地置入椎弓根螺钉，无论椎弓根形态如何。这包括具有挑战性的渡边C型和D型椎弓根，通常位于弯曲顶点，使外科医生能够在ASD患者中实现高植入物密度和最佳脊柱固定。
