Marengo Nicola, Colonna Stefano, Bue Enrico Lo, Pesaresi Alessandro, Saaid Ayoub, Allevi Mario, Ajello Marco, Mahieu Geert, Garbossa Diego, Cofano Fabio
Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
Orthopedic Surgery Department, ORTHOCA - AZ Monica Hospital, Antwerp, Belgium.
Eur Spine J. 2025 Apr;34(4):1248-1255. doi: 10.1007/s00586-025-08679-2. Epub 2025 Feb 5.
Cervical pedicle screw (CPS) instrumentation offers significant biomechanical advantages compared to lateral mass or transarticular fixation. Nonetheless, malpositioning complications constitute a relevant concern. Customized patient-specific 3D-printed templates have been developed to improve CPS placement accuracy and safety. The aim of this study is to present our experience with this surgical technique and its accuracy and safety in a clinical setting.
This single-center retrospective observational study of prospectively collected data included patients undergoing CPS fixation surgery using a patient-specific 3D template guide system. All patients underwent a 3D-volumetric high-resolution CT scan of the cervical spine for preoperative surgical planning. Postoperative CT scans were used to evaluate pedicle perforation, CPS trajectories, and deviations between the planned and the actual screw position.
A total of 115 CPS were implanted in 25 patients, with 107 (93.1%) of the screws completely placed inside the pedicle. Cortical breach within 2 mm was observed in 8 (6.9%) cases, with no cases of more severe pedicle infractions or perioperative neurovascular complication. No differences of CPS accuracies were found between each metameric fusion level, and between monolateral or bilateral templates. Mean total deviations were 0.75 mm vertically and 0.51 mm horizontally at the screw entry point, and 0.72 mm vertically and horizontally at the narrowest pedicle point. Mean total sagittal and transverse angular deviations were 2.94° and 3.04°, respectively.
Cervical pedicle screw placement using patient-specific guides is safe and accurate, supporting the feasibility of this technique in posterior cervical spine fusion surgery.
与侧块或经关节突固定相比，颈椎椎弓根螺钉（CPS）内固定具有显著的生物力学优势。尽管如此，位置不当的并发症仍是一个相关问题。已开发出定制的患者特异性3D打印模板，以提高CPS置入的准确性和安全性。本研究的目的是介绍我们在临床环境中使用这种手术技术的经验及其准确性和安全性。
这项对前瞻性收集数据的单中心回顾性观察研究纳入了使用患者特异性3D模板引导系统进行CPS固定手术的患者。所有患者均接受颈椎3D容积高分辨率CT扫描，用于术前手术规划。术后CT扫描用于评估椎弓根穿孔、CPS轨迹以及计划螺钉位置与实际螺钉位置之间的偏差。
25例患者共植入115枚CPS，其中107枚（93.1%）螺钉完全置入椎弓根内。8例（6.9%）观察到皮质骨破损在2mm以内，无更严重的椎弓根骨折或围手术期神经血管并发症病例。在每个节段融合水平之间以及单侧或双侧模板之间，CPS准确性无差异。螺钉置入点垂直方向平均总偏差为0.75mm，水平方向为0.51mm；在最窄椎弓根点垂直和水平方向平均总偏差均为0.72mm。矢状面和横断面平均总角度偏差分别为2.94°和3.04°。
使用患者特异性导向器进行颈椎椎弓根螺钉置入是安全且准确的，支持该技术在颈椎后路融合手术中的可行性。
