Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis
Introduction: The preparation of the pedicle and the insertion of a transpedicular screw is a high-risk procedure during spine surgeries. To avoid pedicle screw misplacement in posterior spinal deformity surgery, patient specific 3D‐printed guides can be used but technical issues reported in 17% of...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-06-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751924000021 |
| _version_ | 1797259927889117184 |
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| author | Rafael Augusto Azuero Gonzalez Fabio Alexander Diaz Otero Felipe Ramirez-Velandia Orielson Cruz Amaya Andres Felipe Hortua Moreno Ramon Elias Patiño Guerrero Ivan Dario Ramirez Giraldo |
| author_facet | Rafael Augusto Azuero Gonzalez Fabio Alexander Diaz Otero Felipe Ramirez-Velandia Orielson Cruz Amaya Andres Felipe Hortua Moreno Ramon Elias Patiño Guerrero Ivan Dario Ramirez Giraldo |
| author_sort | Rafael Augusto Azuero Gonzalez |
| collection | DOAJ |
| description | Introduction: The preparation of the pedicle and the insertion of a transpedicular screw is a high-risk procedure during spine surgeries. To avoid pedicle screw misplacement in posterior spinal deformity surgery, patient specific 3D‐printed guides can be used but technical issues reported in 17% of screw fixations. To address this concern, our team has developed single-level guide templates and a locking screw mechanism. We share our experience using a surgical planning and support system with 3D printed patient-specific guides that utilize a locking screw, highlighting the advantages of incorporating it into complex spine surgeries. Materials and Methods: The surgical planning and support system is composed of six phases: (1) spine digitization, (2) segmental analysis and vertebral characterization, (3) planning of angulation, depth, and diameter of transpedicular screws, (4) 3D printing of the spine model, and the locking single level drill guides, (5) selection of surgical instruments, and (6) surgery. Illustrative cases: High resolution tomographic images of two 15-year-old females and one 16-year-old male were processed through software analysis for segmental analysis and vertebral characterization. This process aimed to propose the most suitable plan in a multidisciplinary meeting. Sterilized 3D-printed patient-specific locking spine drill guide models were utilized for the spinal instrumentation. Conclusions: Multiple countries are now developing 3D printed drill guides for screw fixation in severe scoliosis. Our guide represents the first one using a transitory locking mechanism to improve accuracy of fixation. The 3D printed locking drill guides enabled accurate insertion and direction of the transpedicular screw, resulting in improvements in sagittal and coronal balance, and all screws classified as accurately placed and with minimal difference with the planned trajectory. Additional outcomes such as surgical time, intraoperative bleeding, radiation exposure, hospital stay, and postoperative complications should also be considered for further studies in this area. |
| first_indexed | 2024-03-08T14:49:59Z |
| format | Article |
| id | doaj.art-5c5f8a6ef5e8436c9e43a4f8421c162d |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-04-24T23:17:13Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-5c5f8a6ef5e8436c9e43a4f8421c162d2024-03-17T07:54:21ZengElsevierInterdisciplinary Neurosurgery2214-75192024-06-0136101956Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosisRafael Augusto Azuero Gonzalez0Fabio Alexander Diaz Otero1Felipe Ramirez-Velandia2Orielson Cruz Amaya3Andres Felipe Hortua Moreno4Ramon Elias Patiño Guerrero5Ivan Dario Ramirez Giraldo6Neurological Surgery, Spine Surgery, Clinica Chicamocha, Bucaramanga, ColombiaOrthopedic Spinal Surgery, Clinica Chicamocha, Bucaramanga, ColombiaNeurosurgery Research Group, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia; Corresponding author at: Pontificia Universidad Javeriana, Bogotá D.C., Colombia; Cra. 7 # 40-62; +57 6013208320Department of Engineering, Mediimplantes, Bucaramanga, ColombiaUniversidad Industrial de Santander, Clinica Chicamocha, Bucaramanga, ColombiaNeurological Surgery, Coneuro, Cúcuta, ColombiaNeurological Surgery, Spine Surgery, Clinica Chicamocha, Bucaramanga, ColombiaIntroduction: The preparation of the pedicle and the insertion of a transpedicular screw is a high-risk procedure during spine surgeries. To avoid pedicle screw misplacement in posterior spinal deformity surgery, patient specific 3D‐printed guides can be used but technical issues reported in 17% of screw fixations. To address this concern, our team has developed single-level guide templates and a locking screw mechanism. We share our experience using a surgical planning and support system with 3D printed patient-specific guides that utilize a locking screw, highlighting the advantages of incorporating it into complex spine surgeries. Materials and Methods: The surgical planning and support system is composed of six phases: (1) spine digitization, (2) segmental analysis and vertebral characterization, (3) planning of angulation, depth, and diameter of transpedicular screws, (4) 3D printing of the spine model, and the locking single level drill guides, (5) selection of surgical instruments, and (6) surgery. Illustrative cases: High resolution tomographic images of two 15-year-old females and one 16-year-old male were processed through software analysis for segmental analysis and vertebral characterization. This process aimed to propose the most suitable plan in a multidisciplinary meeting. Sterilized 3D-printed patient-specific locking spine drill guide models were utilized for the spinal instrumentation. Conclusions: Multiple countries are now developing 3D printed drill guides for screw fixation in severe scoliosis. Our guide represents the first one using a transitory locking mechanism to improve accuracy of fixation. The 3D printed locking drill guides enabled accurate insertion and direction of the transpedicular screw, resulting in improvements in sagittal and coronal balance, and all screws classified as accurately placed and with minimal difference with the planned trajectory. Additional outcomes such as surgical time, intraoperative bleeding, radiation exposure, hospital stay, and postoperative complications should also be considered for further studies in this area.http://www.sciencedirect.com/science/article/pii/S22147519240000213D‐printed guidesSurgical support deviceTranspedicular screwsSpinal deformity surgeryScoliosis |
| spellingShingle | Rafael Augusto Azuero Gonzalez Fabio Alexander Diaz Otero Felipe Ramirez-Velandia Orielson Cruz Amaya Andres Felipe Hortua Moreno Ramon Elias Patiño Guerrero Ivan Dario Ramirez Giraldo Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis Interdisciplinary Neurosurgery 3D‐printed guides Surgical support device Transpedicular screws Spinal deformity surgery Scoliosis |
| title | Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis |
| title_full | Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis |
| title_fullStr | Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis |
| title_full_unstemmed | Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis |
| title_short | Early experience using 3-D printed locking drill guides for transpedicular screw fixation in scoliosis |
| title_sort | early experience using 3 d printed locking drill guides for transpedicular screw fixation in scoliosis |
| topic | 3D‐printed guides Surgical support device Transpedicular screws Spinal deformity surgery Scoliosis |
| url | http://www.sciencedirect.com/science/article/pii/S2214751924000021 |
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