Skip to main content
Erschienen in: Archives of Orthopaedic and Trauma Surgery 7/2013

01.07.2013 | Orthopaedic Surgery

A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine

verfasst von: Matjaz Merc, Igor Drstvensek, Matjaz Vogrin, Tomaz Brajlih, Gregor Recnik

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 7/2013

Einloggen, um Zugang zu erhalten

Abstract

Introduction

The method of free-hand pedicle screw placement is generally safe although it carries potential risks. For this reason, several highly accurate computer-assisted systems were developed and are currently on the market. However, these devices have certain disadvantages. We have developed a method of pedicle screw placement in the lumbar and sacral region using a multi-level drill guide template, created with the rapid prototyping technology and have validated it in a clinical study. The aim of the study was to manufacture and evaluate the accuracy of a multi-level drill guide template for lumbar and first sacral pedicle screw placement and to compare it with the free-hand technique under fluoroscopy supervision.

Materials and methods

In 2011 and 2012, a randomized clinical trial was performed on 20 patients. 54 screws were implanted in the trial group using templates and 54 in the control group using the fluoroscopy-supervised free-hand technique. Furthermore, applicability for the first sacral level was tested. Preoperative CT-scans were taken and templates were designed using the selective laser sintering method. Postoperative evaluation and statistical analysis of pedicle violation, displacement, screw length and deviation were performed for both groups.

Results

The incidence of cortex perforation was significantly reduced in the template group; likewise, the deviation and displacement level of screws in the sagittal plane. In both groups there was no significantly important difference in deviation and displacement level in the transversal plane as not in pedicle screw length. The results for the first sacral level resembled the main investigated group.

Conclusions

The method significantly lowers the incidence of cortex perforation and is therefore potentially applicable in clinical practice, especially in some selected cases. The applied method, however, carries a potential for errors during manufacturing and practical usage and therefore still requires further improvements.
Literatur
1.
Zurück zum Zitat Mattei TA, Meneses MS, Milano JB, Ramina R (2009) “Free-hand” technique for thoracolumbar pedicle screw instrumentation: critical appraisal of current “state-of-art”. Neurol India 57(6):715–721PubMedCrossRef Mattei TA, Meneses MS, Milano JB, Ramina R (2009) “Free-hand” technique for thoracolumbar pedicle screw instrumentation: critical appraisal of current “state-of-art”. Neurol India 57(6):715–721PubMedCrossRef
2.
Zurück zum Zitat Zeiller SC, Lee J, Lim M, Vaccaro AR (2005) Posterior thoracic segmental pedicle screw instrumentation: evolving methods of safe and effective placement. Neurol India 53:458–465PubMedCrossRef Zeiller SC, Lee J, Lim M, Vaccaro AR (2005) Posterior thoracic segmental pedicle screw instrumentation: evolving methods of safe and effective placement. Neurol India 53:458–465PubMedCrossRef
3.
Zurück zum Zitat Berlemann U, Langlotz F, Langlotz U, Nolte LP (1997) Computer-assisted orthopedic surgery. From pedicle screw insertion to further applications. Orthopade 26:463–469PubMed Berlemann U, Langlotz F, Langlotz U, Nolte LP (1997) Computer-assisted orthopedic surgery. From pedicle screw insertion to further applications. Orthopade 26:463–469PubMed
4.
Zurück zum Zitat Richards PJ, Kurta IC, Jasani V, Jones CH, Rahmatalla A, Mackenzie G et al (2007) Assessment of CAOS as a training model in spinal surgery: a randomised study. Eur Spine J 16:239–244PubMedCrossRef Richards PJ, Kurta IC, Jasani V, Jones CH, Rahmatalla A, Mackenzie G et al (2007) Assessment of CAOS as a training model in spinal surgery: a randomised study. Eur Spine J 16:239–244PubMedCrossRef
5.
Zurück zum Zitat Youkilis AS, Quint DJ, McGillicuddy JE, Papadoupoulos SM (2001) Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 48:771–778PubMed Youkilis AS, Quint DJ, McGillicuddy JE, Papadoupoulos SM (2001) Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 48:771–778PubMed
6.
Zurück zum Zitat Hughes SP, Anderson FM (1999) Infection in the operating room. J Bone Jt Surg Br 81(5):754–755CrossRef Hughes SP, Anderson FM (1999) Infection in the operating room. J Bone Jt Surg Br 81(5):754–755CrossRef
7.
Zurück zum Zitat Lim MR, Girardi FP, Yoon SC et al (2005) Accuracy of computerized frameless stereotactic image-guided pedicle screw placement into previously fused lumbar spines. Spine 30(15):1793–1798PubMedCrossRef Lim MR, Girardi FP, Yoon SC et al (2005) Accuracy of computerized frameless stereotactic image-guided pedicle screw placement into previously fused lumbar spines. Spine 30(15):1793–1798PubMedCrossRef
8.
Zurück zum Zitat Sagi HC, Manos R, Benz R et al (2003) Electromagnetic field-based image-guided spine surgery, part 1: results of a cadaveric study evaluating lumbar pedicle screw placement. Spine 28(17):2013–2018PubMedCrossRef Sagi HC, Manos R, Benz R et al (2003) Electromagnetic field-based image-guided spine surgery, part 1: results of a cadaveric study evaluating lumbar pedicle screw placement. Spine 28(17):2013–2018PubMedCrossRef
9.
Zurück zum Zitat Birnbaum K, Schkommodau E, Decker N, Prescher A, Klapper U, Radermacher K (2001) Computer-assisted orthopaedic surgery with individual templates and comparison to conventional operation method. Spine 26(4):365–369PubMedCrossRef Birnbaum K, Schkommodau E, Decker N, Prescher A, Klapper U, Radermacher K (2001) Computer-assisted orthopaedic surgery with individual templates and comparison to conventional operation method. Spine 26(4):365–369PubMedCrossRef
10.
Zurück zum Zitat Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G, Staudte HW (1998) Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 354:28–38PubMedCrossRef Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G, Staudte HW (1998) Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 354:28–38PubMedCrossRef
11.
Zurück zum Zitat Van Brussel K, Vander SJ, van Audekercke R, Swaelens B, Vanden Berghe L, Fabry G (1998) A medical image based template for pedicle screw insertion. Comput Methods Biomech Biomed Eng 2:347–354 Van Brussel K, Vander SJ, van Audekercke R, Swaelens B, Vanden Berghe L, Fabry G (1998) A medical image based template for pedicle screw insertion. Comput Methods Biomech Biomed Eng 2:347–354
12.
Zurück zum Zitat Berry E, Cuppone M, Porada S, Millner PA, Rao A, Chiverton N, Seedhom BB (2005) Personalised image-based templates for intra-operative guidance. Proc Inst Mech Eng H 219(2):111–118PubMed Berry E, Cuppone M, Porada S, Millner PA, Rao A, Chiverton N, Seedhom BB (2005) Personalised image-based templates for intra-operative guidance. Proc Inst Mech Eng H 219(2):111–118PubMed
13.
Zurück zum Zitat Goffin J, Van Brussel K, Martens K, Vander Sloten J, Van Audekercke R, Smet MH (2001) Three-dimensional computed tomography-based, personalized drill guide for posterior cervical stabilization at C1–C2. Spine 26(12):1343–1347PubMedCrossRef Goffin J, Van Brussel K, Martens K, Vander Sloten J, Van Audekercke R, Smet MH (2001) Three-dimensional computed tomography-based, personalized drill guide for posterior cervical stabilization at C1–C2. Spine 26(12):1343–1347PubMedCrossRef
14.
Zurück zum Zitat Owen BD, Christensen GE, Reinhardt JM, Ryken TC (2007) Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comput Aided Surg 12(5):303–308PubMed Owen BD, Christensen GE, Reinhardt JM, Ryken TC (2007) Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comput Aided Surg 12(5):303–308PubMed
15.
Zurück zum Zitat Lu S, Xu YQ, Zhang YZ, Li YB, Xie L, Shi JH et al (2009) A novel computer-assisted drill guide template for lumbar pedicle screw placement: a cadaveric and clinical study. Int J Med Robot 5(2):184–191PubMedCrossRef Lu S, Xu YQ, Zhang YZ, Li YB, Xie L, Shi JH et al (2009) A novel computer-assisted drill guide template for lumbar pedicle screw placement: a cadaveric and clinical study. Int J Med Robot 5(2):184–191PubMedCrossRef
16.
Zurück zum Zitat Ma T, Xu YQ, Cheng YB, Jiang MY, Xu XM, Xie L, Lu S (2012) A novel computer-assisted drill guide template for thoracic pedicle screw placement: a cadaveric study. Arch Orthop Trauma Surg 132(1):65–72PubMedCrossRef Ma T, Xu YQ, Cheng YB, Jiang MY, Xu XM, Xie L, Lu S (2012) A novel computer-assisted drill guide template for thoracic pedicle screw placement: a cadaveric study. Arch Orthop Trauma Surg 132(1):65–72PubMedCrossRef
17.
Zurück zum Zitat Lu S, Zhang YZ, Wang Z, Shi JH, Chen YB, Xu XM, Xu YQ (2012) Accuracy and efficacy of thoracic pedicle screws in scoliosis with patient-specific drill template. Med Biol Eng Comput 50(7):751–758PubMedCrossRef Lu S, Zhang YZ, Wang Z, Shi JH, Chen YB, Xu XM, Xu YQ (2012) Accuracy and efficacy of thoracic pedicle screws in scoliosis with patient-specific drill template. Med Biol Eng Comput 50(7):751–758PubMedCrossRef
18.
Zurück zum Zitat Drstvensek I, Ihan Hren N, Strojnik T, Brajlih T, Valentan B, Pogacar V, Zupancic Hartner T (2008) Applications of rapid prototyping in cranio-maxilofacial surgery procedures. Int J Biol Biomed Eng 1:29–38 Drstvensek I, Ihan Hren N, Strojnik T, Brajlih T, Valentan B, Pogacar V, Zupancic Hartner T (2008) Applications of rapid prototyping in cranio-maxilofacial surgery procedures. Int J Biol Biomed Eng 1:29–38
19.
Zurück zum Zitat Brasiliense LB, Theodore N, Lazaro BC, Sayed ZA, Deniz FE, Sonntag VK, Crawford NR (2010) Quantitative analysis of misplaced pedicle screws in the thoracic spine: how much pullout strength is lost? J Neurosurg Spine 12(5):503–508PubMedCrossRef Brasiliense LB, Theodore N, Lazaro BC, Sayed ZA, Deniz FE, Sonntag VK, Crawford NR (2010) Quantitative analysis of misplaced pedicle screws in the thoracic spine: how much pullout strength is lost? J Neurosurg Spine 12(5):503–508PubMedCrossRef
Metadaten
Titel
A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine
verfasst von
Matjaz Merc
Igor Drstvensek
Matjaz Vogrin
Tomaz Brajlih
Gregor Recnik
Publikationsdatum
01.07.2013
Verlag
Springer-Verlag
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 7/2013
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-013-1755-0

Weitere Artikel der Ausgabe 7/2013

Archives of Orthopaedic and Trauma Surgery 7/2013 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.