CC BY-NC-ND 4.0 · J Neurol Surg Rep 2020; 81(01): e20-e27
DOI: 10.1055/s-0039-1695795
Case Report
Georg Thieme Verlag KG Stuttgart · New York

3D-Customized Guiding Template for Posterior Fixation in Complex Atlantoaxial Instability—Preliminary Experiences of National Cheng Kung University Hospital

Yi-Yun Chen*
1   Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.
,
Liang-Chun Chao*
1   Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.
,
Jing-Jing Fang
2   Department of Mechanical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C.
,
E-Jian Lee
1   Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.
› Author Affiliations
Further Information

Publication History

16 February 2019

18 June 2019

Publication Date:
31 March 2020 (online)

Abstract

Objective Atlantoaxial fixation is technically demanding and challenging, especially in cases with anatomical abnormality. The purpose of this study is to report the effectiveness of the three-dimensional (3D)-customized guiding template for placement of C1 and C2 screws in cases with abnormalities.

Method Two patients with anatomical abnormality and one without were included. The preoperative computed tomography (CT) image was analyzed using our software. The entry point, trajectory, and depth of the screws were designed based on these images. Templates with screw guiding cylinders and cervical spine model were created. In operation, guiding templates were applied directly to the laminae. Drilling, tapping, and screwing were performed through the cylinders. To evaluate the accuracy, deviation of the screw axis from the preplanned trajectory was measured on postoperative CT. A classification system was taking to evaluate the pedicle screw insertion.

Results In complex cases, one of C2 screws has grade 2 deviation, and two has grade 1. There was no deviation in screws of C1. All patients achieved symptoms free after 6 months follow-up.

Conclusion Although 3D-printed template for atlantoaxial fixation still has limitation in complex cases, it has been proved usefulness and makes the most difficult and dangerous spinal posterior fixation easy to achieve.

* Yi-Yun Chen and Liang-Chun Chao contributed equally to this study.


 
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