Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(03): 375-383
DOI: 10.1055/s-0041-1724074
Artigo Original

Use of a Customized Three-dimensional Guide in Preparing the Pilot Pedicle Hole in Spinal Deformities

Article in several languages: português | English
Kelsen de Oliveira Teixeira 
1   Programa de Pós-Graduação, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Thiago Dantas Matos 
1   Programa de Pós-Graduação, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Rodrigo Barra Caiado Fleury 
1   Programa de Pós-Graduação, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Herton Rodrigo Tavares Costa 
2   Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Helton Luiz Aparecido Defino 
3   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective The present study aimed to develop and evaluate the use of customized guides in patients undergoing surgery to correct vertebral deformity with a pedicular fixation system.

Methods Four patients with spinal deformity (three with idiopathic scoliosis and one with congenital kyphoscoliosis) underwent surgical treatment to correct the deformity with a pedicular fixation system. Prototypes of 3D cost guides were developed and evaluated using technical feasibility, accuracy, and radiation exposure.

Results The present study included 85 vertebral pedicles in which pedicle screws were inserted into the thoracic spine (65.8%) and into the lumbar spine (34.2%). Technical viability was positive in 46 vertebral pedicles (54.1%), with 25 thoracic (54%) and 21 lumbar (46%). Technical viability was negative in 39 pedicles (45.9%), 31 of which were thoracic (79.5%), and 8 were lumbar (20.5%). In assessing accuracy, 36 screws were centralized (78.2%), of which 17 were in the thoracic (36.9%) and 19 in the lumbar spine (41.3%). Malposition was observed in 10 screws (21.7%), of which 8 were in the thoracic (17.4%) and 2 in the lumbar spine (4.3%). The average radiation record used in the surgical procedures was of 5.17 ± 0.72 mSv, and the total time of use of fluoroscopy in each surgery ranged from 180.3 to 207.2 seconds.

Conclusion The customized guide prototypes allowed the safe preparation of the pilot orifice of the vertebral pedicles in patients with deformities with improved accuracy and reduced intraoperative radiation.

Keywords

fractures, bone - congenital abnormalities - spine - thoracic vertebrae

Contribution of the Authors

(I) Conception and design: Teixeira K.O., Defino H.L.A.; (II) Administrative support: none; (III) Supply of study materials or of patientes: all authors; (IV) Collection and assembly of data: Teixeira K.O., Matos T.D., Fleury R.B.C.; (V) Data analysis and interpretation : Teixeira K.O., Bergamaschi J.P.M., Defino H.L.A.; (VI) Writing of the manuscript: all authors; (VII) Final approval of the manuscript: all authors.


Financial Support

This work was supported by the Instituto de Pesquisa e Ensino Home, Brasília, DF, Brazil.


Work developed at the Orthopedics and Traumatology Department, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.




Publication History

Received: 31 July 2020

Accepted: 02 October 2020

Article published online:
13 August 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Dobbs MB, Lenke LG, Kim YJ, Kamath G, Peelle MW, Bridwell KH. Selective posterior thoracic fusions for adolescent idiopathic scoliosis: comparison of hooks versus pedicle screws. Spine 2006; 31 (20) 2400-2404
    CrossrefPubMedGoogle Scholar
  • 2 Webb JK, Burwell RG, Cole AA, Lieberman I. Posterior instrumentation in scoliosis. Eur Spine J 1995; 4 (01) 2-5
    CrossrefPubMedGoogle Scholar
  • 3 Boos N, Webb JK. Pedicle screw fixation in spinal disorders: a European view. Eur Spine J 1997; 6 (01) 2-18
    CrossrefPubMedGoogle Scholar
  • 4 Maruyama T, Takeshita K. Surgical treatment of scoliosis: a review of techniques currently applied. Scoliosis 2008; 3: 6
    CrossrefPubMedGoogle Scholar
  • 5 Takeshita K, Maruyama T, Murakami M. et al. Correction of scoliosis using segmental pedicle screw instrumentation versus hybrid constructs with hooks and screws. Stud Health Technol Inform 2006; 123: 571-576
    PubMedGoogle Scholar
  • 6 Kim YJ, Lenke LG, Kim J. et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 2006; 31 (03) 291-298
    CrossrefPubMedGoogle Scholar
  • 7 Bullmann V, Liljenqvist UR, Schmidt C, Schulte TL. [Posterior operative correction of idiopathic scoliosis. Value of pedicle screws versus hooks]. Orthopade 2009; 38 (02) 198-200 , 202–204
    PubMedGoogle Scholar
  • 8 Merc M, Recnik G, Krajnc Z. Lumbar and sacral pedicle screw placement using a template does not improve the midterm pain and disability outcome in comparison with free-hand method. Eur J Orthop Surg Traumatol 2017; 27 (05) 583-589
    CrossrefPubMedGoogle Scholar
  • 9 Abul-Kasim K, Ohlin A. The rate of screw misplacement in segmental pedicle screw fixation in adolescent idiopathic scoliosis. Acta Orthop 2011; 82 (01) 50-55
    CrossrefPubMedGoogle Scholar
  • 10 Pan Y, Lü GH, Kuang L, Wang B. Accuracy of thoracic pedicle screw placement in adolescent patients with severe spinal deformities: a retrospective study comparing drill guide template with free-hand technique. Eur Spine J 2018; 27 (02) 319-326
    CrossrefPubMedGoogle Scholar
  • 11 Esses SI, Sachs BL, Dreyzin V. Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine 1993; 18 (15) 2231-2238 , discussion 2238–2239
    CrossrefPubMedGoogle Scholar
  • 12 Halm H, Niemeyer T, Link T, Liljenqvist U. Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis. Eur Spine J 2000; 9 (03) 191-197
    CrossrefPubMedGoogle Scholar
  • 13 Hamill CL, Lenke LG, Bridwell KH, Chapman MP, Blanke K, Baldus C. The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis. Is it warranted?. Spine 1996; 21 (10) 1241-1249
    CrossrefPubMedGoogle Scholar
  • 14 Panjabi MM, O'Holleran JD, Crisco 3rd JJ, Kothe R. Complexity of the thoracic spine pedicle anatomy. Eur Spine J 1997; 6 (01) 19-24
    CrossrefPubMedGoogle Scholar
  • 15 Liljenqvist UR, Halm HF, Link TM. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 1997; 22 (19) 2239-2245
    CrossrefPubMedGoogle Scholar
  • 16 Lonstein JE, Denis F, Perra JH, Pinto MR, Smith MD, Winter RB. Complications associated with pedicle screws. J Bone Joint Surg Am 1999; 81 (11) 1519-1528
    CrossrefPubMedGoogle Scholar
  • 17 Cordemans V, Kaminski L, Banse X, Francq BG, Detrembleur C, Cartiaux O. Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws. Eur Spine J 2017; 26 (11) 2917-2926
    CrossrefPubMedGoogle Scholar
  • 18 Upendra B, Meena D, Kandwal P, Ahmed A, Chowdhury B, Jayaswal A. Pedicle morphometry in patients with adolescent idiopathic scoliosis. Indian J Orthop 2010; 44 (02) 169-176
    CrossrefPubMedGoogle Scholar
  • 19 Kong X, Tang L, Ye Q, Huang W, Li J. Are computer numerical control (CNC)-manufactured patient-specific metal templates available for posterior thoracic pedicle screw insertion? Feasibility and accuracy evaluation. Eur Spine J 2017; 26 (11) 2927-2933
    CrossrefPubMedGoogle Scholar
  • 20 Cecchinato R, Berjano P, Zerbi A, Damilano M, Redaelli A, Lamartina C. Pedicle screw insertion with patient-specific 3D-printed guides based on low-dose CT scan is more accurate than free-hand technique in spine deformity patients: a prospective, randomized clinical trial. Eur Spine J 2019; 28 (07) 1712-1723
    CrossrefPubMedGoogle Scholar
  • 21 Liu K, Zhang Q, Li X. et al. Preliminary application of a multi-level 3D printing drill guide template for pedicle screw placement in severe and rigid scoliosis. Eur Spine J 2017; 26 (06) 1684-1689
    CrossrefPubMedGoogle Scholar
  • 22 Berry E, Cuppone M, Porada S. et al. Personalised image-based templates for intra-operative guidance. Proc Inst Mech Eng H 2005; 219 (02) 111-118
    CrossrefPubMedGoogle Scholar
  • 23 Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine 2007; 32 (03) E111-E120
    CrossrefPubMedGoogle Scholar
  • 24 Cotrel Y, Dubousset J, Guillaumat M. New universal instrumentation in spinal surgery. Clin Orthop Relat Res 1988; 227 (227) 10-23
    PubMedGoogle Scholar
  • 25 West III JL, Ogilvie JW, Bradford DS. Complications of the variable screw plate pedicle screw fixation. Spine 1991; 16 (05) 576-579
    CrossrefPubMedGoogle Scholar
  • 26 Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in spinal deformities: are they really safe?. Spine 2001; 26 (18) 2049-2057
    CrossrefPubMedGoogle Scholar
  • 27 Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 2001; 48 (04) 771-778 , discussion 778–779
    PubMedGoogle Scholar
  • 28 Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine 1990; 15 (01) 11-14
    CrossrefPubMedGoogle Scholar
  • 29 Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 2000; 25 (20) 2637-2645
    CrossrefPubMedGoogle Scholar
  • 30 Villard J, Ryang YM, Demetriades AK. et al. Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques. Spine 2014; 39 (13) 1004-1009
    CrossrefPubMedGoogle Scholar