Thoracolumbar Spinal Stabilization with Three Dimensional-Printed Drill Guides and Pre-Contoured Polyaxial Bone Plates

Abstract

Objective The aim of this study was to report new preoperative and intraoperative techniques performed for canine thoracic or lumbar spine kyphosis stabilization using three-dimensional-printed patient-specific drill guides, polyaxial titanium bone plates and drill stops, and to determine the accuracy of screw placement using these techniques.

Study Design Retrospective study, five client-owned dogs.

Results Three-dimensional-printed patient-specific drill guides and drill stops allowed safe drilling and screw placement in all of the cases, with (i) 84% of the screws graded as I (ideal placement) and 16% as IIa, IIIa or IIIb according to the modified Zdichavsky classification (partial penetration of medial pedicle wall, partial penetration of lateral pedicle wall and full penetration of lateral pedicle wall respectively), (ii) mean mediolateral deviation of ± 4.06 degrees (standard deviation: 8.21 degrees) compared to planned trajectories and (iii) variation in screw depth of ± 2.29mm (standard deviation: 3.07mm) compared to planned depth.

Conclusion We believe that the techniques presented here for thoracic spinal stabilization in dogs show promise; they allowed safe placement of screws along planned trajectories and depth; they also removed the need to use polymethylmethacrylate, while the use of titanium offers the possibility to repeat magnetic resonance imaging in these cases with chronic spinal conditions.

Keywords

spine - 3D-printed drill guide - polyaxial titanium plate - drill accuracy - dogs

Authors' Contributions

O.G. contributed with conceptualization, study design, data acquisition, data interpretation and analysis, drafting and revising the manuscript. L.E. and D.O., H.V., D.R., and B.O. took part in data acquisition, and drafting and revising the manuscript. N.G. contributed with conceptualization, study design, data acquisition, data interpretation and analysis, drafting and revising the manuscript. All authors approve the submitted manuscript and are publicly accountable for relevant content.

Publikationsverlauf

Eingereicht: 06. Dezember 2021

Angenommen: 02. Juli 2022

Artikel online veröffentlicht:
22. November 2022

• References

• 1 Gutierrez-Quintana R, Guevar J, Stalin C, Faller K, Yeamans C, Penderis J. A proposed radiographic classification scheme for congenital thoracic vertebral malformations in brachycephalic “screw-tailed” dog breeds. Vet Radiol Ultrasound 2014; 55 (06) 585-591
• 2 Dewey CW, Davies E, Bouma JL. Kyphosis and kyphoscoliosis associated with congenital malformations of the thoracic vertebral bodies in dogs. Vet Clin North Am Small Anim Pract 2016; 46 (02) 295-306
• 3 Charalambous M, Jeffery ND, Smith PM. et al. Surgical treatment of dorsal hemivertebrae associated with kyphosis by spinal segmental stabilisation, with or without decompression. Vet J 2014; 202 (02) 267-273
• 4 Downes CJ, Gemmill TJ, Gibbons SE, McKee WM. Hemilaminectomy and vertebral stabilisation for the treatment of thoracolumbar disc protrusion in 28 dogs. J Small Anim Pract 2009; 50 (10) 525-535
• 5 Renwick AIC, Dennis R, Gemmill TJ. Treatment of lumbosacral discospondylitis by surgical stabilisation and application of a gentamicin-impregnated collagen sponge. Vet Comp Orthop Traumatol 2010; 23 (04) 266-272
• 6 Jeffery ND, Smith PM, Talbot CE. Imaging findings and surgical treatment of hemivertebrae in three dogs. J Am Vet Med Assoc 2007; 230 (04) 532-536
• 7 McKee WM, Downes CJ. Vertebral stabilisation and selective decompression for the management of triple thoracolumbar disc protrusions. J Small Anim Pract 2008; 49 (10) 536-539
• 8 Hettlich BF, Fosgate GT, Litsky AS. Biomechanical comparison of 2 veterinary locking plates to monocortical screw/polymethylmethacrylate fixation in canine cadaveric cervical vertebral column. Vet Surg 2017; 46 (01) 95-102
• 9 Farré Mariné A, De Risio L, Mascort J. et al. Transthoracic vertebral distraction and stabilization in 10 dogs with congenital thoracic vertebral malformations. Vet Comp Orthop Traumatol 2021; 34 (05) 367-374
• 10 Gundapaneni D, Goswami T. Thermal isotherms in PMMA and cell necrosis during total hip arthroplasty. J Appl Biomater Funct Mater 2014; 12 (03) 193-202
• 11 Palmisano MP, Dyce J, Olmstead ML. Extraosseous cement granuloma associated with total hip replacement in 6 dogs. Vet Surg 2003; 32 (01) 80-90
• 12 Samer ES, Forterre F, Rathmann JMK, Stein VM, Precht CM, Guevar J. Accuracy and safety of image-guided freehand pin placement in canine cadaveric vertebrae. Vet Comp Orthop Traumatol 2021; 34 (05) 338-345
• 13 Gelalis ID, Paschos NK, Pakos EE. et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 2012; 21 (02) 247-255
• 14 Elford JH, Oxley B, Behr S. Accuracy of placement of pedicle screws in the thoracolumbar spine of dogs with spinal deformities with three-dimensionally printed patient-specific drill guides. Vet Surg 2020; 49 (02) 347-353
• 15 Bufkin BW, Barnhart MD, Kazanovicz AJ, Naber SJ, Kennedy SC. The effect of screw angulation and insertion torque on the push-out strength of polyaxial locking screws and the single cycle to failure in bending of polyaxial locking plates. Vet Comp Orthop Traumatol 2013; 26 (03) 186-191
• 16 Zdichavsky M, Blauth M, Knop C. et al. Accuracy of pedicle screw placement in thoracic spine fractures. Eur J Trauma 2004; 30: 234-240
• 17 Easter TG, Bilmont A, Pink J, Oxley B. Accuracy of three-dimensional printed patient-specific drill guides for treatment of canine humeral intracondylar fissure. Vet Surg 2020; 49 (02) 363-372
• 18 Toni C, Oxley B, Behr S. Atlanto-axial ventral stabilisation using 3D-printed patient-specific drill guides for placement of bicortical screws in dogs. J Small Anim Pract 2020; 61 (10) 609-616
• 19 Oxley B, Behr S. Stabilisation of a cranial cervical vertebral fracture using a 3D-printed patient-specific drill guide. J Small Anim Pract 2016; 57 (05) 277
• 20 Oxley B. Bilateral shoulder arthrodesis in a Pekinese using three-dimensional printed patient-specific osteotomy and reduction guides. Vet Comp Orthop Traumatol 2017; 30 (03) 230-236
• 21 Oxley B. A 3-dimensional-printed patient-specific guide system for minimally invasive plate osteosynthesis of a comminuted mid-diaphyseal humeral fracture in a cat. Vet Surg 2018; 47 (03) 445-453