scholarly journals Accuracy Assessment of Pedicle and Lateral Mass Screw Insertion Assisted by Customized 3D-Printed Drill Guides: A Human Cadaver Study

2018 ◽  
Vol 16 (1) ◽  
pp. 94-102 ◽  
Author(s):  
Peter A J Pijpker ◽  
Joep Kraeima ◽  
Max J H Witjes ◽  
D L Marinus Oterdoom ◽  
Maarten H Coppes ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Patient Specific ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Upper Thoracic Spine ◽  
Screw Insertion ◽  
Drill Guide ◽  
Entry Points ◽  
3D Printed ◽  
Upper Thoracic

Abstract BACKGROUND Accurate cervical screw insertion is of paramount importance considering the risk of damage to adjacent vital structures. Recent research in 3-dimensional (3D) technology describes the advantage of patient-specific drill guides for accurate screw positioning, but consensus about the optimal guide design and the accuracy is lacking. OBJECTIVE To find the optimal design and to evaluate the accuracy of individualized 3D-printed drill guides for lateral mass and pedicle screw placement in the cervical and upper thoracic spine. METHODS Five Thiel-embalmed human cadavers were used for individualized drill-guide planning of 86 screw trajectories in the cervical and upper thoracic spine. Using 3D bone models reconstructed from acquired computed tomography scans, the drill guides were produced for both pedicle and lateral mass screw trajectories. During the study, the initial minimalistic design was refined, resulting in the advanced guide design. Screw trajectories were drilled and the realized trajectories were compared to the planned trajectories using 3D deviation analysis. RESULTS The overall entry point and 3D angular accuracy were 0.76 ± 0.52 mm and 3.22 ± 2.34°, respectively. Average measurements for the minimalistic guides were 1.20 mm for entry points, 5.61° for the 3D angulation, 2.38° for the 2D axial angulation, and 4.80° for the 2D sagittal angulation. For the advanced guides, the respective measurements were 0.66 mm, 2.72°, 1.26°, and 2.12°, respectively. CONCLUSION The study ultimately resulted in an advanced guide design including caudally positioned hooks, crosslink support structure, and metal inlays. The novel advanced drill guide design yields excellent drilling accuracy.

scholarly journals Accuracy of Patient-Specific 3D-Printed Drill Guides for Pedicle and Lateral Mass Screw Insertion

Spine ◽  
2020 ◽  
Vol 46 (3) ◽  
pp. 160-168
Author(s):  
Peter A.J. Pijpker ◽  
Joep Kraeima ◽  
Max J.H. Witjes ◽  
D.L. Marinus Oterdoom ◽  
Rob A. Vergeer ◽  
...  
Keyword(s):  
Patient Specific ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Screw Insertion ◽  
3D Printed

scholarly journals Application of patient-specific 3D navigation templates for pedicle screw fixation of subaxial and upper thoracic vertebrae

2019 ◽  
Vol 16 (2) ◽  
pp. 35-41 ◽  
Author(s):  
R. A. Kovalenko ◽  
V. V. Rudenko ◽  
V. A. Kashin ◽  
V. Yu. Cherebillo ◽  
D. A. Ptashnikov
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Bone Structure ◽  
Pedicle Screws ◽  
Patient Specific ◽  
Thoracic Vertebrae ◽  
3D Navigation ◽  
Average Deviation ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

Objective. To analyze the safety and accuracy of pedicle screw placement in the subaxial cervical and upper thoracic spine using patient-specific 3D navigation templates.Material and Methods. The study included 16 patients who underwent transpedicular implantation of screws in the subaxial cervical and upper thoracic vertebrae using patient-specific 3D navigation templates. A total of 88 screws were installed. All patients underwent preoperative CT angiography to assess visualization of the vertebral artery. Customized vertebral models and navigation templates were created using 3D printing technology. Models and templates were sterilized and used during surgery. The results of screw implantation, as well as the safety and accuracy of the placement, were assessed by postoperative CT.Results. The average deviation from the planned trajectory was 1.8 ± 0.9 mm. Deviation was estimated as class 1 (<2 mm) for 57 (64.77 %) screws, class 2 (2–4 mm) for 29 (32.95 %), and class 3 for two (2.27 %). The safety of screw implantation of grade 0 (the screw is completely inside the bone structure) was in 79 (89.77 %) cases, of grade 1 (<50 % of the screw diameter perforates the bone) – in 5 (5.68 %), and of grade 3 – in 2 (2.27 %).Conclusion. Using 3D navigation templates is an affordable and safe method of installing pedicle screws in the cervical and upper thoracic spine. The method can be used as an alternative to intraoperative CT navigation.

scholarly journals Cortical Bone Trajectory Screws for Fixation Across the Cervicothoracic Junction: Surgical Technique and Outcomes

2019 ◽  
Vol 9 (8) ◽  
pp. 859-865
Author(s):  
Mohammad Obeidat ◽  
Zachary Tan ◽  
Joel A. Finkelstein
Keyword(s):  
Surgical Technique ◽  
Cortical Bone ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
Lateral Mass ◽  
Cervicothoracic Junction ◽  
Upper Thoracic Spine ◽  
Cortical Bone Trajectory ◽  
Thoracic Pedicle Screws ◽  
Upper Thoracic

Study Design: Clinical case series describing a novel surgical technique. Objective: Stabilization across the cervicothoracic junction (CTJ) poses technical difficulties which make this procedure challenging. The transition from cervical lordosis to thoracic kyphosis and the orientation of the lateral masses of the cervical spine compared with the pedicles of the thoracic spine create the need to accommodate for 2 planes of alignment when placing instrumentation. A novel surgical technique for instrumentation across the cervicothoracic junction is described. Methods: The use of cortical bone trajectory (CBT) technique for pedicle fixation in the upper thoracic spine is described in combination with cervical lateral mass or pedicle screws. The application in our first 12 patients for stabilization across the CTJ is described. Two case presentations illustrate the technique. Results: All the patients had rod screw constructs without the need to skip levels, there was no requirement for transverse connectors and only 1 plane of contouring was required. Conclusions: The use of CBT technique has not been described for the upper thoracic spine. This technique avoids many technical problems associated with posterior instrumentation of the CTJ. The facility of their use in this application arises from the similar coronal plane entry points as the cervical lateral mass screws compared with the more lateral starting point of traditional thoracic pedicle screws. The technique has clinical equipoise to traditional thoracic pedicle screw insertion but with the benefits of an easier ability to perform the instrumentation and saving levels of fusion.

Design, Fabrication, and Accuracy of a Novel Noncovering Lock-Mechanism Bilateral Patient-Specific Drill Guide Template for Nondeformed and Deformed Thoracic Spines

2021 ◽  
pp. 155633162199633
Author(s):  
Mehran Ashouri-Sanjani ◽  
Shima Mohammadi-Moghadam ◽  
Parisa Azimi ◽  
Navid Arjmand
Keyword(s):  
Thoracic Spine ◽  
Sagittal Plane ◽  
Ct Scanning ◽  
Entry Point ◽  
In Vivo Studies ◽  
Patient Specific ◽  
Plane Angle ◽  
Severe Scoliosis ◽  
3D Printed

Background: Pedicle screw (PS) placement has been widely used in fusion surgeries on the thoracic spine. Achieving cost-effective yet accurate placements through nonradiation techniques remains challenging. Questions/Purposes: Novel noncovering lock-mechanism bilateral vertebra-specific drill guides for PS placement were designed/fabricated, and their accuracy for both nondeformed and deformed thoracic spines was tested. Methods: One nondeformed and 1 severe scoliosis human thoracic spine underwent computed tomographic (CT) scanning, and 2 identical proportions of each were 3-dimensional (3D) printed. Pedicle-specific optimal (no perforation) drilling trajectories were determined on the CT images based on the entry point/orientation/diameter/length of each PS. Vertebra-specific templates were designed and 3D printed, assuring minimal yet firm contacts with the vertebrae through a noncovering lock mechanism. One model of each patient was drilled using the freehand and one using the template guides (96 pedicle drillings). Postoperative CT scans from the models with the inserted PSs were obtained and superimposed on the preoperative planned models to evaluate deviations of the PSs. Results: All templates fitted their corresponding vertebra during the simulated operations. As compared with the freehand approach, PS placement deviations from their preplanned positions were significantly reduced: for the nonscoliosis model, from 2.4 to 0.9 mm for the entry point, 5.0° to 3.3° for the transverse plane angle, 7.1° to 2.2° for the sagittal plane angle, and 8.5° to 4.1° for the 3D angle, improving the success rate from 71.7% to 93.5%. Conclusions: These guides are valuable, as the accurate PS trajectory could be customized preoperatively to match the patients’ unique anatomy. In vivo studies will be required to validate this approach.

scholarly journals Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

2014 ◽  
Vol 05 (04) ◽  
pp. 349-354 ◽  
Author(s):  
Mark A. Rivkin ◽  
Jessica F. Okun ◽  
Steven S. Yocom
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
High Rate ◽  
Imaging Modalities ◽  
Neurological Deficits ◽  
Upper Thoracic Spine ◽  
Starting Point ◽  
Grade 3 ◽  
Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

FLEXION-DISTRACTION INJURY OF THE UPPER THORACIC SPINE ASSOCIATED WITH TRACHEOESOPHAGEAL PERFORATION

2002 ◽  
Vol 84 (6) ◽  
pp. 1028-1031 ◽  
Author(s):  
SHIH-HAO CHEN ◽  
TSUNG-JEN HUANG ◽  
YEUNG-JEN CHEN ◽  
HUI-PING LIU ◽  
ROBERT WEN-WEI HSU
Keyword(s):  
Thoracic Spine ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

scholarly journals Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain

Pain Medicine ◽  
2019 ◽  
Vol 20 (7) ◽  
pp. 1379-1386 ◽  
Author(s):  
Ricardo Ortega-Santiago ◽  
Maite Maestre-Lerga ◽  
César Fernández-de-las-Peñas ◽  
Joshua A Cleland ◽  
Gustavo Plaza-Manzano
Keyword(s):  
Thoracic Spine ◽  
Pain Sensitivity ◽  
Trigger Points ◽  
Pressure Pain ◽  
Upper Thoracic Spine ◽  
Upper Trapezius ◽  
Spine Pain ◽  
Pressure Pain Thresholds ◽  
Upper Thoracic ◽  
Thoracic Spine Pain

Abstract Objectives The presence of trigger points (MTrPs) and pressure pain sensitivity has been well documented in subjects with neck and back pain; however, it has yet to be examined in people with upper thoracic spine pain. The purpose of this study was to investigate the presence of MTrPs and mechanical pain sensitivity in individuals with upper thoracic spine pain. Methods Seventeen subjects with upper thoracic spine pain and 17 pain-free controls without spine pain participated. MTrPs were examined bilaterally in the upper trapezius, rhomboid, iliocostalis thoracic, levator scapulae, infraspinatus, and anterior and middle scalene muscles. Pressure pain thresholds (PPTs) were assessed over T2, the C5-C6 zygapophyseal joint, the second metacarpal, and the tibialis anterior. Results The numbers of MTrPs between both groups were significantly different (P < 0.001) between patients and controls. The number of MTrPs for each patient with upper thoracic spine pain was 12.4 ± 2.8 (5.7 ± 4.0 active TrPs, 6.7 ± 3.4 latent TrPs). The distribution of MTrPs was significantly different between groups, and active MTrPs within the rhomboid (75%), anterior scalene (65%), and middle scalene (47%) were the most prevalent in patients with upper thoracic spine pain. A higher number of active MTrPs was associated with greater pain intensity and longer duration of pain history. Conclusions This study identified active MTrPs and widespread pain hypersensitivity in subjects with upper thoracic spine pain compared with asymptomatic people. Identifying proper treatment strategies might be able to reduce pain and improve function in individuals with upper thoracic spine pain. However, future studies are needed to examine this.

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