Evaluation of a Three-Dimensional Printed Guide and a Polyoxymethylene Thermoplastic Regulator for Percutaneous Pedicle Screw Fixation in Patients with Thoracolumbar Fracture

Ming Zhang, Jiayi Li, Tao Fang, Jiali Zhao, Wei Pan, Xinhong Wang, Jin Xu, Quan Zhou, Ming Zhang, Jiayi Li, Tao Fang, Jiali Zhao, Wei Pan, Xinhong Wang, Jin Xu, Quan Zhou

Abstract

BACKGROUND This study aimed to evaluate the efficacy of a porous polyoxymethylene thermoplastic regulator combined with a three-dimensional (3D) printed template to guide pedicle needle insertion in patients undergoing percutaneous pedicle screw fixation (PPSF) for thoracolumbar fracture. MATERIAL AND METHODS Forty patients were randomly divided into group A, treated using a porous polyoxymethylene thermoplastic regulator combined with a 3D printed template, and group B, who underwent conventional PPSF. Data recorded included the number of pedicle screws successfully inserted on the first attempt, the number of attempts, the time to successful needle insertion, the total time of fluoroscopy, and the duration of surgery. The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) scores one day before surgery, and at day 1, day 7, month 1, and month 3 after surgery were recorded. The postoperative vertebral posterior kyphotic angle (KA) and the rate of change of KA were recorded. RESULTS Group A had a significantly increased total number of successful first insertions compared with group BV (P<0.05). Postoperative VAS and ODI scores of patients in both groups were significantly lower than before surgery (P<0.05), with no significant difference between the two groups at postoperative month 1 and month 3 (P>0.05). The postoperative vertebral posterior KA decreased significantly in both groups after surgery, with no significant difference between the two groups (P>0.05). CONCLUSIONS The use of a porous polyoxymethylene thermoplastic regulator combined with a 3D printed template may improve the success of pedicle insertion in patients undergoing PPSF.

Conflict of interest statement

Conflict of interest

None.

Figures

Figure 1
Figure 1
Principles and procedures of percutaneous guide plate combined with lotus-style regulator assist puncture positioning.
Figure 2
Figure 2
(A) Lotus-type regulator parameter dimensions. (B, C): Top view and side view of the lotus-type regulator. (D) 3D printed percutaneous guide plate.
Figure 3
Figure 3
The main process of percutaneous guide plate design and 3D printing. (A) Preoperative localization of markers was performed by CT scan. (B–E) CAD of the main process of person alized percutaneous guide plate. (F, G) 3D printer is printing the real percutaneous guide plate.
Figure 4
Figure 4
(A1–E1) The main steps of percutaneous guide combined with lotus root adjuster to assist PPSF. (A2–E2) The perspective image of the corresponding step.
Figure 5
Figure 5
(A, B): X-ray of group A 1 day after operation, and the heigh of the affected vertebra recovered well after operation. (C) CT of group A 1 day after operation, and the pedicle screw is in the pedicle.
Figure 6
Figure 6
(A) KA is the angle between the upper and lower endplate planes. (B) A Stands for normal vertebral height and b represents the height of the compressed vertebra; CR=(a–b)/a×100%.

References

    1. Lau D, Terman SW, Patel R, et al. Incidence of and risk factors for superior facet violation in minimally invasive versus open pedicle screw placement during transforaminal lumbar interbody fusion: A comparative analysis. J Neurosurg Spine. 2013;18(4):356–61.
    1. Millimaggi DF, Norcia VD, Luzzi S, et al. Minimally invasive transforaminal lumbar interbody fusion with percutaneous bilateral pedicle screw fixation for lumbosacral spine degenerative diseases. A retrospective database of 40 consecutive cases and literature review. Turk Neurosurg. 2018;28(3):454–61.
    1. Alander DH, Cui S. Percutaneous pedicle screw stabilization: Surgical technique, fracture reduction, and review of current spine trauma applications. J Am Acad Orthop Surg. 2018;26(7):231–40.
    1. Mobbs RJ, Sivabalan P, Li J. Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci. 2011;18(6):741–49.
    1. Tinelli M, Matschke S, Adams M, et al. Correct positioning of pedicle screws with a percutaneous minimal invasive system in spine trauma. Orthop Traumatol Surg Res. 2014;100(4):389–93.
    1. Nakashima H, Sato K, Ando T, et al. Comparison of the percutaneous screw placement precision of isocentric C-arm 3-dimensional fluoroscopy-navigated pedicle screw implantation and conventional fluoroscopy method with minimally invasive surgery. J Spinal Disord Tech. 2009;22(7):468–72.
    1. Patel K, Tajsic T, Budohoski KP, et al. Simultaneous navigated cervico-thoracic and thoraco-lumbar fixation. Eur Spine J. 2018;27(Suppl 3):318–22.
    1. Mariscalco MW, Yamashita T, Steinmetz MP, et al. Radiation exposure to the surgeon during open lumbar microdiscectomy and minimally invasive microdiscectomy: A prospective, controlled trial. Spine. 2011;36(3):255–60.
    1. Siasios ID, Pollina J, Khan A, et al. Percutaneous screw placement in the lumbar spine with a modified guidance technique based on 3D CT navigation system. J Spine Surg. 2017;3(4):657–65.
    1. Kang HY, Lee SH, Jeon SH, et al. Computed tomography-guided percutaneous facet screw fixation in the lumbar spine. Technical note. J Neurosurg Spine. 2007;7(1):95–98.
    1. Prokop A, Löhlein F, Chmielnicki M, et al. [Minimally invasive percutaneous instrumentation for spine fractures]. Unfallchirurg. 2009;112(7):621–28. [in German]
    1. Garrido BJ, Wood KE. Navigated placement of iliac bolts: Description of a new technique. Spine J. 2011;11(4):331–35.
    1. Fraser JF, Von Jako R, Carrino JA, Härtl R. Electromagnetic navigation in minimally invasive spine surgery: Results of a cadaveric study to evaluate percutaneous pedicle screw insertion. SAS J. 2008;2:43–47.
    1. Wu JY, Yuan Q, Liu YJ, et al. Robot-assisted percutaneous transfacet screw fixation supplementing oblique lateral interbody fusion procedure: Accuracy and safety evaluation of this novel minimally invasive technique. Orthop Surg. 2019;11(1):25–33.
    1. Stefan P, Habert S, Winkler A, et al. A radiation-free mixed-reality training environment and assessment concept for C-arm-based surgery. Int J Comput Assist Radiol Surg. 2018;13(9):1335–44.
    1. Acosta FL, Jr, Thompson TL, Campbell S, et al. Use of intraoperative isocentric C-arm 3D fluoroscopy for sextant percutaneous pedicle screw placement: case report and review of the literature. Spine J. 2005;5(3):339–43.
    1. Li J, Lin J, Yang Y, et al. 3-Dimensional printing guide template assisted percutaneous vertebroplasty: Technical note. J Clin Neurosci. 2018;52:159–64.
    1. Kim DY, Lee SH, Chung SK, Lee HY. Comparison of multifidus muscle atrophy and trunk extension muscle strength. Spine. 2005;30(1):123–29.
    1. Ringel F, Stoffel M, Stüer C, Meyer B. Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery. 2006;59(4 Suppl 2):ONS361–66.
    1. Oh HS, Kim JS, Lee SH, et al. Comparison between the accuracy of percutaneous and open pedicle screw fixations in lumbosacral fusion. Spine J. 2013;13(12):1751–57.
    1. Godzik J, Walker CT, Hartman C, et al. A quantitative assessment of the accuracy and reliability of robotically guided percutaneous pedicle screw placement: Technique and application accuracy. Oper Neurosurg. 2019;17(4):389–95.
    1. Tsuji H, Takigawa T, Misawa H, et al. Minimally invasive percutaneous spinopelvic fixation for unstable pelvic ring fracture performed with the patient in a lateral position. Clin Spine Surg. 2019;32(5):191–97.
    1. Feng ZH, Li XB, Phan K, et al. Design of a 3D navigation template to guide the screw trajectory in spine: A step-by-step approach using Mimics and 3-Matic software. J Spine Surg. 2018;4(3):645–53.
    1. Pu X, Luo C, Lu T, et al. Clinical application of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. Clinics (Sao Paulo) 2018;73:e259.
    1. Wang L, Wang Y, Yu B, et al. Comparison of cranial facet joint violation rate between percutaneous and open pedicle screw placement: A systematic review and meta-analysis. Medicine (Baltimore) 2015;94(5):e504.
    1. Court C, Vincent C. Percutaneous fixation of thoracolumbar fractures: Current concepts. Orthop Traumatol Surg Res. 2012;98(8):900–9.
    1. Heintel TM, Berglehner A, Meffert R. Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: A prospective trial. Eur Spine J. 2013;22(3):495–502.
    1. Kocis J, Kelbl M, Kocis T, Návrat T. Percutaneous versus open pedicle screw fixation for treatment of type A thoracolumbar fractures. Eur J Trauma Emerg Surg. :2018. [Epub ahead of print]
    1. Tian F, Tu LY, Gu WF, et al. Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures: A systematic review and meta-analysis. Medicine (Baltimore) 2018;97(41):e12535.
    1. Tan T, Rutges J, Marion T, et al. Anterior versus posterior approach in traumatic thoracolumbar burst fractures deemed for surgical management: Systematic review and meta-analysis. J Clin Neurosci. 2019;70:189–97.
    1. Cornelis FH, Joly Q, Nouri-Neuville M, et al. Innovative spine implants for improved augmentation and stability in neoplastic vertebral compression fracture. Medicina (Kaunas) 2019;55(8) pii: E426.
    1. Zhang T, Guo N, Chen T, et al. Comparison of outcomes between cortical screws and traditional pedicle screws for lumbar interbody fusion: A systematic review and meta-analysis. J Orthop Surg Res. 2019;14(1):269.
    1. Sharma SB, Lin GX, Jabri H, et al. Radiographic and clinical outcomes of huge lumbar disc herniations treated by transforaminal endoscopic discectomy. Clin Neurol Neurosurg. 2019;185:105485.
    1. Deng H, Li Y, Zhou J, et al. Therapeutic efficacy of transpedicular Intracorporeal cement augmentation with short segmental posterior instrumentation in treating osteonecrosis of the vertebral body: A retrospective case series with a minimum 5-year follow-up. BMC Musculoskelet Disord. 2019;20(1):305.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit