Does Three-Dimensional Printed Patient-Specific Templates Add Benefit in Revision Surgeries for Complex Pediatric Kyphoscoliosis Deformity with Sublaminar Wires in Situ? A Clinical Study
Open Access
- 28 February 2021
- journal article
- research article
- Published by Asian Spine Journal (ASJ) in Asian Spine Journal
- Vol. 15 (1), 46-53
- https://doi.org/10.31616/asj.2019.0021
Abstract
Study Design: Case-control study. Purpose: To evaluate the accuracy of three-dimensional (3D) printed patient-specific templates (PSTs) for placement of pedicle screws (PAs) in patients undergoing revision surgeries for complex kyphoscoliosis deformity with sublaminar wires in situ. Overview of Literature: Revision kyphoscoliosis correction surgery in pediatric patients is a challenging task for the treating surgeon. In patients with sublaminar wires in situ, the native anatomical landmarks are obscured, thus making the freehand screw placement technique a highly specialized task. Hence, the concept of using PSTs for insertion of PAs in such surgeries is always intriguing and attractive. Methods: Five consecutive patients undergoing revision deformity correction with sublaminar wires in situ were included in this study. Patients were divided in two groups based on the technique of PA insertion. A total of 91 PAs were inserted using either a freehand technique (group A) or 3D printed templates (group B) (34 vs. 57). The placement of PAs was classified according to a postoperative computed tomography scan using Neo's classification. Perforation beyond class 2 (>2 mm) was termed as a misplaced screw. The average time required for the insertion of screws was also noted. Results: Mean age, surgical time, and blood loss were recorded. The change in mean Cobb's angle in both groups was also recorded. The difference in rates of misplaced screws was noted in group A and group B (36.21% vs. 2.56%); however, the mean number of misplaced PAs per patient in group A and group B was statistically insignificant (6.5 +/- 3.54 vs. 4.67 +/- 1.53, p=0.4641). The mean time required to insert a single PA was also statistically insignificant (120 +/- 28.28 vs. 90 +/- 30 seconds, p=0.3456). Conclusions: Although 3D printed PSTs help to avoid the misplacement of PAs in revision deformity correction surgeries with sublaminar wires in situ, the mean number of misplaced screws per patient using this technique was found to be statistically insignificant when compared with the freehand technique in this study.Keywords
This publication has 32 references indexed in Scilit:
- Accuracy and Safety Assessment of Pedicle Screw Placement Using the Rapid Prototyping Technique in Severe Congenital ScoliosisJournal of Spinal Disorders & Techniques, 2011
- Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniquesEuropean Spine Journal, 2011
- Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality databaseJournal of Neurosurgery: Pediatrics, 2011
- Complications of Pedicle Screw Fixation in Scoliosis SurgerySpine, 2010
- Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot studyEuropean Spine Journal, 2010
- Segmental Pedicle Screwing for Idiopathic Scoliosis Using Computer-assisted SurgeryJournal of Spinal Disorders & Techniques, 2008
- Accuracy Analysis of Pedicle Screw Placement in Posterior Scoliosis SurgerySpine, 2007
- Repeat Surgical Interventions Following “Definitive” Instrumentation and Fusion for Idiopathic ScoliosisSpine, 2006
- Miniature robotic guidance for spine surgery — introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centresInternational Journal of Medical Robotics and Computer Assisted Surgery, 2006
- Pedicle Screw Instrumentation of the Thoracic Spine in Idiopathic ScoliosisSpine, 1997