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Article: A novel patient-specific navigational template for cervical pedicle screw placement

TitleA novel patient-specific navigational template for cervical pedicle screw placement
Authors
Issue Date2009
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2009, v. 34 n. 26, p. E959-E964 How to Cite?
AbstractStudy Design: Prospective trial. Objective: To develop and validate a novel, patient-specific navigational template for cervical pedicle placement. Summary of Background Data: Owing to the narrow bony anatomy and the proximity to the vertebral artery and the spinal cord, cervical instrumentation procedures demand the need for a precise technique for screw placement. PATIENT.: Specific drill template with preplanned trajectory has been thought as a promising solution for cervical pedicle screw placement. Methods: Patients with cervical spinal pathology (n = 25) requiring instrumentation were recruited. Volumetric CT scan was performed on each desired cervical vertebra and a 3-dimensional reconstruction model was generated from the scan data. Using reverse engineering technique, the optimal screw size and orientation were determined and a drill template was designed with a surface that is the inverse of the posterior vertebral surface. The drill template and its corresponding vertebra were manufactured using rapid prototyping technique and tested for violations. The navigational template was sterilized and used intraoperatively to assist with the placement of cervical screws. In total, 88 screws were inserted into levels C2-C7 with 2 to 6 screw in each patient. After surgery, the positions of the pedicle screws were evaluated using CT scan and graded for validation. Results: This method showed its ability to customize the placement and the size of each screw based on the unique morphology of the cervical vertebra. In all the cases, it was relatively very easy to manually place the drill template on the lamina of the vertebral body during the surgery. The required time between fixation of the template to the lamina and insertion of the pedicle screws was about 80 seconds. Of the 88 screws, 71 screws had no deviation and 14 screws had deviation <2 mm, 1 screw had a deviation between 2 to 4 mm and there were no misplacements. Fluoroscopy was used only once for every patient after the insertion of all the pedicle screws. Conclusion: The authors have developed a novel patient-specific navigational template for cervical pedicle screw placement with good applicability and high accuracy. This method significantly reduces the operation time and radiation exposure for the members of the surgical team. The potential use of such a navigational template to insert cervical pedicle screws is promising. This technique has been clinically validated to provide an accurate trajectory for pedicle screw placement in the cervical spine. © 2009, Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/170152
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLu, Sen_US
dc.contributor.authorXu, YQen_US
dc.contributor.authorLu, WWen_US
dc.contributor.authorNi, GXen_US
dc.contributor.authorLi, YBen_US
dc.contributor.authorShi, JHen_US
dc.contributor.authorLi, DPen_US
dc.contributor.authorChen, GPen_US
dc.contributor.authorChen, YBen_US
dc.contributor.authorZhang, YZen_US
dc.date.accessioned2012-10-30T06:05:38Z-
dc.date.available2012-10-30T06:05:38Z-
dc.date.issued2009en_US
dc.identifier.citationSpine, 2009, v. 34 n. 26, p. E959-E964en_US
dc.identifier.issn0362-2436en_US
dc.identifier.urihttp://hdl.handle.net/10722/170152-
dc.description.abstractStudy Design: Prospective trial. Objective: To develop and validate a novel, patient-specific navigational template for cervical pedicle placement. Summary of Background Data: Owing to the narrow bony anatomy and the proximity to the vertebral artery and the spinal cord, cervical instrumentation procedures demand the need for a precise technique for screw placement. PATIENT.: Specific drill template with preplanned trajectory has been thought as a promising solution for cervical pedicle screw placement. Methods: Patients with cervical spinal pathology (n = 25) requiring instrumentation were recruited. Volumetric CT scan was performed on each desired cervical vertebra and a 3-dimensional reconstruction model was generated from the scan data. Using reverse engineering technique, the optimal screw size and orientation were determined and a drill template was designed with a surface that is the inverse of the posterior vertebral surface. The drill template and its corresponding vertebra were manufactured using rapid prototyping technique and tested for violations. The navigational template was sterilized and used intraoperatively to assist with the placement of cervical screws. In total, 88 screws were inserted into levels C2-C7 with 2 to 6 screw in each patient. After surgery, the positions of the pedicle screws were evaluated using CT scan and graded for validation. Results: This method showed its ability to customize the placement and the size of each screw based on the unique morphology of the cervical vertebra. In all the cases, it was relatively very easy to manually place the drill template on the lamina of the vertebral body during the surgery. The required time between fixation of the template to the lamina and insertion of the pedicle screws was about 80 seconds. Of the 88 screws, 71 screws had no deviation and 14 screws had deviation <2 mm, 1 screw had a deviation between 2 to 4 mm and there were no misplacements. Fluoroscopy was used only once for every patient after the insertion of all the pedicle screws. Conclusion: The authors have developed a novel patient-specific navigational template for cervical pedicle screw placement with good applicability and high accuracy. This method significantly reduces the operation time and radiation exposure for the members of the surgical team. The potential use of such a navigational template to insert cervical pedicle screws is promising. This technique has been clinically validated to provide an accurate trajectory for pedicle screw placement in the cervical spine. © 2009, Lippincott Williams & Wilkins.en_US
dc.languageengen_US
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_US
dc.relation.ispartofSpineen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshBone Screwsen_US
dc.subject.meshCervical Vertebrae - Radiography - Surgeryen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshImaging, Three-Dimensional - Instrumentation - Methodsen_US
dc.subject.meshInternal Fixatorsen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshOrthopedic Procedures - Instrumentation - Methodsen_US
dc.subject.meshSpinal Fusion - Instrumentation - Methodsen_US
dc.subject.meshSpinal Injuries - Radiography - Surgeryen_US
dc.subject.meshSurgery, Computer-Assisted - Instrumentation - Methodsen_US
dc.titleA novel patient-specific navigational template for cervical pedicle screw placementen_US
dc.typeArticleen_US
dc.identifier.emailLu, WW:wwlu@hku.hken_US
dc.identifier.authorityLu, WW=rp00411en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/BRS.0b013e3181c09985en_US
dc.identifier.pmid20010385-
dc.identifier.scopuseid_2-s2.0-74249096974en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-74249096974&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume34en_US
dc.identifier.issue26en_US
dc.identifier.spageE959en_US
dc.identifier.epageE964en_US
dc.identifier.isiWOS:000272794000012-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridLu, S=7404227390en_US
dc.identifier.scopusauthoridXu, YQ=8449345700en_US
dc.identifier.scopusauthoridLu, WW=7404215221en_US
dc.identifier.scopusauthoridNi, GX=36658171900en_US
dc.identifier.scopusauthoridLi, YB=8934248500en_US
dc.identifier.scopusauthoridShi, JH=23668990200en_US
dc.identifier.scopusauthoridLi, DP=14058294700en_US
dc.identifier.scopusauthoridChen, GP=7407500890en_US
dc.identifier.scopusauthoridChen, YB=35114452600en_US
dc.identifier.scopusauthoridZhang, YZ=7601314522en_US

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