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Accuracy assessment of patient-specific 3D-printed drill guides for pedicle and lateral mass screw insertion
EANS Academy. Pijpker P. 09/25/19; 275555; EP12025
Mr. Peter Pijpker
Mr. Peter Pijpker

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Abstract
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Background: In recent years, the use of surgical 3D planning and printing technology has been gaining increased interest. The technology can facilitate precise preoperative planning of spinal screw trajectories. By producing corresponding individualized 3D-printed drilling guides, the plan can be translated to the actual surgical procedure. There is however a large variety in guide designs, and no consensus exist about the best method for evaluating the system's accuracy. We previously described the development of our optimized drill guide design, and presented a method for 3D trajectory deviation analysis. In this study we describe the clinical use and accuracy of 3D-printed drill guides for pedicle screw and mass lateral screw insertion.
Methods: We retrospectively analyzed 15 consecutive patients who underwent cervical and/or upper-thoracic spinal fixation surgery assisted by means of 3D-printed drill guides. After meticulous planning of the 3D trajectories, the drill guides were tailored to each patient´s bone configuration and 3D-printed to be used intraoperatively. 3D models obtained from the postoperative CT scan were superimposed on the preoperative planning, confirming the entry point and angular accuracy of the technique. We moreover assessed the safety based on cortical breach assessment.
Results: A total of 76 screw trajectories were assessed, showing an overall average entry point accuracy of 1.35mm. The entry point accuracy for only the pedicle and lateral mass screws were 1.84mm and 1.25mm, respectively. The average angular deviation of the respective measurements were, 6.80°, 6.63°, and 6.84°. An excellent safety of 100% was found based on cortical breach classification. There were no postoperative complications.
Conclusions: 3D virtual surgical planning is useful to precisely plan pedicle and lateral mass screw trajectories. The corresponding 3D printed surgical guides are feasible for accurate screw insertion.


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