CLINICAL APPLICATION OF INDIVIDUALIZED REFERENCE MODEL OF SAGITTAL CURVES BY THREE-DIMENSIONAL PRINTING TECHNIQUE AND COMPUTER-AIDED NAVIGATION SYSTEM FOR LUMBAR SPONDYLOLISTHESIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUChao ,  TANLun , LINXu , HUHaigang

Department of Orthopedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P. R. China;

Corresponding?author：

TANLun, Email: flightiness@163.com

Keywords：

Lumbar spondylolisthesis; Posterior lumbar interbody fusion; Computer-aided technique; Three-dimensional printing technique

DOI：

10.7507/1002-1892.20150158

Video：

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Objective To evaluate the clinical significance of individualized reference model of sagittal curves by three-dimensional (3D) printing technique and computer-aided navigation system for lumbar spondylolisthesis. Methods Between February 2011 and October 2012, 66 patients with lumbar spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) by traditional operation in 36 cases (control group) and by individualized reference model of sagittal curves by 3D printing technique and computer-aided navigation system in 30 cases (trial group). There was no significant difference in gender, age, disease duration, segment, type of disease, degree of spondylolisthesis, and preoperative the visual analogue scale (VAS) of low back pain and leg pain between 2 groups (P>0.05). The operation time, blood loss, fluoroscopy times, VAS score of low back pain and leg pain were compared between 2 groups; the sagittal screw angle (SSA), accuracy rate of pedicle screw, Taillard index, disc height recovery rate, and sagittal angle recovery rate were compared between 2 groups. Results There was no significant difference in operation time and blood loss between 2 groups (P>0.05). But fluoroscopy times of control group were significantly higher than those of trial group (P<0.05). One case had radicular symptoms after operation in control group. The patients of 2 groups were followed up 24-36 months (mean, 26 months). The VAS scores of low back pain and leg pain at last follow-up were significantly better than pre-operative scores in 2 groups (P<0.05); VAS score of low back pain in trial group at last follow-up was significantly lower than that in control group (P<0.05). The accuracy rate of pedicle screw was 81.9% (118/144) in control group and 91.7% (110/120) in trial group, showing significant difference (χ²=5.25, P=0.03). There was significant difference in SSA between 2 groups at immediate after operation (t=-6.21, P=0.00). At immediate after operation and last follow-up, Taillard index, disc height recovery rate, and sagittal angle recovery rate in trial group were significantly better than those in control group (P<0.05). Conclusion PLIF by individualized reference model of sagittal curves by 3D printing technique and computer-aided navigation system can effectively correct spondylolisthesis, recover the lumbar sagittal angle and improve the VAS score of low back pain though it has similar operation time and blood loss to traditional PLIF.

Citation： WUChao, TANLun, LINXu, HUHaigang. CLINICAL APPLICATION OF INDIVIDUALIZED REFERENCE MODEL OF SAGITTAL CURVES BY THREE-DIMENSIONAL PRINTING TECHNIQUE AND COMPUTER-AIDED NAVIGATION SYSTEM FOR LUMBAR SPONDYLOLISTHESIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 734-740. doi: 10.7507/1002-1892.20150158 Copy

1.	張超, 孫天威, 田融, 等. 兩種手術方式治療峽部裂型腰椎滑脫癥的對比研究. 中國修復重建外科雜志, 2015, 29(2):179-183.
2.	Wang JC, Mummaneni PV, Haid RW. Current treatment strategies for the painful lumbar motion segment:posterolateral fusion versus interbody fusion. Spine (Phila Pa 1976), 2005, 30(16 Suppl):S₃3-43.
3.	龔全, 孔清泉, 李濤, 等. 后路復位技術在重度腰椎滑脫癥治療中的應用. 中國修復重建外科雜志, 2013, 27(4):393-398.
4.	Hresko MT, Hirschfeld R, Buerk AA, et al. The effect of reduction and instrument-ation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop, 2009, 29(2):157-162.
5.	李鵬飛, 賈楠, 靳憲輝, 等. 椎間植骨粒體積對腰椎后路滑脫復位植骨融合內固定術后融合效果的影響. 中國修復重建外科雜志, 2013, 27(6):696-702.
6.	Park SJ, Lee CS, Chung SS. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery, 2011, 68(2 Suppl Operative):355-363.
7.	Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease:a systematic review of Oswestry Disability Index and MOS Short Form 36 outcomes. Spine J, 2008, 8(5):747-755.
8.	Korovessis PG, Stamatakis MV, Baikousis AG. Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic greek population. Spine (Phila Pa 1976), 1998, 23(6):700-704.
9.	鄭光新, 趙曉鷗, 劉廣林, 等. Oswestry功能障礙指數評定腰痛患者的可信性. 中國脊柱脊髓雜志, 2002, 12(1):13-15.
10.	譚倫, 吳超, 羅曉中, 等. 以椎板邊緣對腰椎椎弓根螺釘進釘點的個體化定位. 中國矯形外科雜志, 2008, 16(3):207-210.
11.	田偉, 劉亞軍, 劉波, 等. 計算機導航在脊柱外科手術應用實驗和臨床研究. 中華骨科雜志, 2006, 26(10):671-675.
12.	馮海龍, 陳隆益, 譚海斌, 等. 計算機導航輔助椎弓根螺釘固定的臨床研究. 中華神經外科雜志, 2007, 23(5):332-335.
13.	Richter M, Mattes T, Cakir B. Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J, 2004, 13(1):50-59.
14.	Poussa M, Schlenzka D, Seitsalo S, et al. Surgical treatment of severe isthmic spondylolisthesis in adolescents. Reduction or fusion in situ. Spine (Phila Pa 1976), 1993, 18(7):894-901.
15.	Mehta VA, Amin A, Omeis I, et al. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery, 2012, 70(3):707-721.
16.	Hohmann F, Sturz H. Diferential indications for lumbarsacral fusion and reposition operation in spondylolisthesis. Orthopade, 1997, 26(9):781-789.
17.	Kawakami M, Tamaki T, Ando M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976), 2002, 27(1):59-64.
18.	張良, 徐宏兵, 王英民, 等. 二維計算機輔助手術導航對雙側腰椎椎弓根螺釘置入一致性的影響. 中華骨科雜志, 2013, 33(12):1190-1195.

1. 張超, 孫天威, 田融, 等. 兩種手術方式治療峽部裂型腰椎滑脫癥的對比研究. 中國修復重建外科雜志, 2015, 29(2):179-183.
2. Wang JC, Mummaneni PV, Haid RW. Current treatment strategies for the painful lumbar motion segment:posterolateral fusion versus interbody fusion. Spine (Phila Pa 1976), 2005, 30(16 Suppl):S₃3-43.
3. 龔全, 孔清泉, 李濤, 等. 后路復位技術在重度腰椎滑脫癥治療中的應用. 中國修復重建外科雜志, 2013, 27(4):393-398.
4. Hresko MT, Hirschfeld R, Buerk AA, et al. The effect of reduction and instrument-ation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop, 2009, 29(2):157-162.
5. 李鵬飛, 賈楠, 靳憲輝, 等. 椎間植骨粒體積對腰椎后路滑脫復位植骨融合內固定術后融合效果的影響. 中國修復重建外科雜志, 2013, 27(6):696-702.
6. Park SJ, Lee CS, Chung SS. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery, 2011, 68(2 Suppl Operative):355-363.
7. Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease:a systematic review of Oswestry Disability Index and MOS Short Form 36 outcomes. Spine J, 2008, 8(5):747-755.
8. Korovessis PG, Stamatakis MV, Baikousis AG. Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic greek population. Spine (Phila Pa 1976), 1998, 23(6):700-704.
9. 鄭光新, 趙曉鷗, 劉廣林, 等. Oswestry功能障礙指數評定腰痛患者的可信性. 中國脊柱脊髓雜志, 2002, 12(1):13-15.
10. 譚倫, 吳超, 羅曉中, 等. 以椎板邊緣對腰椎椎弓根螺釘進釘點的個體化定位. 中國矯形外科雜志, 2008, 16(3):207-210.
11. 田偉, 劉亞軍, 劉波, 等. 計算機導航在脊柱外科手術應用實驗和臨床研究. 中華骨科雜志, 2006, 26(10):671-675.
12. 馮海龍, 陳隆益, 譚海斌, 等. 計算機導航輔助椎弓根螺釘固定的臨床研究. 中華神經外科雜志, 2007, 23(5):332-335.
13. Richter M, Mattes T, Cakir B. Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J, 2004, 13(1):50-59.
14. Poussa M, Schlenzka D, Seitsalo S, et al. Surgical treatment of severe isthmic spondylolisthesis in adolescents. Reduction or fusion in situ. Spine (Phila Pa 1976), 1993, 18(7):894-901.
15. Mehta VA, Amin A, Omeis I, et al. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery, 2012, 70(3):707-721.
16. Hohmann F, Sturz H. Diferential indications for lumbarsacral fusion and reposition operation in spondylolisthesis. Orthopade, 1997, 26(9):781-789.
17. Kawakami M, Tamaki T, Ando M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976), 2002, 27(1):59-64.
18. 張良, 徐宏兵, 王英民, 等. 二維計算機輔助手術導航對雙側腰椎椎弓根螺釘置入一致性的影響. 中華骨科雜志, 2013, 33(12):1190-1195.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL APPLICATION OF INDIVIDUALIZED REFERENCE MODEL OF SAGITTAL CURVES BY THREE-DIMENSIONAL PRINTING TECHNIQUE AND COMPUTER-AIDED NAVIGATION SYSTEM FOR LUMBAR SPONDYLOLISTHESIS

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