Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Lihang ¹ , TANG Qian ² , CHEN Qiling ¹ , LU Tingsheng ¹ , YAO Shudan ¹ , PU Xingwei ¹ , JI Linsong ¹ ,  LUO Chunshan ¹

1. Department of Spine Surgery, Beijing Jishuitan Hospital Guizhou Hospital/Guizhou Provincial Orthopedic Hospital, Guiyang Guizhou, 550004, P. R. China;
2. Department of Burn and Plastic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang Guizhou, 550004, P. R. China;

Corresponding?author：

LUO Chunshan, Email: lyz8088gk@163.com

Keywords：

Scoliosis correction surgery; new point contact pedicle navigation template; three-dimensional printing technology; five-point positioning

DOI：

10.7507/1002-1892.202302089

Video：

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Objective To explore the effectiveness of a new point contact pedicle navigation template (referred to as “new navigation template” for simplicity) in assisting screw implantation in scoliosis correction surgery. Methods Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups (P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. Results Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups (P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group (P<0.05). There was no complications related to screws implantation during or after operation in the two groups. Conclusion The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.

Citation： WANG Lihang, TANG Qian, CHEN Qiling, LU Tingsheng, YAO Shudan, PU Xingwei, JI Linsong, LUO Chunshan. Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 700-705. doi: 10.7507/1002-1892.202302089 Copy

1.	Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-294.
2.	Miekisiak G, Kornas P, Lekan M, et al. Accuracy of the free-hand placement of pedicle screws in the lumbosacral spine using a universal entry point: clinical validation. J Spinal Disord Tech, 2015, 28(4): E194-E198.
3.	Liu Z, Jin M, Qiu Y, et al. The superiority of intraoperative O-arm navigation-assisted surgery in instrumenting extremely small thoracic pedicles of adolescent idiopathic scoliosis: A case-control study. Medicine (Baltimore), 2016, 95(18): e3581. doi: 10.1097/MD.0000000000003581.
4.	Sugawara T, Higashiyama N, Kaneyama S, et al. Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C₁-C₂ fixation. Spine (Phila Pa 1976), 2017, 42(6): E340-E346.
5.	魏巍, 邢龍顏, 焦甲勛, 等. 數字化導航模板技術聯合頸椎椎弓根螺釘植入的有效性及安全性: 前瞻性、單中心、自身對照臨床試驗方案. 中國組織工程研究, 2017, 21(35): 5644-5648.
6.	李洪珂, 董勝利, 劉帥, 等. 3D打印導航模板輔助置釘在脊柱側彎術中的應用價值. 生物醫學工程與臨床, 2022, 26(3): 300-306.
7.	余城墻, 韋建勛. 3D打印技術在脊柱外科圍手術期應用的研究進展. 中國脊柱脊髓雜志, 2019, 29(3): 275-278.
8.	王力航, 陳啟鸰, 陸廷盛, 等. 頭盆環牽引治療重度僵硬型脊柱側后凸伴復雜椎管內畸形的臨床研究. 中華外科雜志, 2021, 59(5): 370-377.
9.	李洪珂, 郝申申, 王鵬程, 等. 3D打印導航模板輔助特發性脊柱側彎椎弓根螺釘置入的準確性. 中國組織工程研究, 2020, 24(30): 4757-4762.
10.	Lu C, Ma L, Wang X, et al. Comparison of 3D-printed navigation template-assisted pedicle screws versus freehand screws for scoliosis in children and adolescents: A systematic review and meta-analysis. J Neurol Surg A Cent Eur Neurosurg, 2023, 84(2): 188-197.
11.	鐘遠鳴, 萬通, 鐘錫鋒, 等. 3D打印模型輔助置釘技術與傳統置釘技術治療脊柱畸形有效與安全性的Meta分析. 中國組織工程研究, 2021, 25(30): 4900-4906.
12.	曾柏方, 吳超, 李濤, 等. 3D打印皮外導板輔助微創椎弓根螺釘植入治療多節段胸腰椎骨折. 中國修復重建外科雜志, 2021, 35(6): 742-749.
13.	聞志靖, 高正超, 盧騰, 等. 導航模板輔助脊柱椎弓根內固定術與傳統椎弓根內固定術手術效果比較的Meta分析. 中國骨傷, 2018, 31(11): 1069-1076.
14.	杜心如, 趙玲秀, 張一模, 等. 胸腰椎椎弓根內徑的測量及其臨床意義. 中國脊柱脊髓雜志, 2001, 11(3): 162-164.
15.	史亞民, 柴偉, 侯樹勛, 等. 胸椎椎弓根形態測量研究. 中國脊柱脊髓雜志, 2002, 12(3): 191-193.
16.	石銳, 劉浩, 袁元, 等. 不同節段椎弓根內部結構的測量和比較. 中國臨床解剖學雜志, 2005, 23(5): 458-462.
17.	侯樹勛, 史亞民. 國人下胸椎及腰椎椎弓根形態學特點及其臨床意義. 中華骨科雜志, 1994, 14(4): 222-225.
18.	Modi HN, Suh SW, Fernandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
19.	Kotani Y, Abumi K, Ito M, et al. Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine (Phila Pa 1976), 2007, 32(14): 1543-1550.
20.	Rao G, Brodke DS, Rondina M, et al. Inter- and intraobserver reliability of computed tomography in assessment of thoracic pedicle screw placement. Spine (Phila Pa 1976), 2003, 28(22): 2527-2530.
21.	Fisher CG, Sahajpal V, Keynan O, et al. Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine, 2006, 5(6): 520-526.

1. Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-294.
2. Miekisiak G, Kornas P, Lekan M, et al. Accuracy of the free-hand placement of pedicle screws in the lumbosacral spine using a universal entry point: clinical validation. J Spinal Disord Tech, 2015, 28(4): E194-E198.
3. Liu Z, Jin M, Qiu Y, et al. The superiority of intraoperative O-arm navigation-assisted surgery in instrumenting extremely small thoracic pedicles of adolescent idiopathic scoliosis: A case-control study. Medicine (Baltimore), 2016, 95(18): e3581. doi: 10.1097/MD.0000000000003581.
4. Sugawara T, Higashiyama N, Kaneyama S, et al. Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C₁-C₂ fixation. Spine (Phila Pa 1976), 2017, 42(6): E340-E346.
5. 魏巍, 邢龍顏, 焦甲勛, 等. 數字化導航模板技術聯合頸椎椎弓根螺釘植入的有效性及安全性: 前瞻性、單中心、自身對照臨床試驗方案. 中國組織工程研究, 2017, 21(35): 5644-5648.
6. 李洪珂, 董勝利, 劉帥, 等. 3D打印導航模板輔助置釘在脊柱側彎術中的應用價值. 生物醫學工程與臨床, 2022, 26(3): 300-306.
7. 余城墻, 韋建勛. 3D打印技術在脊柱外科圍手術期應用的研究進展. 中國脊柱脊髓雜志, 2019, 29(3): 275-278.
8. 王力航, 陳啟鸰, 陸廷盛, 等. 頭盆環牽引治療重度僵硬型脊柱側后凸伴復雜椎管內畸形的臨床研究. 中華外科雜志, 2021, 59(5): 370-377.
9. 李洪珂, 郝申申, 王鵬程, 等. 3D打印導航模板輔助特發性脊柱側彎椎弓根螺釘置入的準確性. 中國組織工程研究, 2020, 24(30): 4757-4762.
10. Lu C, Ma L, Wang X, et al. Comparison of 3D-printed navigation template-assisted pedicle screws versus freehand screws for scoliosis in children and adolescents: A systematic review and meta-analysis. J Neurol Surg A Cent Eur Neurosurg, 2023, 84(2): 188-197.
11. 鐘遠鳴, 萬通, 鐘錫鋒, 等. 3D打印模型輔助置釘技術與傳統置釘技術治療脊柱畸形有效與安全性的Meta分析. 中國組織工程研究, 2021, 25(30): 4900-4906.
12. 曾柏方, 吳超, 李濤, 等. 3D打印皮外導板輔助微創椎弓根螺釘植入治療多節段胸腰椎骨折. 中國修復重建外科雜志, 2021, 35(6): 742-749.
13. 聞志靖, 高正超, 盧騰, 等. 導航模板輔助脊柱椎弓根內固定術與傳統椎弓根內固定術手術效果比較的Meta分析. 中國骨傷, 2018, 31(11): 1069-1076.
14. 杜心如, 趙玲秀, 張一模, 等. 胸腰椎椎弓根內徑的測量及其臨床意義. 中國脊柱脊髓雜志, 2001, 11(3): 162-164.
15. 史亞民, 柴偉, 侯樹勛, 等. 胸椎椎弓根形態測量研究. 中國脊柱脊髓雜志, 2002, 12(3): 191-193.
16. 石銳, 劉浩, 袁元, 等. 不同節段椎弓根內部結構的測量和比較. 中國臨床解剖學雜志, 2005, 23(5): 458-462.
17. 侯樹勛, 史亞民. 國人下胸椎及腰椎椎弓根形態學特點及其臨床意義. 中華骨科雜志, 1994, 14(4): 222-225.
18. Modi HN, Suh SW, Fernandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
19. Kotani Y, Abumi K, Ito M, et al. Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine (Phila Pa 1976), 2007, 32(14): 1543-1550.
20. Rao G, Brodke DS, Rondina M, et al. Inter- and intraobserver reliability of computed tomography in assessment of thoracic pedicle screw placement. Spine (Phila Pa 1976), 2003, 28(22): 2527-2530.
21. Fisher CG, Sahajpal V, Keynan O, et al. Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine, 2006, 5(6): 520-526.

Chinese Journal of Reparative and Reconstructive Surgery

Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery

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