Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations

Abstract This study explores the feasibility and clinical value of using 3D-Slicer for preoperative planning in posterior C1–C2 fixation in patients with vertebral artery variations. A total of 118 patients who underwent posterior atlantoaxial fixation from January 2013 to December 2022 were include...

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Main Authors: Jia-xuan Zhang, Zhen-yong Ke, Guo-sheng Zhao, Yang Liu, Dian Zhong, Shan Wu, Hai-juan Wu, Yang Wang
Format: Article
Language:English
Published: Nature Portfolio 2025-07-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-13469-3
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author Jia-xuan Zhang
Zhen-yong Ke
Guo-sheng Zhao
Yang Liu
Dian Zhong
Shan Wu
Hai-juan Wu
Yang Wang
author_facet Jia-xuan Zhang
Zhen-yong Ke
Guo-sheng Zhao
Yang Liu
Dian Zhong
Shan Wu
Hai-juan Wu
Yang Wang
author_sort Jia-xuan Zhang
collection DOAJ
description Abstract This study explores the feasibility and clinical value of using 3D-Slicer for preoperative planning in posterior C1–C2 fixation in patients with vertebral artery variations. A total of 118 patients who underwent posterior atlantoaxial fixation from January 2013 to December 2022 were included, with 51 cases utilizing 3D reconstruction and 67 cases not utilizing this approach. We employed four personalized screw placement strategies tailored to the type of vertebral artery variation: (1) Normal vertebral artery: pedicle screws for both C1 and C2; (2) Axis vertebral foramen variation: pedicle screws for C1 and Laminar screws for C2; (3) vertebral artery hypoplasia: pedicle screws for C1 and Laminar screws for C2; and (4) posterior atlas arch variation: lateral mass screws for C1 and pedicle screws for C2. The preoperative demographic and diagnostic data showed no significant differences between the groups. However, the use of 3D reconstruction with 3D-Slicer led to significantly improved outcomes, including 27.97% increase in optimal fixation method selection, reduced operating time, decreased intraoperative blood loss, and a lower risk of vertebral artery injury (VAI). The use of 3D-Slicer for preoperative planning in posterior C1-C2 fixation in patients with vertebral artery variations shows promising potential.
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spelling doaj-art-6297ed5b9f2e40d5b1ea18ce07b3ca542025-08-20T03:42:22ZengNature PortfolioScientific Reports2045-23222025-07-0115111110.1038/s41598-025-13469-3Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variationsJia-xuan Zhang0Zhen-yong Ke1Guo-sheng Zhao2Yang Liu3Dian Zhong4Shan Wu5Hai-juan Wu6Yang Wang7Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical UniversityAbstract This study explores the feasibility and clinical value of using 3D-Slicer for preoperative planning in posterior C1–C2 fixation in patients with vertebral artery variations. A total of 118 patients who underwent posterior atlantoaxial fixation from January 2013 to December 2022 were included, with 51 cases utilizing 3D reconstruction and 67 cases not utilizing this approach. We employed four personalized screw placement strategies tailored to the type of vertebral artery variation: (1) Normal vertebral artery: pedicle screws for both C1 and C2; (2) Axis vertebral foramen variation: pedicle screws for C1 and Laminar screws for C2; (3) vertebral artery hypoplasia: pedicle screws for C1 and Laminar screws for C2; and (4) posterior atlas arch variation: lateral mass screws for C1 and pedicle screws for C2. The preoperative demographic and diagnostic data showed no significant differences between the groups. However, the use of 3D reconstruction with 3D-Slicer led to significantly improved outcomes, including 27.97% increase in optimal fixation method selection, reduced operating time, decreased intraoperative blood loss, and a lower risk of vertebral artery injury (VAI). The use of 3D-Slicer for preoperative planning in posterior C1-C2 fixation in patients with vertebral artery variations shows promising potential.https://doi.org/10.1038/s41598-025-13469-3Atlantoaxial internal fixationPreoperative planVertebral artery variation3D reconstruction3D-Slicer
spellingShingle Jia-xuan Zhang
Zhen-yong Ke
Guo-sheng Zhao
Yang Liu
Dian Zhong
Shan Wu
Hai-juan Wu
Yang Wang
Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations
Scientific Reports
Atlantoaxial internal fixation
Preoperative plan
Vertebral artery variation
3D reconstruction
3D-Slicer
title Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations
title_full Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations
title_fullStr Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations
title_full_unstemmed Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations
title_short Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations
title_sort application of 3d slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations
topic Atlantoaxial internal fixation
Preoperative plan
Vertebral artery variation
3D reconstruction
3D-Slicer
url https://doi.org/10.1038/s41598-025-13469-3
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