Improvement of pedicle screw placement with first-time use of patient specific drill guides by novice surgeon
Purpose: Accurate placement of pedicle screws is a key component of spine surgery. The goal of this study is to evaluate the accuracy and precision of a 3-dimensional (3D) printed patient-specific instrumentation (PSI) guide in improving pedicle screw trajectory placement for a first-time user. Meth...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-08-01
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| Series: | Annals of 3D Printed Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266696412500030X |
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| Summary: | Purpose: Accurate placement of pedicle screws is a key component of spine surgery. The goal of this study is to evaluate the accuracy and precision of a 3-dimensional (3D) printed patient-specific instrumentation (PSI) guide in improving pedicle screw trajectory placement for a first-time user. Methods: A computed tomography scan of a cadaveric spine was obtained and 3D reconstructed virtually. One pedicle at each vertebra was randomized to the PSI or freehand (FH) grouping. Screw trajectories were virtually planned for T1-L5 vertebral levels. A junior orthopaedic surgery resident used the PSI to place a screw at 17 vertebral levels and then returned on a separate day to place screws using FH technique. No adjustments from the initial placement were allowed. Postoperatively the spine was rescanned and analyzed by a blinded senior attending surgeon for perforation, adequacy of placement, and likelihood of unfavorable outcome. The PSI grouping was analyzed objectively for deviation from the preoperative plan. Results: Five of the FH screws were deemed to likely result in paralysis or major neurovascular injury vs zero in the PSI grouping (p-value 0.045). The mean PSI placement time was 47.9 s faster per level than the FH placement time (145.2 ± 74.4 vs 193.1 ± 43.0 s; p-value 0.032). The PSI trajectories were accurate within 2.75 mm and 9.0 degrees of the planned trajectories (p-value 0.045; p-value 0.036). Conclusions: The PSI system appears to offer a relatively inexpensive, user-friendly, and sufficiently accurate solution to pedicle screw placement for even a novice surgeon using the technology for the first time. |
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| ISSN: | 2666-9641 |