Clinical Use of 3D Printing Guide Plate in Posterior Lumbar Pedicle Screw Fixation

Abstract

BACKGROUND This study aimed to evaluate the clinical efficacy of use of a 3D printing guide plate in posterior lumbar pedicle screw fixation. MATERIAL AND METHODS We enrolled 43 patients receiving posterior lumbar pedicle screw fixation. The experimental group underwent 3D printing guide plate-assisted posterior lumbar pedicle screw fixation, while the control group underwent traditional x-ray-assisted posterior lumbar pedicle screw fixation. After surgery, CT scanning was done to evaluate the accuracy of screw placement according to the Richter standard. RESULTS All patients were followed up for 1 month. The mean time of placement for each screw and the amount of hemorrhage was 4.9±2.1 min and 8.0±11.1 mL in the experimental group while 6.5±2.2 min and 59.9±13.0 mL in the control group, respectively, with significant differences (p<0.05). The fluoroscopy times of each screw placement was 0.5±0.4 in the experimental group, which was significantly lower than that in the control group 1.2±0.7 (p<0.05). The excellent and good screw placement rate was 100% in the experimental group and 98.4% in the control group, without any statistical difference (P>0.05). No obvious complications were reported in either group. CONCLUSIONS Compared with the traditional treatment methods, the intra-operative application of 3D printing guide plate can shorten the operation time and reduce the amount of hemorrhage. It can also reduce the fluoroscopy times compared with the traditional fluoroscopy, which cannot improve the accuracy rate of screw placement.

Figure 1

(A–C) Pre-operative lumbar MRI images.

Figure 2

A) The pre-operative 3D CT reconstruction images; (B) A virtual screw path was established on the operational vertebral body model using the MedCAD, making the path parallel to the long axis of the pedicle; (C) 3D pedicle screw guide plates corresponding to the surgical vertebral were reconstructed according to the image data. (D) The pedicle screw path was established with the assistance of the corresponding pedicle screw guide plate, which was performed for the opposite side by the same method.

Figure 3

A) The post-operative lateral x-ray films; (B) The post-operative anterior-posterior x-ray films. Both revealed a good position of pedicle screw. (C) The pedicle screw path was established under the assistance of individualized 3D pedicle screw guide plate during the operation.