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Randomized Controlled Trial
. 2022 Mar;56(2):138-146.
doi: 10.5152/j.aott.2021.21332.

Patient-specific three-dimensional printing spine model for surgical planning in AO spine type-C fracture posterior long-segment fixation

Anıl Murat Öztürk  1 , Onur Süer  2 , Figen Govsa  3 , Mehmet Asım Özer  3 , Ömer Akçalı  4
Affiliations
Randomized Controlled Trial

Patient-specific three-dimensional printing spine model for surgical planning in AO spine type-C fracture posterior long-segment fixation

Anıl Murat Öztürk et al. Acta Orthop Traumatol Turc. 2022 Mar.

Abstract

Objective: The aim of this study was to compare duration of surgery, intraoperative fluoroscopy exposure, blood loss and the accuracy of pedicular screw placement between 3D model-assisted surgery and conventional surgery for AO spinal C-type injuries.

Methods: In this study 32 patients who were admitted with thoracolumbar AO spinal C-type injuries were included. These patients were divided randomly into two groups of 16 where one group was operated on using conventional surgery and the other group was operated on using 3D model-assisted surgery. During surgery, instrumentation time, amount of blood loss and intraoperative fluoroscopy exposure were recorded. Moreover, the status of the screws in the pedicles was assessed as described by Learch and Wiesner's and regional sagittal angles (RSA) were measured preop and postoperatively.

Results: It was found that there was a statistically significant difference in instrumentation time, blood loss and intraoperative fluoroscopy exposure in the 3D model-assisted surgery group (61.9 ± 4.7 min, 268.4 ± 42.7 ml, 16.3 ± 1.9 times) compared to the conventional surgery group (75.5 ± 11.0 min, 347.8 ± 52.2 mL, 19.7 ± 2.4 times) (t=4.5325, P < 0.0001 and t=4.7109, P < 0.0001 and t=4.4937, P < 0.0001, respectively) Although the screw misplacement rate of the conventional surgery group was higher than that of the 3D model-assisted surgery group, the only statistically significant difference was in the medial axial encroachment (t=5.101 P=0.02) . There was no severe misplacement of pedicle screws in either group. There were no statistically significant differences between postoperative RSA angles and were in both groups restored significantly.

Conclusion: The results of this study have shown us that the 3D model helps surgeons see patients' pathoanatomy and determine rod lengths, pedicle screw angles and lengths preoperatively and peroparatively, which in turn shortens operative time, reduces blood loss and fluoroscopy exposure.

Level of evidence: Level I, Therapeutic Study.

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Figures

Figure 1. a-c.
Figure 1. a-c.
Preoperative determination of the pedicle screw size (a), transverse connector size (b), and rod length (c) on the three-dimensional (3D)-printed model by the 3D-assisted surgery group.
Figure 2. a-h.
Figure 2. a-h.
Simulation of the surgery on the three-dimensional model. Preparation of the table for surgery simulation (a). First, the rod length was determined on model (b). The entry point was located with a marker on the model (intersection of the lateral margin of the facet joint and the line passing through the longitudinal midline of the transverse process) (c). A K-wire was inserted to the entry point of the pedicle screw (d). With a guidewire, the optimal direction angle for the pedicle screw implantation was decided. Subsequently, drilling with a small-diameter drill into the vertebrae was performed to make a hole and the drilling was continued with tappers up to 5 mm (e). A small spherical tip probe was used to examine the opening of the pedicle screw entrance and to confirm the reliability of the pathway for the pedicle screw. Further, the length of the drill hole was also determined to decide the screw length (f). Pedicle screw size was determined (g). Finally, the pedicle screw was gently placed (h).
Figure 3. a-d.
Figure 3. a-d.
All pedicle screws were placed into the three-dimensional (3D) model (anteroposterior (a)–lateral (b) view). Assessment of the screws by fluoroscopy (anteroposterior (c)–lateral (d) view). The pedicle screw positions on the 3D model were with acceptable accuracy.
Figure 4. a, b.
Figure 4. a, b.
The position of the screws on the three-dimensional model is evaluated with fluoroscopy, and cranial misplacement of the pedicle screws was recognized in the sagittal view (a). With the revision of the position of the pedicle screws, the ideal entry point and direction angle for the pedicle screws were determined (b).
Figure 5. a-f.
Figure 5. a-f.
All pedicle screw sizes determined preoperatively on the three-dimensional (3D) model were used during surgery sagittal (a)–axial (b, c) view by computed tomography (CT) scan of the model with implanted pedicle screws and sagittal (d)–axial (e, f) view (same vertebral segments with axial CT scans of the 3D model of the patient’s postoperative CT scan).
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