Skip to main content

Advertisement

Log in

Additive-manufactured patient-specific titanium templates for thoracic pedicle screw placement: novel design with reduced contact area

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Image-based navigational patient-specific templates (PSTs) for pedicle screw (PS) placement have been described. With recent advances in three-dimensional computer-aided designs and additive manufacturing technology, various PST designs have been reported, although the template designs were not optimized. We have developed a novel PST design that reduces the contact area without sacrificing stability. It avoids susceptibility to intervening soft tissue, template geometric inaccuracy, and difficulty during template fitting.

Methods

Fourteen candidate locations on the posterior aspect of the vertebra were evaluated. Among them, locations that had high reproducibility on computed tomography (CT) images and facilitated accurate PS placement were selected for the final PST design. An additive manufacturing machine (EOSINT M270) fabricated the PSTs using commercially pure titanium powder. For the clinical study, 36 scoliosis patients and 4 patients with ossification of the posterior longitudinal ligament (OPLL) were treated with thoracic PSs using our newly developed PSTs. We intraoperatively and postoperatively evaluated the accuracy of the PS hole created by the PST.

Results

Based on the segmentation reproducibility and stability analyses, we selected seven small, round contact points for our PST: bilateral superior and inferior points on the transverse process base, bilateral inferior points on the laminar, and a superior point on the spinous process. Clinically, the success rates of PS placement using this PST design were 98.6 % (414/420) for scoliosis patients and 100 % (46/46) for OPLL patients.

Conclusion

This study provides a useful design concept for the development and introduction of patient-specific navigational templates for placing PSs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Berry E, Cuppone M, Porada S, Millner PA, Rao A, Chiverton N, Seedhom BB (2005) Personalised image-based templates for intra-operative guidance. Proc Inst Mech Eng [H] 219:111–118. doi:10.1243/095441105X9273

    Article  CAS  Google Scholar 

  2. Ma T, Xu YQ, Cheng YB, Jiang MY, Xu XM, Xie L, Lu S (2012) A novel computer-assisted drill guide template for thoracic pedicle screw placement: a cadaveric study. Arch Orthop Trauma Surg 132:65–72. doi:10.1007/s00402-011-1383-5

    Article  PubMed  Google Scholar 

  3. Kawaguchi Y, Nakano M, Yasuda T, Seki S, Hori T, Kimura T (2012) Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide. Spine 37:1983–1988. doi:10.1097/BRS.0b013e31825ab547

    Article  PubMed  Google Scholar 

  4. Yang JC, Ma XY, Lin J, Wu ZH, Zhang K, Yin QS (2010) Personalised modified osteotomy using computer-aided design-rapid prototyping to correct thoracic deformities. Int Orthop. doi:10.1007/s00264-010-1155-9

    Google Scholar 

  5. Lu S, Xu YQ, Zhang YZ, Li YB, Xie L, Shi JH, Guo H, Chen GP, Chen YB (2009) A novel computer-assisted drill guide template for lumbar pedicle screw placement: a cadaveric and clinical study. Int J Med Robot 5:184–191. doi:10.1002/rcs.249

    Article  PubMed  Google Scholar 

  6. Ryken TC, Owen BD, Christensen GE, Reinhardt JM (2009) Image-based drill templates for cervical pedicle screw placement. J Neurosurg Spine 10:21–26. doi:10.3171/2008.9.SPI08229

    Article  PubMed  Google Scholar 

  7. Lu S, Xu YQ, Lu WW, Ni GX, Li YB, Shi JH, Li DP, Chen GP, Chen YB et al (2009) A novel patient-specific navigational template for cervical pedicle screw placement. Spine 34:E959–E966. doi:10.1097/BRS.0b013e3181c09985

    Article  PubMed  Google Scholar 

  8. Birnbaum K, Schkommodau E, Decker N, Prescher A, Klapper U, Radermacher K (2001) Computer-assisted orthopedic surgery with individual templates and comparison to conventional operation method. Spine (Phila Pa 1976) 26:365–370

    Article  CAS  Google Scholar 

  9. Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G, Staudte HW (1998) Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 354:28–38

    Article  PubMed  Google Scholar 

  10. Sugawara T, Higashiyama N, Kaneyama S, Takabatake M, Watanabe N, Uchida F, Sumi M, Mizoi K (2013) Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine: clinical article. J Neurosurg Spine 19:185–190. doi:10.3171/2013.4.SPINE121059

    Article  PubMed  Google Scholar 

  11. Goffin J, Van Brussel K, Martens K, Vander Sloten J, Van Audekercke R, Smet MH (2001) Three-dimensional computed tomography-based, personalized drill guide for posterior cervical stabilization at C1-C2. Spine (Phila Pa 1976) 26:1343–1347

    Article  CAS  Google Scholar 

  12. Lu S, Xu YQ, Zhang YZ, Xie L, Guo H, Li DP (2009) A novel computer-assisted drill guide template for placement of C2 laminar screws. Eur Spine J 18:1379–1385. doi:10.1007/s00586-009-1051-4

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pattanayak DK, Fukuda A, Matsushita T, Takemoto M, Fujibayashi S, Sasaki K, Nishida N, Nakamura T, Kokubo T (2011) Bioactive Ti metal analogous to human cancellous bone: fabrication by selective laser melting and chemical treatments. Acta Biomater 7:1398–1406. doi:10.1016/j.actbio.2010.09.034

    Article  CAS  PubMed  Google Scholar 

  14. Neo M, Sakamoto T, Fujibayashi S, Nakamura T (2005) The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 30:2800–2805

    Article  PubMed  Google Scholar 

  15. Shin BJ, James AR, Njoku IU, Härtl R (2012) Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. J Neurosurg Spine 17:113–122. doi:10.3171/2012.5.SPINE11399

    Article  PubMed  Google Scholar 

  16. Otsuki B, Takemoto M, Kawanabe K, Awa Y, Akiyama H, Fujibayashi S, Nakamura T, Matsuda S (2013) Developing a novel custom cutting guide for curved peri-acetabular osteotomy. Int Orthop. doi:10.1007/s00264-013-1873-x

    PubMed  PubMed Central  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mitsuru Takemoto.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takemoto, M., Fujibayashi, S., Ota, E. et al. Additive-manufactured patient-specific titanium templates for thoracic pedicle screw placement: novel design with reduced contact area. Eur Spine J 25, 1698–1705 (2016). https://doi.org/10.1007/s00586-015-3908-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-015-3908-z

Keywords

Navigation