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Deviation analysis of C2 translaminar screw placement assisted by a novel rapid prototyping drill template: a cadaveric study

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Abstract

Purpose

The goal of this study is to evaluate the accuracy of patient-specific CT-based rapid prototype drill templates for C2 translaminar screw insertion.

Methods

Volumetric CT scanning was performed in 32 cadaveric cervical spines. Using computer software, the authors constructed drill templates that fit onto the posterior surface of the C2 vertebrae with drill guides to match the slope of the patient’s lamina. Thirty-two physical templates were created from the computer models using a rapid prototyping machine. The drill templates were used to guide drilling of the lamina and post-operative CT images were obtained. The entry point and direction of the planned and inserted screws were measured and compared.

Results

Sixty-four C2 translaminar screws were placed without violating the cortical bone of a single lamina. The bilateral average transverse angle of intended and actual screw for C2TLS was 56.60 ± 2.22°, 56.38 ± 2.51°, 56.65 ± 2.24°, 56.39 ± 2.45°. The bilateral mean coronal angle of the planned and actual screw for C2TLS was 0°, 0°, −0.07 ± 0.32°, 0.12 ± 0.57°. The average displacement of the entry point of the superior and inferior C2TLS in the x, y, z axis was 0.27 ± 0.85, 0.49 ± 1.46, −0.28 ± 0.69, 0.43 ± 0.88, 0.38 ± 1.51, 0.23 ± 0.64 mm.

Conclusion

The small deviations seen are likely due to human error in the form of small variations in the surgical technique and use of software to design the prototype. This technology improves the safety profile of this fixation technique and should be further studied in clinical applications.

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References

  1. Bransford RJ, Russo AJ, Freeborn M et al (2011) Posterior C2 instrumentation: accuracy and complications associated with four techniques. Spine 36:E936–E943

    Article  PubMed  Google Scholar 

  2. Guo Q, Liu J, Ni B et al (2011) C2 laminar screw and C1–2 transarticular screw combined with C1 laminar hooks for atlantoaxial instability with unilateral vertebral artery injury. Arch Orthop Trauma Surg 131:1207–1210

    Article  PubMed  Google Scholar 

  3. Hong JT, Yi JS, Kim JT et al (2010) Clinical and radiologic outcome of laminar screw at C2 and C7 for posterior instrumentation—review of 25 cases and comparison of C2 and C7 intralaminar screw fixation. World Neurosurg 73:112–118

    Article  PubMed  Google Scholar 

  4. Lee SH, Kim ES, Sung JK et al (2010) Clinical and radiological comparison of treatment of atlantoaxial instability by posterior C1–C2 transarticular screw fixation or C1 lateral mass-C2 pedicle screw fixation. J Clin Neurosci 17:886–892

    Article  PubMed  Google Scholar 

  5. Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir 129:47–53

    Article  PubMed  CAS  Google Scholar 

  6. Goel A, Desai KI, Muzumdar DP (2002) Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery 51:1351–1356

    PubMed  Google Scholar 

  7. Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:2467–2471

    Article  PubMed  CAS  Google Scholar 

  8. Jeanneret B, Magerl F (1992) Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 5:464–475

    Article  PubMed  CAS  Google Scholar 

  9. Guo X, Ni B, Zhao W et al (2009) Biomechanical assessment of bilateral C1 laminar hook and C1–2 transarticular screws and bone graft for atlantoaxial instability. J Spinal Disord Tech 22:578–585

    Article  PubMed  Google Scholar 

  10. Xu H, Chi YL, Wang XY et al (2012) Comparison of the anatomic risk for vertebral artery injury associated with percutaneous atlantoaxial anterior and posterior transarticular screws. Spine J 12:656–662

    Article  PubMed  Google Scholar 

  11. Wright NM (2004) Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 17:158–162

    PubMed  Google Scholar 

  12. Leonard JR, Wright NM (2006) Pediatric atlantoaxial fixation with bilateral, crossing C-2 translaminar screws. J Neurosurg 104:59–63

    PubMed  Google Scholar 

  13. Wright NM (2005) Translaminar rigid screw fixation of the axis. J Neurosurg Spine 3:409–414

    Article  PubMed  Google Scholar 

  14. Ma W, Feng L, Xu R et al (2010) Clinical application of C2 laminar screw technique. Eur Spine J 19:1312–1317

    Article  PubMed  Google Scholar 

  15. Nakanishi K, Tanaka M, Sugimoto Y et al (2008) Application of laminar screws to posterior fusion of cervical spine: measurement of the cervical vertebral arch diameter with a navigation system. Spine 33:620–623

    Article  PubMed  Google Scholar 

  16. Hu Y, Gu YJ, Ye PH et al (2010) Posterior cervical spine arthrodesis incorporating C2 laminar screw fixation in the treatment of cervical spine injury. Orthop Surg 2:32–37

    Article  PubMed  Google Scholar 

  17. Lapsiwala SB, Anderson PA, Oza A et al (2006) Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws. Neurosurgery 58:516–521

    Article  PubMed  Google Scholar 

  18. Lu S, Xu YQ, Zhang YZ et al (2009) A novel computer-assisted drill guide template for placement of C2 laminar screws. Eur Spine J 18:1379–1385

    Article  PubMed  Google Scholar 

  19. Wang S, Wang C, Passias PG et al (2010) Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2–3 fusion patients? Eur Spine J 19:1306–1311

    Article  PubMed  Google Scholar 

  20. Park JS, Cho DC, Sung JK (2012) Feasibility of C2 Translaminar Screw as an alternative or salvage of C2 pedicle screws in atlantoaxial instability. J Spinal Disord Tech 25:254–258

    Article  PubMed  Google Scholar 

  21. Wang MY (2007) Cervical crossing laminar screws: early clinical results and complications. Neurosurgery 61:311–315

    Article  PubMed  Google Scholar 

  22. Wang MY (2006) C2 crossing laminar screws: cadaveric morphometric analysis. Neurosurgery 59:ONS84–ONS88

    Article  PubMed  Google Scholar 

  23. Kabir SMR, Casey AT (2009) Modification of Wright’s technique for C2 translaminar screw fixation: technical note. Acta Neurochir 151:1543–1547

    Article  PubMed  CAS  Google Scholar 

  24. Rajasekaran S, Avadhani A, Shetty AP (2011) Axial translaminar screw placement using three-dimensional fluoroscopy-based navigation. Singap Med J 52:15–18

    CAS  Google Scholar 

  25. Nottmeier EW, Foy AB (2008) Placement of C2 laminar screws using three-dimensional fluoroscopy-based image guidance. Eur Spine J 17:610–615

    Article  PubMed  Google Scholar 

  26. Lehman RA Jr, Sasso RC, Helgeson MD et al (2007) Accuracy of intraoperative plain radiographs to detect violations of intralaminar screws placed into the C2 vertebrae: a reliability study. Spine 32:3036–3040

    Article  PubMed  Google Scholar 

  27. Lu S, Xu YQ, Chen GP et al (2011) Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement. Comput Aided Surg 16:240–248

    Article  PubMed  Google Scholar 

  28. Kawaguchi Y, Nakano M, Yasuda T et al (2012) Development of a new technique for pedicle screw and magerl screw insertion using a 3-dimensional image guide. Spine 37:1983–1988

    Article  PubMed  Google Scholar 

  29. Goffin J, Van Brussel K, Martens K et al (2001) Three-dimensional computed tomography-based, personalized drill guide for posterior cervical stabilization at C1–C2. Spine 26:1343–1347

    Article  PubMed  CAS  Google Scholar 

  30. Van Cleynenbreugel J, Schutyser F, Goffin J et al (2002) Image-based planning and validation of C1–C2 transarticular screw fixation using personalized drill guides. Comput Aided Surg 7:41–48

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, Zhejiang, China

    Yong Hu, Zhen-shan Yuan, Wei-xin Dong & Hui Xie

  2. Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    William Ryan Spiker & Todd J. Albert

  3. Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical and Power Energy Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China

    Jian-bing Yuan & Cheng-tao Wang

Authors
  1. Yong Hu
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  2. Zhen-shan Yuan
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  3. William Ryan Spiker
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  4. Todd J. Albert
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  5. Wei-xin Dong
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  6. Hui Xie
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  7. Jian-bing Yuan
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  8. Cheng-tao Wang
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Correspondence to Yong Hu.

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Hu, Y., Yuan, Zs., Spiker, W.R. et al. Deviation analysis of C2 translaminar screw placement assisted by a novel rapid prototyping drill template: a cadaveric study. Eur Spine J 22, 2770–2776 (2013). https://doi.org/10.1007/s00586-013-2993-0

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  • DOI: https://doi.org/10.1007/s00586-013-2993-0

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