Skip to main content

Advertisement

SpringerLink
Log in

Comparative study of 3D printed navigation template-assisted atlantoaxial pedicle screws versus free-hand screws for type II odontoid fractures

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

Abstract

Objective

The objective of the study was to compare the safety, efficacy, and accuracy of the pedicle screws with the three-dimensional (3D) printed navigation template to the free-hand screws for type II odontoid fractures.

Patients and methods

A total of 60 patients with type II odontoid fractures, treated with either template guiding pedicle screws or free-hand screws, were retrospectively assessed. The guiding group was treated with pedicle screws with the assistance of a virtual reality (VR) software-designed, 3D printed navigation template with two guide tubes. The safety rate and treatment efficacy of the screw placement, as well as the trajectory accuracy, were evaluated by respective measures and compared between two surgical groups.

Results

There were reduced surgical time (P < 0.05), blood loss (P < 0.01), and C-arm shots (P < 0.01) with 3D printed template guiding screws. The rates of safe pedicle screws in both C1 and C2 were significantly higher in 3D guiding group (P < 0.01) compared to the free-hand group, and the scores of visual analogue scale (VAS) and impairment scale (ASIA) were improved in guiding group at 1 week post-surgery (P < 0.01 and P < 0.05, respectively). Postoperative CT and image reconstruction showed the 3D guiding group had better horizontal screw accuracy on both sides of C1 (L: P < 0.001, R: P < 0.01) and C2 (L: P < 0.001, R: P < 0.01) than free-hand group.

Conclusion

The herein screw technique using 3D printed navigation template leads to greater improvement in the screw safety, efficacy, and accuracy, which may be a promising alternative to free-hand surgery for the treatment of odontoid fractures.

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

Access this article

Log in via an institution

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

Similar content being viewed by others

References

  1. Du JY, Aichmair A, Kueper J et al (2015) Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis. J Neurosurg Spine 22(2):151–161

    Article  Google Scholar 

  2. Scheyerer MJ, Zimmermann SM, Simmen HP et al (2013) Treatment modality in type II odontoid fractures defines the outcome in elderly patients. BMC Surg 13:13–54

    Article  Google Scholar 

  3. Lohrer L, Raschke MJ, Thiesen D et al (2012) Current concepts in the treatment of Anderson Type II odontoid fractures in the elderly in Germany. Austria Switz Inj 43(4):462–469

    CAS  Google Scholar 

  4. Pal D, Sell P, Grevitt M (2011) Type II odontoid fractures in the elderly: an evidence-based narrative review of management. Eur Spine J 20(2):195–204

    Article  CAS  Google Scholar 

  5. Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129(1–2):47–53

    Article  CAS  Google Scholar 

  6. Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26(22):2467–2471

    Article  CAS  Google Scholar 

  7. Cecchinato R, Berjano P, Zerbi A et al (2019) Pedicle screw insertion with patient-specific 3D-printed guides based on low-dose CT scan is more accurate than free-hand technique in spine deformity patients: a prospective, randomized clinical trial. Eur Spine J 28(7):1712–1723

    Article  Google Scholar 

  8. Pu X, Yin M, Ma J et al (2018) Design and application of a novel patient-specific three-dimensional printed drill navigational guiding in atlantoaxial pedicle screw placement. World Neurosurg 114:e1–e10

    Article  Google Scholar 

  9. Huang DG, Hao DJ, Li GL et al (2014) C2 nerve dysfunction associated with C1 lateral mass screw fixation. Orthop Surg 6(4):269–273

    Article  Google Scholar 

  10. Steltzlen C, Lazennec JY, Catonne Y et al (2013) Unstable odontoid fracture: surgical strategy in a 22-case series, and literature review. Orthop Traumatol Surg Res 99(5):615–623

    Article  CAS  Google Scholar 

  11. Jacobson ME, Khan SN, An HS (2012) C1–C2 posterior fixation: indications, technique, and results. Orthop Clin North Am 43(1):11–8, vii

    Article  Google Scholar 

  12. Huybregts JG, Jacobs WC, Vleggeert-Lankamp CL (2013) The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review. Eur Spine J 22(1):1–13

    Article  Google Scholar 

  13. Barnes AH, Eguizabal JA, Acosta FL, Jr. et al (2009) Biomechanical pullout strength and stability of the cervical artificial pedicle screw. Spine (Phila Pa 1976) 34(1):E16-20

    Article  Google Scholar 

  14. Yoshimoto H, Sato S, Hyakumachi T et al (2005) Spinal reconstruction using a cervical pedicle screw system. Clin Orthop Relat Res 431:111–119

    Article  Google Scholar 

  15. Tan M, Li X, Dong L (2013) Review of surgical treatment of atlantoaxial dislocation in recent 20 years in Chinese on in recent years in Chinese. Chin J Spine Spin Cord 23(5):399–404

    Google Scholar 

  16. Richter M, Cakir B, Schmidt R (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine (Phila Pa 1976) 30(20):2280–2287

    Article  Google Scholar 

  17. Weng C, Tian W, Li ZY et al (2012) Surgical management of symptomatic os odontoideum with posterior screw fixation performed using the magerl and harms techniques with intraoperative 3-dimensional fluoroscopy-based navigation. Spine (Phila Pa 1976) 37(21):1839–1846

    Article  Google Scholar 

  18. Uehara M, Takahashi J, Hirabayashi H et al (2012) Computer-assisted C1–C2 transarticular screw fixation “magerl technique” for atlantoaxial instability. Asian Spine J 6(3):168–177

    Article  Google Scholar 

  19. Chen XL, Xie YF, Li JX et al (2019) Design and basic research on accuracy of a novel individualized three-dimensional printed navigation template in atlantoaxial pedicle screw placement. PLoS ONE 14(4):e0214460

    Article  CAS  Google Scholar 

  20. Jiang L, Dong L, Tan M et al (2016) Accuracy assessment of atlantoaxial pedicle screws assisted by a novel drill guide template. Arch Orthop Trauma Surg 136(11):1483–1490

    Article  Google Scholar 

Download references

Funding

Funding was provided by National Natural Science Foundation (Grant No. 81772367) and Major Military Science Research (Grant No. AWS17J004).

Author information

Author notes

  1. Yang Li, Jing Lin and Yuan Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, The 920th Hospital of Joint Logistic Support Force of PLA, Kunming, 650032, China

    Yang Li, Haotian Luo, Jing Wang, Sheng Lu & Yongqing Xu

  2. Department of Neurosurgery, The 452 Hospital of Western Air Force, Chengdu, 610021, China

    Jing Lin

  3. Department of Health Statistics, Second Military Medical University, Shanghai, 200003, China

    Jing Lin

  4. Second Department of Spine Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, 20003, China

    Yuan Wang

Authors
  1. Yang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jing Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haotian Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sheng Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yongqing Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yongqing Xu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Formal consent is not required for this type of study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Y., Lin, J., Wang, Y. et al. Comparative study of 3D printed navigation template-assisted atlantoaxial pedicle screws versus free-hand screws for type II odontoid fractures. Eur Spine J 30, 498–506 (2021). https://doi.org/10.1007/s00586-020-06644-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-020-06644-9

Keywords

Search

Navigation