Medical & Biological Engineering & Computing

, Volume 55, Issue 9, pp 1549–1562 | Cite as

An automatic and patient-specific algorithm to design the optimal insertion direction of pedicle screws for spine surgery templates

  • Francesco Naddeo
  • Emilio Cataldo
  • Alessandro Naddeo
  • Nicola Cappetti
  • Nicola Narciso
Original Article


Many diseases of the spine require surgical treatments that are currently performed based on the experience of the surgeon. For pedicle arthrodesis surgery, two critical factors must be addressed: Screws must be applied correctly and exposure to harmful radiation must be avoided. The incorrect positioning of the screws may cause operating failures that lead to subsequent reoperations, an increase in the overall duration of surgery and, therefore, more harmful, real-time X-ray checks. In this paper, the authors solve these problems by developing a method to realize a customized surgical template that acts as a drilling template. The template has two cylindrical guides that follow a correct trajectory previously calculated by means of an automatic algorithm generated on the basis of a vertebra CAD model for a specific patient. The surgeon sets the template (drilling guides) on the patient’s vertebra and safely applies the screws. Three surgical interventions for spinal stabilization have been performed using the template. These have had excellent results with regard to the accuracy of the screw positioning, reduction of the overall duration of the intervention, and reduction of the number of times the patient was exposed to X-rays.


Spine surgery Surgical template Pedicle arthrodesis Screw direction optimization X-ray minimization 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Italian ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Italian Law and have been approved by the Ethical Review Board of the San Giovanni di Dio e Ruggi di Aragona University Hospital in Salerno, where the trial/tests were conducted.

Informed consent

All human participants have had the testing protocol explained, including the nature of the used medical devices and risks and benefits they might have while being treated with the new surgery device. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© International Federation for Medical and Biological Engineering 2017

Authors and Affiliations

  1. 1.Department of Industrial EngineeringUniversity of SalernoFiscianoItaly
  2. 2.Techno DESIGN S.r.l.BattipagliaItaly
  3. 3.“San Giovanni di Dio e Ruggi di Aragona” University HospitalSalernoItaly

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