European Spine Journal

, Volume 28, Issue 7, pp 1712–1723 | Cite as

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

  • Riccardo CecchinatoEmail author
  • Pedro Berjano
  • Alberto Zerbi
  • Marco Damilano
  • Andrea Redaelli
  • Claudio Lamartina
Original Article



Screw misplacement incidence can be as high as 15–30% in spine deformity surgery, with possible devastating consequences. Some technical solutions to prevent misplacement require expensive devices. MySpineTM comprises a low-dose CT scan of the patient’s spine to build a virtual model of the spine to plan the screw trajectories and a 3D-printed patient-specific guide system to prepare the screw trajectories and to implant the screws in the vertebrae in order to increase reproducibility and safety of the implants. The aim of this open-label, single-center, prospective randomized clinical trial with independent evaluation of outcomes was to compare the accuracy of free-hand insertion of pedicle screws to MySpineTM 3D-printed patient-specific guides.


Twenty-nine patients undergoing surgical correction for spinal deformity were randomized to Group A (pedicle screws implantation with MySpineTM) or Group B (free-hand implantation). Group A received 297 pedicle screws, and Group B 243 screws. Forty-three screws in Group A crossed over to free-hand implantation. Screw position was graded according to Gertzbein in grades 0, A, B or C, with grades 0 or A considered as “safe area.” Total fluoroscopy dose and time were compared in six patients of each group.


Comparing the two study groups, we observed a statistically significant difference between the two groups (p < 0.05), with 96.1% of screws in the “safe area” in Group A versus a 82.9% in Group B. Group-A patients had a mean effective dose of 0.23 mSv compared to 0.82 mSv in Group B. Patient-specific, 3D-printed pedicle screw guides increase safety in a wide spectrum of deformity conditions. In addition, the total radiation dose is reduced, even considering the need of a low-dose preoperative CT for surgical planning.

Level of evidence


Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Scoliosis Navigation 3D printing Accuracy Spine deformity 



This study was financed with an unrestricted research Grant of 22,975 Euros from Medacta SA, CH.

Compliance with ethical standards

Conflict of interest

Authors RC, PB, AZ, MD and CL are consultants for Medacta SA.

Supplementary material

586_2019_5978_MOESM1_ESM.pptx (3.7 mb)
Supplementary material 1 (PPTX 3780 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.GSpine4IRCCS Istituto Ortopedico GaleazziMilanItaly

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