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3D-printed navigation template in cervical spine fusion: a systematic review and meta-analysis

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Abstract

Purpose

To explore the effectiveness and advantage of three-dimensional (3D)-printed navigation templates (3DPN-template) assisted in cervical spine fusion (CSF) surgery as compared to conventional surgery.

Methods

An electronic literature search in PubMed, Scopus, Web of Science, and Cochrane was conducted for studies of 3DPN-templates in CSF up to May 2020. Outcome measures as the accuracy rate, operation time, intra-operative blood loss, and fluoroscopy used, associated with CSF were extracted. Mean difference based on changes was quantified using Hedges’ g.

Results

From 4414 potentially relevant studies, 61 full-text publications were screened. Thirteen studies comprising 330 cases with 1323 screw placements were eligible for inclusion. For template group, pooled estimates were as follows: 97.3% accuracy rate for screw placement, 144.7 min for operating time, 273.6 ml for blood loss, and 3.2 min for fluoroscopic times. A significantly positive difference was observed between the template group compared to control group in terms of accuracy rate of screw placement (Z = 5.3), operation time (Z = 2.41), intra-operative blood loss (Z = 2.64), and fluoroscopic times (Z = 3.64) (all, P value < 0.0001). Risk of bias for studies under review was assessed using the Newcastle–Ottawa Scale (NOS), and 11 studies were found as having high quality. Overall, funnel plot and Begg’s test did not indicate obvious publication bias.

Conclusion

The 3D-printed navigation template in the cervical surgery can improve accuracy of pedicle screw placement and consequently improve outcomes. In future, multi-center efforts are needed to validate the relationships found in this review.

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Abbreviations

3DPN-template:

Three-dimensional-printed navigation template (3DPN-template)

CMA:

Comprehensive Meta-analysis Software

References

  1. Winegar CD, Lawrence JP, Friel BC, Fernandez C, Hong J, Maltenfort M, Anderson PA, Vaccaro AR (2010) A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine 13:5–16. https://doi.org/10.3171/2010.3.SPINE08143

    Article  PubMed  Google Scholar 

  2. Youmans and Winn Neurological Surgery (2017) Posterior subaxial and cervicothoracic instrumentation, 4-Volume Set - 7th edn, p 2668

  3. Mummaneni PV, Haid RW (2005) Atlantoaxial fixation: overview of all techniques. Neurol India. https://doi.org/10.4103/0028-3886.22606

    Article  PubMed  Google Scholar 

  4. Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M (2000) Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 25:2637–2645. https://doi.org/10.1097/00007632-200010150-00016

    Article  CAS  PubMed  Google Scholar 

  5. Kovanda TJ, Ansari SF, Qaiser R, Fulkerson DH (2015) Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience. J NeurosurgPediatr 16:590–598. https://doi.org/10.3171/2015.2.PEDS14556

    Article  Google Scholar 

  6. 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). https://doi.org/10.1097/00007632-200106150-00017

    Article  Google Scholar 

  7. Tack P, Victor J, Gemmel P, Annemans L (2016) 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online. https://doi.org/10.1186/s12938-016-0236-4

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wilcox B, Mobbs RJ, Wu AM, Phan K (2017) Systematic review of 3D printing in spinal surgery the current state of play. J Spine Surg 3(3):433–443

    Article  Google Scholar 

  9. Tian Y, Zhang J, Liu T, Tang S, Chen H, Ding K, Hao D (2019) A Comparative Study of C2 Pedicle or Pars Screw Placement with Assistance from a 3-Dimensional (3D)-Printed Navigation Template versus C-Arm Based Navigation. Med Sci Monit 25:9981–9990

    Article  Google Scholar 

  10. Jiang L, Dong L, Tan M, Qi Y, Yang F, Yi P, Tang X (2017) A Modified Personalized Image-Based Drill Guide Template for Atlantoaxial Pedicle Screw Placement: a Clinical Study. Med SciMonit 23:1325–1333

    Google Scholar 

  11. Yu C, Ou Y, Xie C, Zhang Y, Wei J, Mu X (2020) Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis. J Orthop Surg. https://doi.org/10.1186/s13018-019-1510-5

    Article  Google Scholar 

  12. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647. https://doi.org/10.1136/bmj.g7647

    Article  PubMed  Google Scholar 

  13. Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P (2020) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. https://www.ohri.ca/ programs/clinical_epidemiology/nosgen.pdf. Accessed on April 18, 2020.

  14. Hedges LV, Olkin I (1985) Statistical methods for meta-analysis. Academic Press, Orlando, FL

    Google Scholar 

  15. 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(Ohila Pa 1976) 37:1983–1988

    Article  Google Scholar 

  16. Kaneyama S, Sugawara T, Sumi M, Higashiyama N, Takabatake M, Mizoi K (2014) A novel screw guiding method with a screw guide template system for posterior C-2 fixation: clinical article. J Neurosurg Spine 21:231–238. https://doi.org/10.3171/2014.3.SPINE13730

    Article  PubMed  Google Scholar 

  17. KaneyamaSugawaraSumi STM (2015) Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system. Spine(Phila Pa 1976) 40:E341–E348. https://doi.org/10.1097/BRS.0000000000000772

    Article  Google Scholar 

  18. Deng T, Jiang M, Lei Q, Cai L, Chen L (2016) The accuracy and the safety of individualized 3D printing screws insertion templates for cervical screw insertion. Comput Assist Surg (Abingdon) 21:143–149. https://doi.org/10.1080/24699322.2016.1236146

    Article  Google Scholar 

  19. Sugawara T, Higashiyama N, Kaneyama S, Sumi M (2017) Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C1–C2 fixation. Spine 42:E340–E346. https://doi.org/10.1097/BRS.0000000000001807

    Article  PubMed  Google Scholar 

  20. Guo F, Dai J, Zhang J, Ma Y, Zhu G, Shen J, Niu G (2017) Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS ONE 12:e0171509. https://doi.org/10.1371/journal.pone.0171509

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Wu X, Liu R, Yu J, Lu L, Yang C, Shao Z, Ye Z (2017) Deviation analysis for C1/2 pedicle screw placement using a three-dimensional printed drilling guide. ProcInstMechEng H 231:547–554. https://doi.org/10.1177/0954411916680382

    Article  Google Scholar 

  22. PuLuoLuYaoChen XCTS1Q (2018) Clinical application of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. Clinics (Sao Paulo) 73:e259. https://doi.org/10.6061/clinics/2018/e259

    Article  Google Scholar 

  23. Pu X, Yin M, Ma J, Liu Y, Chen G, Huang Q, Zhao G, Lu T, Yao S, Chen Q, Luo C (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. https://doi.org/10.1016/j.wneu.2017.11.042

    Article  PubMed  Google Scholar 

  24. Sugawara T, Kaneyama S, Higashiyama N, Tamura S, Endo T, Takabatake M, Sumi M (2018) Prospective multicenter study of a multistep screw insertion technique using patient-specific screw guide templates for the cervical and thoracic spine. Spine(Phila.Pa.1976) 43:1685–1694. https://doi.org/10.1097/BRS.0000000000002810

    Article  Google Scholar 

  25. Wang F, Li CH, Liu ZB, Hua ZJ, He YJ, Liu J, Liu YX, Dang XQ (2019) The effectiveness and safety of 3-dimensional printed composite guide plate for atlantoaxial pedicle screw: a retrospective study. Medicine (Baltimore) 98:e13769. https://doi.org/10.1097/MD.0000000000013769

    Article  Google Scholar 

  26. Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine(Phila Pa 1976) 15:11–14. https://doi.org/10.1097/00007632-199001000-00004

    Article  CAS  Google Scholar 

  27. Hlubek RJ, Bohl MA, Cole TS, Morgan CD, Xu DS, Chang SW, Turner JD, Kakarla UK (2018) Safety and accuracy of freehand versus navigated C2 pars or pedicle screw placement. Spine J 18:1374–1381. https://doi.org/10.1016/j.spinee.2017.12.003

    Article  PubMed  Google Scholar 

  28. Fan Y, Du JP, Wu QN, Zhang JN, Hao DJ (2017) Accuracy of a patient-specific template for pedicle screw placement compared with a conventional method: a meta-analysis. Arch Orthop Trauma Surg 137:1641–1649. https://doi.org/10.1007/s00402-017-2815-7

    Article  PubMed  Google Scholar 

  29. Lu T, Liu C, Dong J, Lu M, Li H, He X (2016) Cervical screw placement using rapid prototyping drill templates for navigation: a literature review. Int J Comput Assist Radiol Surg 11:2231–2240. https://doi.org/10.1007/s11548-016-1414-3

    Article  PubMed  Google Scholar 

  30. Shin BJ, James AR, NjokuIU HR (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. https://doi.org/10.3171/2012.5.SPINE11399

    Article  PubMed  Google Scholar 

  31. Dea N, Fisher CG, Batke J, Strelzow J, Mendelsohn D, Paquette SJ, Kwon BK, Boyd MD, Dvorak MF, Street JT (2016) Economic evaluation comparing intraoperative cone beam CT-based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: a patient level data cost-effectiveness analysis. Spine J 16:23–31. https://doi.org/10.1016/j.spinee.2015.09.062

    Article  PubMed  Google Scholar 

  32. Rajasekaran S, Bhushan M, Aiyer S, Kanna R, Shetty AP (2018) Accuracy of pedicle screw insertion by AIRO((R)) intraoperative CT in complex spinal deformity assessed by a new classification based on technical complexity of screw insertion. Eur Spine J 27:2339–2347. https://doi.org/10.1007/s00586-017-5453-4

    Article  CAS  PubMed  Google Scholar 

  33. Costa F, Cardia A, Ortolina A, Fabio G, Zerbi A, Fornari M (2011) Spinal navigation: standard preoperative versus intraoperative computed tomography data set acquisition for computer-guidance system: radiological and clinical study in 100 consecutive patients. Spine(Phila Pa 1976) 36:2094–2098. https://doi.org/10.1097/BRS.0b013e318201129d

    Article  Google Scholar 

  34. Oertel MF, Hobart J, Stein M, Schreiber V, Scharbrodt W (2011) Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging. J Neurosurg Spine 14:532–536. https://doi.org/10.3171/2010.10.SPINE091032

    Article  PubMed  Google Scholar 

  35. Pedicle screw positioning with MySpinevs free hand technique (2020). https://clinicaltrials.gov/ct2/show/NCT03369158. Accessed on April 2020

  36. Wu X, Liu R, Xu S, Yang C, Yang S, Shao Z, Li S, Ye Z (2019) Feasibility of mixed reality-based intraoperative three-dimensional image-guided navigation for atlanto-axial pedicle screw placement. Proc Inst Mech Eng H 33:1310–1317. https://doi.org/10.1177/0954411919881255

    Article  Google Scholar 

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Authors and Affiliations

  1. NeuroScience Research Center, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, 19839-63113, Tehran, Iran

    Parisa Azimi

  2. School of Medicine, Capital Medical University, Beijing, China

    Taravat Yazdanian

  3. Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Edward C. Benzel

  4. Department of Mechanical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran

    Ali Azimi

  5. Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

    Ali Montazeri

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  1. Parisa Azimi
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Correspondence to Parisa Azimi.

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Azimi, P., Yazdanian, T., Benzel, E.C. et al. 3D-printed navigation template in cervical spine fusion: a systematic review and meta-analysis. Eur Spine J 30, 389–401 (2021). https://doi.org/10.1007/s00586-020-06601-6

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  • DOI: https://doi.org/10.1007/s00586-020-06601-6

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