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Pedicle screw placement safety with the aid of patient-specific guides in a case series of patients with thoracic scoliosis

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Abstract

Purpose

Pedicle screw (PS) placement in thoracic scoliotic deformities can be challenging due to altered vertebral anatomy; malposition can result in severe functional disability or inferior construct stability. Three-dimensional (3D) printed patient-specific guides (PSGs) have been recently used to supplement other PS placement techniques. We conducted a single-center, retrospective observational study to assess the accuracy of PS placement using PSGs in a consecutive case series of pediatric and adult patients with thoracic scoliosis.

Methods

We analyzed the data of patients with thoracic scoliosis who underwent PS placement using 3D-printed PSG as a vertebral cannulation aid between June 2013 and July 2018. PS positions were determined via Gertzbein–Robbins (GR) and Heary classifications on computed tomography images. We determined the concordance of actual and preoperatively planned PS positions and defined the technique learning curve using a receiver-operating characteristic (ROC) curve.

Results

We performed 362 thoracic PS placement procedures in 39 consecutive patients. We classified 352 (97.2%), 2 (0.6%), and 8 (2.2%) screws as GR grades 0 (optimal placement), I, and II, respectively. The average instrumented PS entry point offsets on the X- and Y-axes were both 0.8 mm, and the average differences in trajectory between the planned and the actual screw placements on the oblique sagittal and oblique transverse planes were 2.0° and 2.4°, respectively. The learning process was ongoing until the first 12 PSs were placed.

Conclusions

The accuracy of PS placement using patient-specific 3D templates in our case series exceeds the accuracies of established thoracic PS placement techniques.

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Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Spine Surgery, Valdoltra Orthopedic Hospital, Jadranska C. 31, 6280, Ankaran, Europe, Slovenia

    Janez Mohar, Matej Valič, Eva Podovšovnik & Rene Mihalič

  2. Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia

    Janez Mohar & Rene Mihalič

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  1. Janez Mohar
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  2. Matej Valič
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  3. Eva Podovšovnik
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  4. Rene Mihalič
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Correspondence to Janez Mohar.

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Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board and Ethics Committee of Valdoltra Orthopedic Hospital (Document No. 1/2017, issued on January 13th, 2017).

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Informed consent was obtained from all individual participants included in the study.

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Mohar, J., Valič, M., Podovšovnik, E. et al. Pedicle screw placement safety with the aid of patient-specific guides in a case series of patients with thoracic scoliosis. Eur Spine J 31, 3544–3550 (2022). https://doi.org/10.1007/s00586-022-07427-0

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  • DOI: https://doi.org/10.1007/s00586-022-07427-0

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