Skip to main content

Advertisement

Log in

A novel computer-assisted drill guide template for thoracic pedicle screw placement: a cadaveric study

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The objective of this study was to develop a novel, patient-specific, navigational template for thoracic pedicle screw placement.

Methods

Twenty thoracic cadaver specimens were randomly divided into two groups of 10: the navigational template group and the free-hand group. A volumetric CT scan was performed on each thoracic vertebra, and a three-dimensional reconstruction model was generated. A drill template was designed with a surface that was the inverse of the posterior vertebral surface. Each drill template and its corresponding vertebra were manufactured using a rapid prototyping technique and tested for violation. Two hundred and forty screws were implanted into the thoracic spines and the positions of the screws were evaluated.

Results

Two hundred and forty thoracic screws were inserted using either the navigational template method or the free-hand method. The accuracy rate and incidence of risk for setting thoracic pedicle screws differed statistically between the two methods (P < 0.05): The navigational template method had a higher accuracy rate and a lower incidence of risk than the free-hand method. Moreover, the free-hand method had a significant learning curve, whereas a learning curve for the navigational template method was not obvious.

Conclusion

We have developed a novel, patient-specific, navigational template for thoracic pedicle screw placement with good applicability and high accuracy.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29(18):2040–2048 00007632-200409150-00014

    Article  Google Scholar 

  2. Lee SM, Suk SI, Chung ER (2004) Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29(3):343–349 00007632-200402010-00020

    Article  Google Scholar 

  3. Liljenqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976) 22(19):2239–2245

    Article  CAS  Google Scholar 

  4. Amiot LP, Lang K, Putzier M, Zippel H, Labelle H (2000) Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine 25(5):606

    Article  PubMed  CAS  Google Scholar 

  5. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29(3):333

    Article  PubMed  Google Scholar 

  6. Panjabi MM, O’Holleran JD, Crisco JJ 3rd, Kothe R (1997) Complexity of the thoracic spine pedicle anatomy. Eur Spine J 6(1):19–24

    Article  PubMed  CAS  Google Scholar 

  7. Ebraheim NA, Jabaly G, Xu R, Yeasting RA (1997) Anatomic relations of the thoracic pedicle to the adjacent neural structures. Spine (Phila Pa 1976) 22(14):1553–1556 discussion 1557

    Article  CAS  Google Scholar 

  8. Vaccaro AR, Rizzolo SJ, Allardyce TJ, Ramsey M, Salvo J, Balderston RA, Cotler JM (1995) Placement of pedicle screws in the thoracic spine. Part I: Morphometric analysis of the thoracic vertebrae. J Bone Joint Surg Am 77(8):1193–1199

    PubMed  CAS  Google Scholar 

  9. Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, An HS (1995) Placement of pedicle screws in the thoracic spine. Part II: An anatomical and radiographic assessment. J Bone Joint Surg Am 77(8):1200–1206

    PubMed  CAS  Google Scholar 

  10. Lu S, Xu YQ, Zhang YZ, Li YB, Xie L, Shi JH, Guo H, Chen GP, Chen YB (2009) A novel computer-assisted drill guide template for lumbar pedicle screw placement: a cadaveric and clinical study. Int J Med Robot 5(2):184–191

    Article  PubMed  Google Scholar 

  11. Xu R, Ebraheim NA, Ou Y, Yeasting RA (1998) Anatomic considerations of pedicle screw placement in the thoracic spine. Roy-Camille technique versus open-lamina technique. Spine (Phila Pa 1976) 23(9):1065–1068

    Article  CAS  Google Scholar 

  12. Yingsakmonkol W, Karaikovic E, Gaines RW (2002) The accuracy of pedicle screw placement in the thoracic spine using the “funnel technique”: Part 1 a cadaveric study. J Spinal Disord Tech 15(6):445

    Article  PubMed  Google Scholar 

  13. Kuntz IV C, Maher PC, Levine NB, Kurokawa R (2004) Prospective evaluation of thoracic pedicle screw placement using fluoroscopic imaging. J Spinal Disord Tech 17(3):206

    Article  Google Scholar 

  14. Rajasekaran S, Vidyadhara S, Ramesh P, Shetty AP (2007) Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976) 32(2):E56–E64. doi:10.1097/01.brs.0000252094.64857.ab

    Article  CAS  Google Scholar 

  15. Mirza SK, Wiggins GC, Kuntz Iv C, York JE, Bellabarba C, Knonodi MA, Chapman JR, Shaffrey CI (2003) Accuracy of thoracic vertebral body screw placement using standard fluoroscopy, fluoroscopic image guidance, and computed tomographic image guidance: a cadaver study. Spine 28(4):402

    PubMed  Google Scholar 

  16. Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, Teodorescu V, Hollier LH, Marin ML (2004) Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report. J Vasc Surg 39(4):893–896. doi:10.1016/j.jvs.2003.10.056

    Article  PubMed  Google Scholar 

  17. O’Brien JR, Krushinski E, Zarro CM, Sciadini M, Gelb D, Ludwig S (2006) Esophageal injury from thoracic pedicle screw placement in a polytrauma patient: a case report and literature review. J Orthop Trauma 20(6):431–434. doi:10.1097/00005131-200607000-00012

    Article  PubMed  Google Scholar 

  18. Di Silvestre M, Parisini P, Lolli F, Bakaloudis G (2007) Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976) 32(15):1655–1661. doi:10.1097/BRS.0b013e318074d604

    Article  Google Scholar 

  19. Kakkos SK, Shepard AD (2008) Delayed presentation of aortic injury by pedicle screws: report of two cases and review of the literature. J Vasc Surg 47(5):1074–1082

    Article  PubMed  Google Scholar 

  20. Bransford R, Bellabarba C, Thompson JH, Henley MB, Mirza SK, Chapman JR (2006) The safety of fluoroscopically-assisted thoracic pedicle screw instrumentation for spine trauma. J Trauma 60(5):1047–1052. doi:10.1097/01.ta.0000215949.95089.18

    Article  PubMed  Google Scholar 

  21. Husted DS, Yue JJ, Fairchild TA, Haims AH (2003) An extrapedicular approach to the placement of screws in the thoracic spine: an anatomic and radiographic assessment. Spine (Phila Pa 1976) 28(20):2324–2330. doi:10.1097/01.BRS.0000085361.32600.63

    Article  Google Scholar 

  22. White KK, Oka R, Mahar AT, Lowry A, Garfin SR (2006) Pullout strength of thoracic pedicle screw instrumentation: comparison of the transpedicular and extrapedicular techniques. Spine (Phila Pa 1976) 31(12):E355–E358. doi:10.1097/01.brs.0000219394.48091.d6

    Article  Google Scholar 

  23. Upendra BN, Meena D, Chowdhury B, Ahmad A, Jayaswal A (2008) Outcome-based classification for assessment of thoracic pedicular screw placement. Spine (Phila Pa 1976) 33(4):384–390. doi:10.1097/BRS.0b013e3181646ba1

    Article  Google Scholar 

  24. Guzey FK, Emel E, Hakan Seyithanoglu M, Serdar Bas N, Ozkan N, Sel B, Aycan A, Alatas I (2006) Accuracy of pedicle screw placement for upper and middle thoracic pathologies without coronal plane spinal deformity using conventional methods. J Spinal Disord tech 19(6):436

    Article  PubMed  Google Scholar 

  25. Bergeson RK, Schwend RM, DeLucia T, Silva SR, Smith JE, Avilucea FR (2008) How accurately do novice surgeons place thoracic pedicle screws with the free hand technique? Spine 33(15):E501

    Article  PubMed  Google Scholar 

  26. Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM (2001) Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 48(4):771–778 discussion 778–779

    PubMed  CAS  Google Scholar 

  27. Belmont PJ Jr, Klemme WR, Dhawan A, Polly DW Jr (2001) In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976) 26(21):2340–2346

    Article  Google Scholar 

  28. Berry E, Cuppone M, Porada S, Millner PA, Rao A, Chiverton N, Seedhom BB (2005) Personalised image-based templates for intra-operative guidance. Proc Inst Mech Eng H 219(2):111–118

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr Yu-Hua Cheng for his assistance with the CT data collection. This work was supported by the Yunnan Natural Science Foundation (Grant No. 2010ZC183).

Conflict of interest

None declared.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sheng Lu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ma, T., Xu, YQ., Cheng, YB. et al. A novel computer-assisted drill guide template for thoracic pedicle screw placement: a cadaveric study. Arch Orthop Trauma Surg 132, 65–72 (2012). https://doi.org/10.1007/s00402-011-1383-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-011-1383-5

Keywords

Navigation