Use of a Customized Three-dimensional Guide in Preparing the Pilot Pedicle Hole in Spinal Deformities

Abstract

Objective The present study aimed to develop and evaluate the use of customized guides in patients undergoing surgery to correct vertebral deformity with a pedicular fixation system.

Methods Four patients with spinal deformity (three with idiopathic scoliosis and one with congenital kyphoscoliosis) underwent surgical treatment to correct the deformity with a pedicular fixation system. Prototypes of 3D cost guides were developed and evaluated using technical feasibility, accuracy, and radiation exposure.

Results The present study included 85 vertebral pedicles in which pedicle screws were inserted into the thoracic spine (65.8%) and into the lumbar spine (34.2%). Technical viability was positive in 46 vertebral pedicles (54.1%), with 25 thoracic (54%) and 21 lumbar (46%). Technical viability was negative in 39 pedicles (45.9%), 31 of which were thoracic (79.5%), and 8 were lumbar (20.5%). In assessing accuracy, 36 screws were centralized (78.2%), of which 17 were in the thoracic (36.9%) and 19 in the lumbar spine (41.3%). Malposition was observed in 10 screws (21.7%), of which 8 were in the thoracic (17.4%) and 2 in the lumbar spine (4.3%). The average radiation record used in the surgical procedures was of 5.17 ± 0.72 mSv, and the total time of use of fluoroscopy in each surgery ranged from 180.3 to 207.2 seconds.

Conclusion The customized guide prototypes allowed the safe preparation of the pilot orifice of the vertebral pedicles in patients with deformities with improved accuracy and reduced intraoperative radiation.

Keywords

fractures, bone - congenital abnormalities - spine - thoracic vertebrae

Contribution of the Authors

(I) Conception and design: Teixeira K.O., Defino H.L.A.; (II) Administrative support: none; (III) Supply of study materials or of patientes: all authors; (IV) Collection and assembly of data: Teixeira K.O., Matos T.D., Fleury R.B.C.; (V) Data analysis and interpretation : Teixeira K.O., Bergamaschi J.P.M., Defino H.L.A.; (VI) Writing of the manuscript: all authors; (VII) Final approval of the manuscript: all authors.

Financial Support

This work was supported by the Instituto de Pesquisa e Ensino Home, Brasília, DF, Brazil.

Work developed at the Orthopedics and Traumatology Department, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Publication History

Received: 31 July 2020

Accepted: 02 October 2020

Article published online:
13 August 2021

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