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J Neurol Surg A Cent Eur Neurosurg 2023; 84(02): 188-197
DOI: 10.1055/a-1938-0254
Review Article

Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis

Chunli Lu  ‡   *
1   Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
2   Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
3   Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
,
Longbing Ma‡   *
1   Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
2   Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
3   Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
,
Xinyu Wang
1   Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
2   Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
3   Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
,
Qingyu Yao
1   Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
4   National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
,
Can Zhang
1   Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
2   Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
3   Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
,
Yueqi Du
1   Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
2   Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
3   Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
,
Wei Li
1   Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
2   Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
3   Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
,
Fengzeng Jian
1   Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
2   Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
3   Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
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Abstract

Background There is a lack of attention to screw placement techniques for surgical treatment of scoliosis in children and adolescents. This meta-analysis aims to compare the accuracy and safety of pedicle screw placement between the 3D-printed navigation template technique and the freehand technique during corrective surgery for scoliosis in children and adolescents.

Methods A comprehensive search was conducted for relevant articles up to December 2021 in databases including PubMed, Embase, MEDLINE, Cochrane, and Web of Science. The systematic meta-analysis compared the efficacy of pedicle screw placement between the two techniques, including accuracy of pedicle screw placement, complication rate, operation time, blood loss, mean placement time per screw, and mean times for fluoroscopy.

Results The seven articles analyzed in this study involved 229 patients altogether. A total of 2,805 pedicle screws were placed by the two methods. Our results revealed that the 3D-printed guide template technique was more accurate than the freehand technique in pedicle screw placement (odds ratio [OR] =2.96; 95% confidence interval [CI]: 2.24–3.91; p < 0.000) with a lower complication rate (OR = 0.21; 95% CI: 0.06–0.78; p = 0.02). The operation time (mean difference [MD] = –34.37; 95% CI: –67.47 to –1.28; p = 0.04) and mean placement time per screw (MD = –3.11; 95% CI: –6.13 to –0.09; p = 0.04) and mean times for fluoroscopy (MD = –6.60; 95% CI: –8.66 to –4.55; p < 0.000) significantly decreased among patients in the 3D-printed navigation template group compared with those in the freehand technique group. In addition, the two techniques had no significant statistical difference in blood loss.

Conclusions Compared with the traditional freehand technique, the 3D-printed guide template is a promising technique with higher accuracy and safety in screw placement for surgical treatment of scoliosis in children and adolescents, and is worth popularizing and validating through more prospective clinical studies.

Keywords

3D printing - drill guide template - freehand technique - pedicle screw - scoliosis

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Xuanwu Hospital, Capital Medical University.


Authors' Contributions

All the authors contributed to the study's concept and design. Material preparation, data collection, and analysis were performed by Chunli Lu, Longbing Ma, and Xinyu Wang. The first draft of the manuscript was written by Chunli Lu and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.


* Chunli Lu and Longbing Ma contributed equally to this work.




Publication History

Received: 05 March 2022

Accepted: 01 September 2022

Accepted Manuscript online:
07 September 2022

Article published online:
09 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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