3D-printed thoracolumbar spine tuberculosis model and guide plate to guide the accuracy and safety of surgery

doi:10.12307/2022.750

Abstract

Abstract: BACKGROUND: Debridement of spinal tuberculosis lesions with bone graft fusion and internal fixation is a common clinical standard procedure. With the help of the personalized lesion model made by 3D printing, the preoperative planning and the production of surgical nail guides to assist the operation can not only reduce the risk of surgery, but also have higher surgical efficiency and precision compared with traditional methods.
OBJECTIVE: To explore the accuracy and safety of 3D-printed thoracolumbar spine tuberculosis model and guide plate to guide the operation.
METHODS: From July 2017 to December 2019, there were 61 cases of tuberculosis of thoracolumbar spine treated in Affiliated Hospital of Zunyi Medical University. The patients were divided into 3D group and traditional group. Before operation, thin-layer CT image data of the diseased segments of 24 patients in the 3D group were collected and the thoracolumbar spine tuberculosis model was printed with a 3D printer. The pedicle screw guide plate was designed and produced by 3D printing technology, and the model and guide plate were used to formulate the surgical plan and guide the surgical treatment. In the traditional group (n=37), after the CT and X-ray imaging examinations before surgery, the patients were discussed and operated according to the traditional surgical methods. The operation time, intraoperative blood loss, nail placement time, C-arm fluoroscopy number, acceptable nail placement percentage, nail placement accuracy rate, and Cobb angle correction of patients were observed and recorded in 3D group and traditional group. Whether it caused complications such as nerves, blood vessels, and visceral injury was observed.
RESULTS AND CONCLUSION: (1) All patients successfully completed the operation. The operation time, intraoperative blood loss, time spent nailing, and C-arm fluoroscopy times were significantly better in the 3D group than those in the traditional group (P < 0.05). The postoperative hospital stay and postoperative drainage were not statistically significant (P > 0.05). (2) There was no statistically significant difference between the parameters of 3D-printed model data before operation and CT data after operation in the 3D group (P > 0.05). (3) There was no significant difference between the two groups in the accuracy of nail placement and the percentage of acceptable nail placement (P > 0.05). (4) There were no complications such as blood vessels, viscera or nerve injury in the two groups. (5) It is concluded that 3D printing technology is used to simulate thoracolumbar spine tuberculosis model planning operation plan; printing pedicle screw guides to guide nail placement is feasible. They have high efficiency, high precision and high safety, and can provide a reference for the surgical treatment of thoracolumbar spine tuberculosis.

Key words: thoracolumbar tuberculosis, 3D printing, spinal surgery, three-dimensional model, nail placement

CLC Number:

Yang Yi, Cao Guangru, Wang Chong, Yuan Hao, Cai Yuqiang. 3D-printed thoracolumbar spine tuberculosis model and guide plate to guide the accuracy and safety of surgery[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(36): 5798-5806.

Figures/Tables 10

References

[1] 高静韬,刘宇红.2018年世界卫生组织全球结核病报告要点解读[J].国际呼吸杂志,2019,39(19):1441-1446.
[2] DUNN RN,BEN HUSIEN M. Spinal tuberculosis: review of current management. Bone Joint. 2018;100-B(4):425-431.
[3] ELLIS H. Percival Pott; Pott’s fracture, Pott’s disease of the spine, Pott’s paraplegia. J Perioper Pract. 2012;22(11):366-367.
[4] 杨学军,霍洪军,肖宇龙,等.胸腰椎结核一期病灶清除重建脊柱前中柱功能[J].中国修复重建外科杂志,2010,24(1):37-40.
[5] JAIN AK. Tuberculosis of the spine: a fresh look at an old disease. Bone Joint Surg Br. 2010;92(7):905-913.
[6] MOON MS. Tuberculosis of spine: current views in diagnosis and management. Asian Spine. 2014;8(1):97-111.
[7] SOARES DO BRITO J, BATISTA N, TIRADO A, et al. Surgical Treatment of Spinal Tuberculosis: An Orthopedic Service Experience. Acta Med Port. 2013;26(4):349-356.
[8] JUTTE PC, VAN LOENHOUT-ROOYACKERS JH. Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev. 2006;(5):CD004532.
[9] KHANNA K, SABHARWAL S. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine(Phila Pa 1976). 2019; 19(11):1858-1870.
[10] BERGESON RK, SCHWEND RM, DELUCIA T, et al. How accurately do novice surgeons place thoracic pedicle screws with the free hand technique. Spine (Phila Pa 1976). 2008;33(15):501-507.
[11] UPENDRA BN, MEENA D, CHOWDHURY B, et al. Outcome-based classification for assessment of thoracic pedicular screw placement. Spine (Phila Pa 1976). 2008;33(4):384-390.
[12] SMORGICK Y, MILLGRAM MA, ANEKSTEIN Y,et al. Accuracy and safety of thoracic pedicle screw placement in spinal deformities. J Spinal Disord Tech. 2005;18(6):522-526.
[13] DI SILVESTRE M, PARISINI P, LOLLI F, et al. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976). 2007; 32(15):1655-1661.
[14] CARBONE JJ, TORTOLANI PJ, QUARTARARO LG. Fluoroscopically assisted pedicle screw fixation for thoracic and thoracolumbar injuries: technique and short-term complications. Spine (Phila Pa 1976). 2003; 28(1):91-97.
[15] MOHANTY SP, BHAT SN, PAI KANHANGAD M, et al. Pedicle screw fixation in thoracolumbar and lumbar spine assisted by lateral fluoroscopic imaging: a study to evaluate the accuracy of screw placement. Musculoskelet Surg. 2018;102(1):47-55.
[16] YINGSAKMONGKOL W, HANGSAPHUK N, LERDLAM S. The accuracy of pedicle screw placement in thoracic spine using the Funnel technique in idiopathic scoliosis. Med Assoc Thailand. 2007;90(1): 96-105.
[17] LIAO Y, YE R, TANG Q, et al. Is it necessary to perform the second surgery stage of anterior debridement in the treatment of spinal tuberculosis. World Neurosurg. 2019;3(19):1878-1883.
[18] MUHEREMU A, NIU X, WU Z, et al. Study on anterior and posterior approaches for spinal tuberculosis: a meta-analysis. Eur J Orthop Surg Traumatol. 2015;25(1):69-76.
[19] SIVERSSON C, AKHONDI-ASL A, BIXBY S, et al. Three-dimensional hip cartilage quality assessment of morphology and dGEMRIC by planar maps and automated segmentation. Osteoarthritis Cartilage. 2014;22(10):1511-1515.
[20] BASTAWROUS S, WAKE N, LEVIN D, et al. Principles of three-dimensional printing and clinical applications within the abdomen and pelvis. Abdom Radiol (NY). 2018;43(10):2809-2822.
[21] GALVEZ M, MONTOYA CE, FUENTES J, et al. Error Measurement Between Anatomical Porcine Spine, CT Images, and 3D Printing. Acad Radiol. 2020;27(5):651-660.
[22] VENTOLA CL. Medical Applications for 3D Printing: Current and Projected Uses. Pharm Ther. 2014;39(10):704.
[23] GALVEZ M, ASAHI T, BAAR A, et al. Use of Three-dimensional Printing in Orthopaedic Surgical Planning. Am Acad Orthop Surg. 2018;2(5):71.
[24] CHAE MP, LIN F, SPYCHAL RT, et al. 3D-Printed haptic “Reverse”models for preoperative planning in soft tissue reconstruction: A case report. Microsurgery. 2015;35(2):148-153.
[25] LI XS, WU ZH, XIA H, et al. The development and evaluation of individualized templates to assist transoral C2 articular mass or transpedicular screw placement in TARP-IV procedures: adult cadaver specimen study. Clinics (Sao Paulo). 2014;69(11):750-757.
[26] LEE GY, MASSICOTTE EM, RAMPERSAUD YR. Clinical accuracy of cervicothoracic pedicle screw placement: a comparison of the “open” lamino-foraminotomy and computer-assisted techniques. J Spinal Disord Tech. 2007;20(1):25-32.
[27] KOLLER H, HITZL W, ACOSTA F, et al. In vitro study of accuracy of cervical pedicle screw insertion using an electronic conductivity device (ATPS part III). Eur Spine J. 2009;18(9):1300-1313.
[28] FU M, LIN L, KONG X, et al. Construction and accuracy assessment of patient-specific biocompatible drill template for cervical anterior transpedicular screw (ATPS) insertion: an in vitro study. PLoS One. 2013;8(1):3580.
[29] REICHLE E, MORLOCK M, SELLENSCHLOH K, et al.Definition of pedicle malposition. Primary stability and loosening characteristics of pedicle screws in relation to position: spongious anchoring, cortical anchoring, perforation and malposition. Orthopade. 2002;31(4):402-405.
[30] WU AM, LIN JL, KWAN K, et al. 3D-printing techniques in spine surgery: the future prospects and current challenges. Exp Rev Med Dev. 2018; 15(6):399-401.
[31] IZATT MT, THORPE PL, THOMPSON RG, et al. The use of physical biomodelling in complex spinal surgery. Eur Spine. 2007;16(9):1507-1518.
[32] D’URSO PS, WILLIAMSON OD, THOMPSON RG. Biomodeling as an aid to spinal instrumentation. Spine (Phila Pa 1976). 2005;30(24):2841-2845.
[33] WU AM, SHAO ZX, WANG JS, et al. The accuracy of a method for printing three-dimensional spinal models. PLoS One. 2015;10(4):4291.
[34] WILCOX B, MOBBS RJ, WU AM, et al.Systematic review of 3D printing in spinal surgery: the current state of play. Spine Surg. 2017;3(3):433-443.
[35] WU AM, WANG S, WENG WQ, et al. The radiological feature of anterior occiput-to-axis screw fixation as it guides the screw trajectory on 3D printed models: a feasibility study on 3D images and 3D printed models. Medicine (Baltimore). 2014;93(28):242.
[36] WU ZX, HUANG LY, SANG HX, et al. Accuracy and safety assessment of pedicle screw placement using the rapid prototyping technique in severe congenital scoliosis. J Spinal Disord Tech. 2011;24(7):444-450.
[37] GUARINO J, TENNYSON S, MCCAIN G, et al. Rapid prototyping technology for surgeries of the pediatric spine and pelvis: benefits analysis. Pediatric Orthop. 2007;27(8):955-960.
[38] GRANT CA, IZATT MT, LABROM RD, et al. Use of 3D Printing in Complex Spinal Surgery. Techniq Orthop. 2016;31(3):172-180.
[39] LU S, XU YQ, CHEN GP, et al. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement. Comput Aided Surg. 2011;16(5):240-248.
[40] SHAO ZX, WANG JS, LIN ZK, et al. Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computer-assisted 3D-printed custom drill guide. Peer. 2017;5(3):3564.
[41] SUGAWARA T, HIGASHIYAMA N, KANEYAMA S, et al. Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine: clinical article. Neurosurg Spine. 2013; 19(2):185-190.
[42] SHETTY A, KANNA RM, RAJASEKARAN S. TB Spine – Current Aspects on Clinical Presentation, Diagnosis And Management Options. Semin Spine Surg. 2015;28(3):85-90.
[43] SAE-JUNG S, WONGBA N, LEURMPRASERT K. Predictive factors for neurological deficit in patients with spinal tuberculosis. Orthop Surg (Hong Kong). 2019;27(3):8813.
[44] ZENG Y, CHENG P, TAN J, et al. Comparison of three surgical approaches for thoracolumbar junction (T12-L1) tuberculosis: a multicentre, retrospective study. BMC Musculoskelet Disord. 2019;20(1):524.
[45] PARK DW, SOHN JW, KIM EH, et al. Outcome and Management of Spinal Tuberculosis According to the Severity of Disease. Spine (Phila Pa 1976). 2007;32(4):130-135.
[46] COQUEUGNIOT H, DUTAILLY B, DESBARATS P, et al. Three-dimensional imaging of past skeletal TB: From lesion to process. Tuberculosis (Edinb). 2015;95(1):73-79.
[47] MOBBS RJ, COUGHLAN M, THOMPSON R, et al. The utility of 3D printing for surgical planning and patient-specific implant design for complex spinal pathologies: case report. J Neurosurg Spine. 2017; 26(4):513-518.
[48] TAN LA, YERNENI K, TUCHMAN A, et al. Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction. Spine Surg. 2018;4(2):319-327.
[49] SUGAWARA T, HIGASHIYAMA N, KANEYAMA S, et al. Accurate and Simple Screw Insertion Procedure With Patient-Specific Screw Guide Templates for Posterior C1-C2 Fixation. Spine (Phila Pa 1976). 2017;42(6):340-346.
[50] PROVAGGI E, LEONG J, KALASKAR DM. Applications of 3D printing in the management of severe spinal conditions. Proc Inst Mech Eng H. 2017;231(6):471-486.
[51] DENG T, JIANG M, LEI Q, et al. The accuracy and the safety of individualized 3D printing screws insertion templates for cervical screw insertion. Comput Assist Surg (Abingdon). 2016;21(1):143-149.
[52] LIU K, ZHANG Q, LI X, et al. Preliminary application of a multi-level 3D printing drill guide template for pedicle screw placement in severe and rigid scoliosis. Eur Spine. 2017;26(6):1684-1689.
[53] PLOS ONE EDITORS. Correction: Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One. 2019;14(2):2213.
[54] GUO F, DAI J, ZHANG J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One. 2017;12(2):1509.
[55] TIAN NF, XU HZ. Image-guided pedicle screw insertion accuracy: a meta-analysis. Int Orthop. 2009;33(4):895-903.
[56] MENDELSOHN D, STRELZOW J, DEA N, et al. Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation. Spine (Phila Pa 1976). 2016; 16(3):343-354.
[57] OTSUKI B, TAKEMOTO M, FUJIBAYASHI S, et al. Utility of a custom screw insertion guide and a full-scale, color-coded 3D plaster model for guiding safe surgical exposure and screw insertion during spine revision surgery. Neurosurg Spine. 2016;25(1):94-102.
[58] CHEN H, WU D, YANG H, et al. Clinical Use of 3D Printing Guide Plate in Posterior Lumbar Pedicle Screw Fixation. Med Sci Monit. 2015;21(2): 3948-3954.
[59] LIN CL, FANG JJ, LIN RM. Resection of giant invasive sacral schwannoma using image-based customized osteotomy tools. Eur Spine. 2016; 25(12):4103-4107.
[60] TU Q, DING HW, CHEN H, et al. Three-Dimensional-Printed Individualized Guiding Templates for Surgical Correction of Severe Kyphoscoliosis Secondary to Ankylosing Spondylitis: Outcomes of 9 Cases. World Neurosurg. 2019;130(3):961-970.
[61] KANEYAMA S, SUGAWARA T, SUMI M, et al. A novel screw guiding method with a screw guide template system for posterior C-2 fixation: clinical article. Neurosurg Spine. 2014;21(2):231-238.