Digital placement and clinical application of lumbar pedicle screws based on 3D printing

doi:10.3969/j.issn.2095-4344.2015.17.023

Abstract

Abstract:

BACKGROUND: 3D printing to prepare individualized navigation template-assisted screw placement can elevate screw placement accuracy of spinal pedicle screw, and have good prospects for clinical application.

OBJECTIVE: To investigate the method of lumbar pedicle screw navigation placement using digital design of Mimics software combined with 3D printing module, and to explore its feasibility and accuracy.

METHODS: From February 2012 to August 2013, a total of 60 patients with lumbar diseases underwent 3D printing module-assisted lumbar pedicle screw navigation placement. All patients received continuous thin slice CT scan. We collected Dicom format images. Mimics software was used for 3D reconstruction to design screw channel and the supporting column of lumbar pedicle screw placement and to divide strippable bone surface, to design navigation module with screw channel, and then to carry out 3D printing. Navigation module was utilized for navigation screw placement during the surgery. The position and replacement of screw were observed. X-ray and CT scan were applied to assess the outcomes of screw placement. The patients were followed up for (12.17±3.21) months. Oswestry Disability Index was employed to evaluate the improvement of lumbar function. Japanese Orthopaedic Association (low back pain) scoring system was used to assess the therapeutic effects.

RESULTS AND CONCLUSION: 253 navigation modules were made and 253 screws were implanted. Screw channel and postoperative bone surrounding the vertebral body were observed, and no breakage was found. Postoperative X-ray and CT scan revealed that the direction of eight pedicle screws was migrated compared with preoperative design, but their positions were still satisfactory. The placement site, direction and length of 245 pedicle screws were consistent with the desired site, direction and length in Mimics software, with an accuracy of 96.84%. The navigation module was tightly connected to bone structure in front of the corresponding vertebral body, with good chimeric degree. During application, the position and stability were good. During final follow-up, Japanese Orthopaedic Association score increased, and Oswestry Disability Index was lower compared with pre-operation (P < 0.01), with an excellent and good rate of 95%. Above results confirmed that with the aid of navigation module, the digital placement of lumbar pedicle screws was precise, characterized by less complications and good therapeutic effects, and contributed to the recovery of lumbar function in patients.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Lumbar Vertebrae, Computer-Aided Design, Internal Fixators

CLC Number:

R318

Chen Xuan-huang, Xu Wei-hong, Huang Wen-hua, Lin Hai-bin, Zhang Guo-dong, Wu Chang-fu, Chen Xu, Yu Zheng-xi. Digital placement and clinical application of lumbar pedicle screws based on 3D printing[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(17): 2752-2757.

Figures/Tables 1

References

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