Odontoid cannulated screw fixation using digital navigation based on three-dimensional printing technique

doi:10.3969/j.issn.2095-4344.2015.35.023

Abstract

Abstract:

BACKGROUND: Odontoid fracture is very common in cervical spine injuries, the special position of odontoid process, which is adjacent to important anatomic structure, makes screw placement difficult, and a slight discrepancy in position and orientation of the inserted screw leads to a decrease in intensity of internal fixation, even invalid internal fixation. Therefore, it is very necessary to develop an individualized treatment protocol by which screws can be precisely and safely placed and which is worthy of clinical popularization.
OBJECTIVE: To study the navigation of Mimics software and three dimensional (3D)-printed module in anterior odontoid cannulated screw fixation and to investigate its feasibility and accuracy.
METHODS: Sixteen human cadaveric cervical spines were scanned by a continuous thin-slice CT scanner. Original DICOM CT images were three-dimensionally reconstructed using Mimics software. The screw channel and support column were designed for C2 vertebra odontoid cannulated screw fixation for odontoid fracture. Segmentation of bone surface was performed. Navigation modules with screw channel were built using 3D printing technique. Navigation modules were used to aid screw placement. Screw fitting and placement were evaluated using X-ray and CT scan.
RESULTS AND CONCLUSION: Totally 16 navigation modules were built and 22 screws were implanted. During and after screw placement, the cortical bone along screw channel and surrounding the vertebral body was not cracked. Postoperative X-ray and CT scans showed that some factors regarding screw placement such as entry point, orientation and depth of placement were consistent with those ideal factors simulated by Mimics software. The navigation modules were closely attached to the corresponding bony structure in front of the vertebral body, with a satisfactory gomphosis. Screw fitting and stability were good during application. These results verify that with the aid of navigation module, anterior odontoid cannulated screw fixation is reliable for treatment of odontoid fracture, which provides insights into the popularization of 3D printing-based digital navigation technique in orthopedic implantation.

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

Key words: Tissue Engineering, Internal Fixators, Cervical Vertebrae, Computer-Aided Design

CLC Number:

R318

Chen Xuan-huang, Zhang Guo-dong, Wu Chang-fu, Lin Hai-bin, Chen Xu, Yu Zheng-xi, Sun Yu-qing. Odontoid cannulated screw fixation using digital navigation based on three-dimensional printing technique[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(35): 5697-5704.

Figures/Tables 1

References

[1] Rajasekaran S, Kamath V, Avadhani A. Odontoid anterior screw fixation. Eur Spine J. 2010;19(2):339-340.
[2] Fountas KN, Kapsalaki EZ, Karampelas I, et al. Results of long-term follow-up in patients undergoing anterior screw fixation for type II and rostral type III odontoid fractures. Spine (Phila Pa 1976). 2005;30(6):661-669.
[3] Pryputniewicz DM, Hadley MN. Axis fractures. Neurosurgery. 2010;66(3 Suppl):68-82.
[4] Böhler J. Screw-osteosynthesis of fractures of the dens axis (author's transl). Unfallheilkunde. 1981;84(6):221-223.
[5] Koller H, Acosta F, Forstner R, et al. C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes. Eur Spine J. 2009;18(8):1135-1153.
[6] Osti M, Philipp H, Meusburger B, et al. Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J. 2011;20(11):1915-1920.
[7] Brown GA, Firoozbakhsh K, DeCoster TA, et al. Rapid prototyping: the future of trauma surgery? J Bone Joint Surg Am. 2003;85-A Suppl 4:49-55.
[8] Paiva WS, Amorim R, Bezerra DA, et al. Aplication of the stereolithography technique in complex spine surgery. Arq Neuropsiquiatr. 2007;65(2B):443-445.
[9] Xie A, Fang C, Huang Y, et al. Application of three-dimensional reconstruction and visible simulation technique in reoperation of hepatolithiasis. J Gastroenterol Hepatol. 2013;28(2):248-254.
[10] White AP, Hashimoto R, Norvell DC, et al. M orbidity and mortality related to odontoid fracture surgery in the elderly population. Spine (Phila Pa 1976). 2010;35(9 Suppl): S146-S157.
[11] Dantas FL, Prandini MN, Caires AC, et al. Management of odontoid fractures using anterior screw fixation: analysis of 15 cases. Arq Neuropsiquiatr. 2002;60(3B):823-829.
[12] Ochoa G. Surgical management of odontoid fractures. Injury. 2005;36 Suppl 2:B54-864.
[13] Song KJ, Lee KB, Kim KN. Treatment of odontoid fractures with single anterior screw fixation. J Clin Neurosci. 2007; 14(9):824-830.
[14] Agrillo A, Russo N, Marotta N, et al. Treatment of remote type ii axis fractures in the elderly: feasibility of anterior odontoid screw fixation. Neurosurgery. 2008;63(6):1145-1150.
[15] Omeis I, Duggal N, Rubano J, et al. Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis. J Spinal Disord Tech. 2009;22(2):91-95.
[16] Chiba K, Fujimura Y, Toyama Y, et al. Treatment protocol for fractures of the odontoid process. J Spinal Disord. 1996;9(4): 267-276.
[17] Wang MY. Cervical crossing laminar screws: early clinical results and complications. Neurosurgery. 2007;61(5 Suppl 2):311-325.
[18] Lantada AD, Morgado PL. Rapid prototyping for biomedical engineering: current capabilities and challenges. Annu Rev Biomed Eng. 2012;14:73-96.
[19] Magarelli N, Milano G, Baudi P, et al. Comparison between 2D and 3D computed tomography evaluation of glenoid bone defect in unilateral anterior gleno-humeral instability. Radiol Med. 2012;117(1):102-111.
[20] 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.
[21] Uehara M, Takahashi J, Hirabayashi H, et al. Computer-assisted C1-C2 Transarticular Screw Fixation "Magerl Technique" for Atlantoaxial Instability. Asian Spine J. 2012;6(3):168-177.
[22] Hu Y, Yuan ZS, Spiker WR, et al. Deviation analysis of C2 translaminar screw placement assisted by a novel rapid prototyping drill template: a cadaveric study. Eur Spine J. 2013;22(12):2770-2776.