Navigation template for vertebral pedicle passage in transpedicular screw fixation

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Abstract

Transpedicular screw fixation is the most established means to stabilize the spine. Present study evaluates personalized navigation templates application for vertebral pedicle passage. Navigation templates were used for inserting 35 transpedicular screws in 5 patients with spinal deformity (age 2–16). Each patient underwent computed tomography preoperatively. Acquired data was processed into a virtual 3d-model of target zone. Life size virtual pedicular probes were placed onto transpedicular trajectories determined on multiplanar cross-sections of the model. Navigation template was created by modification and union of geometric primitives. Target zone model and navigation template were made with PLA by 3D-printer. In surgery the template was placed on skeletonized posterior surface of appropriate vertebrae. After confirmation of template stability trajectories were passed to a depth of 20 mm through guiding tubes by pedicular probe. Resulting channels were controlled with ball tip feeler, and the full depth trajectories were made by free hand technique. Postoperatively screws placement accuracy was assessed by plain X-rays in each patient. Two patients (16 screws) also underwent computed tomography. In these patients screw placement accuracy was assessed by system based on 2 mm breach increments. 15 screws (93. 7%) were fully contained within the pedicle (grade 0), 1 screw breached external cortex of the pedicle by 0. 8 mm (grade 1). Efficacy and safety of navigation template for transpedicular screws insertion was demonstrated.

About the authors

Artem V. Kosulin

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: hackenlad@mail.ru

Assistant Professor, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Dmitriy V. Elyakin

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: dimaelkins@mail.ru

Pediatric Surgeon, Surgical Department No. 2

Russian Federation, Saint Petersburg

Kristina D. Lebedeva

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: moon2807@mail.ru

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Aleksandra E. Sukhomlinova

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: alexsashashmlmv@gmail.com

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Ekaterina A. Kozlova

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: kea13doc@gmail.com

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Anna E. Orekhova

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: myzikanya@mail.ru

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Virtual models of target zone and navigation template

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3. Fig. 2. 3D-printed target zone model and navigation templates

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4. Fig. 3. Navigation template assisted pedicle passage on surgery

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Copyright (c) 2019 Kosulin A.V., Elyakin D.V., Lebedeva K.D., Sukhomlinova A.E., Kozlova E.A., Orekhova A.E.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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