Three-dimensional anatomic analysis and navigation templates for C1 pedicle screw placement perpendicular to the coronal plane: a retrospective study. (2nd December 2021)

• Record Type: Journal Article
• Authors: Wu, Chao; Deng, Jiayan; Zeng, Bofang; Zhu, Yuan Fang; Li, Tao
• Is Part Of: Neurological research. Volume 43:Number 12(2021)
• Page Start: 961
• Page End: 969
• Publication Date: 2021-12-02
• Subjects: C1 -- 3D reconstruction -- pedicle screw -- navigation templates; Neurology -- Periodicals; Neurosciences -- Periodicals; 616.8005
• DOI: 10.1080/01616412.2021.1948741
• Languages: English
• ISSNs: 0161-6412

Abstract

ABSTRACT: Objective: To explore the corridor for atlas pedicle screw placement perpendicular to the coronal plane and to develop patient-specific navigation templates for pedicle screw placement. Methods: This study is a retrospective analysis. A total of 71 patients (41 males and 30 females) were involved in this study from June 2016 to June 2018, and they were divided into a template group (39 patients) and a conventional group (32 patients). The CT-based 3D reconstruction models were analyzed in the template group. From the perspective of the 3D atlas in a coronal view, the pedicle corridor was obtained. Taking the center of the tangential circle of the pedicle as the entry point, we simulated screw placement perpendicular to the coronal plane. Then, the individual navigation template was designed and used in surgery. In the conventional group, free-hand pedicle screw placement was performed perpendicular to the coronal plane. The diameter of the maximum tangential circle and screw length of the pedicle corridor were measured in the template group. The surgical time, radiation exposure time, screw grading criteria and so on were evaluated and compared between the two groups after surgery. Results: ;The diameter of the maximum tangential circle and the distance between the entry point and posterior tubercle were significantly greater in males than in females. The operation was successfully completed in all patients, without aggravation of nerve injury, and the follow-up was 12-20 months, with an average of 15.6 months. A total of 78 screws were inserted in the template group, and 64 screws were inserted in the conventional group. The surgical times in the template group and conventional group were 76.47±24.44 min and 125.63±36.41 min, respectively. The radiation exposure times in the template group and conventional group were 3.51±1.77 and 10.15±4.95, respectively, and there was a significant difference between the two groups. In the template group, the deviation in the screw entry point and screw angle were 1.92±1.67 mm and 2.08±1.98°, respectively. The medial angle deviation between the left and right sides was 2.71±1.88° in the template group, which was significantly less than the deviation of 3.76±2.22° in the conventional group. Conclusion: A pedicle screw trajectory perpendicular to the coronal plane can be quickly obtained based on the perspective of 3D models. The technique of screw placement perpendicular to the coronal plane assisted by navigation templates has a shorter operative time, lessintraoperative fluoroscopy and a higher safety of screw placement than traditional surgery.