Use of rapid prototyping drill guide templatefor pedicle screw placement
2013
Background: Pedicle screw placement using
free hand technique has high incidence of pedicle
perforation. The said risk can be reduced
with intra-operative fluoroscopy or navigation,
which have some disadvantages. A promising
principle for solving most of the issues is the
rapid prototyping technology. By this technique
it is possible to manufacture patient specific
drill guide templates that enable optimal pedicle
screw placement. In the last decade, many studies
have featured relatively successful implantations
of pedicle screws through the use of drill
guide templates, though mostly on cadavers. We
performed a similar clinical study involving the
manufacture of templates for the lumbar and
sacral regions that enable simultaneous multiple-
level screw implanting.
Methods: A randomized clinical trial was performed
in 15 patients. In the lumbar and sacral
spine 30 screws were implanted using drill guide
template and 36 screws using free hand technique
under fluoroscopy supervision. Preoperative
CT-scans were taken for drill guide template
design and manufacture using selective laser sintering
method. According to postoperative CTscan
analysis, pedicle perforation incidence was
estimated.
Results: The incidence of cortex perforation was
significantly reduced in the drill guide template
group.
Conclusions: Drill guide templates have turned
out to be a reliable solution that importantly reduces
pedicle perforation incidence and complications
related to it. However, there are shortcomings:
a relatively lengthy manufacturing
process, possible manufacturing faults and incorrect
positioning during the operation. Owing
to mentioned disadvantages, templates have not
replaced free hand and navigation technique yet,
but could represent a useful tool in some selected
cases.
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