A novel computer-assisted drill guide template for placement of C2 laminar screws |
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Authors: | Sheng Lu Yong Q Xu Yuan Z Zhang Le Xie Hai Guo Dong P Li |
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Institution: | (1) Department of Orthopedics, Kunming General Hospital, Chengdu Military Region, PLA, Kunming, China;(2) Department of Orthopedics, The Hospital Affiliated to the Inner Mongolia Medical College, Hohhot, China;(3) Department of Plasticity Forming Engineering, Shanghai Jiaotong University, Shanghai, China;(4) Department of Neurosurgery, Kunming General Hospital, Chengdu Military Region, PLA, Kunming, China |
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Abstract: | The present method of C2 laminar screw placement relies on anatomical landmarks for screw placement. Placement of C2 laminar
screws using drill template has not been described in the literature. The authors reported on their experience with placement
of C2 laminar screws using a novel computer-assisted drill guide template in nine patients undergoing posterior occipito-cervical
fusion. CT scan of C2 vertebrae was performed. 3D model of C2 vertebrae was reconstructed by software MIMICS 10.01. The 3D
vertebral model was then exported in STL format, and opened in a workstation running software UG imageware12.0 for determining
the optimal laminar screw size and orientation. A virtual navigational template was established according to the laminar anatomic
trait. The physical vertebrae and navigational template were manufactured using rapid prototyping. The navigational template
was sterilized and used intraoperative to assist the placement of laminar screw. Overall, 19 C2 laminar screws were placed
and the accuracy of screw placement was confirmed with postoperative X-ray and CT scanning. There were not complications of
related screws insertion. Average follow-up was 9 months (range 4–13 months), 77.8% of the patients exhibited improvement
in their myelopathic symptoms; in 22.2% the symptoms were unchanged. Postoperative computed tomographic (CT) scanning was
available for allowing the evaluation of placement of thirteen C2 laminar screws, all of which were in good position with
no spinal canal violation. This study shows a patient-specific template technique that is easy to use, can simplify the surgical
act and generates highly accurate C2 laminar screw placement. Advantages of this technology over traditional techniques include
planning of the screw trajectory is done completely in the presurgical period as well as the ability to size the screw to
the patient’s anatomy. |
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