Research ArticleSpecial Issue (Invited)

Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? A 5-Year, Single-Center Experience With 2210 Screws Placed for Adult Spinal Deformity Reconstruction

Rakesh Kumar, Jean-Christophe Leveque, Philip K. Louie, Rajiv Sethi and Venu M. Nemani
International Journal of Spine Surgery August 2024, 18 (S1) S50-S56; DOI: https://doi.org/10.14444/8641

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Intraoperative images of custom 3D-printed pedicle screw guides. (A) Sterile, back table preparation of all 3D-printed guides for a specific patient. (B) One specific guide being placed at planned instrumented level. (C) A pedicle tract being drilled with orientation provided by the custom 3D-printed guide.

  • Figure 2
    Figure 2

    Computed tomography axial image showing safe placement of thoracic pedicle screw instrumentation into a type B pedicle on the left and type D pedicle on the right (A and B).

Tables

  • Table 1

    Demographic details and primary diagnosis of patient cohort (N = 115).

    VariableValue
    Age, y, mean (range)62 (18–81)
    Sex, M:F14:101
    Diagnosis, n
     Adult degenerative scoliosis62
     Adult idiopathic scoliosis30
     Others (pathological scoliosis, congenital scoliosis, and kyphoscoliosis)23
    Levels instrumented per case, median; mean16; 13.8
    Levels instrumented using 3D-printed drill guides per case, median; mean11; 9.7
  • Table 2

    Details of pedicle screw instrumentation (N = 115).

    Instrumentation DetailsValue
    No. of levels instrumented1595
    No. of levels instrumented with 3DPSG1112
    Pedicle screws placed with 3DPSG2210
     Thoracic1452
     Lumbar758
    Misplaced pedicle screws with 3DPSG10

    • Abbreviation: 3DPSG, 3D-printed pedicle screw guides.

  • Table 3

    Details of type C and D pedicles.

    Pedicle Type (Location)ConcaveConvex N
    Type C (35 thoracic, 8 lumbar)32 (75%)11 (25%)43
    Type D (35 thoracic, 2 lumbar)32 (86%)5 (14%)37
  • Table 4

    Summary of pedicle screws placed using 3DPSG.

    Type of PedicleMisplacedPlaced
    A/B10a 2130
    C043
    D037
    Total102210

    • ↵a For A/B pedicles, 7 thoracic and 3 lumbar pedicles were misplaced.

  • Table 5

    Details for misplaced/revised pedicle screws.

    NumberThoracic/LumbarType of Pedicle
    (Type A/B/C/D)    		Location
    in Curve    		Pedicle Breach
    (Lateral/Medial)    		Revised/RedirectedIONM/Neurological Change
    1Thoracic (T5)BConcaveLateralYesNo
    2Lumbar (L5)AConcaveLateralYesNo
    3Thoracic (T7)BConcaveLateralYesNo
    4Thoracic (T10)BConcaveLateralYesNo
    5Lumbar (L3)AConcaveLateralNoNo
    6Thoracic (T10)AConcaveMedialYesNo
    7Lumbar (L2)BConcaveLateralYesNo
    8Thoracic (T9)BConcaveMedialYesNo
    9Thoracic (T9)BConcaveMedialYesNo
    10Thoracic (T10)BConcaveMedialYesNo

    • Abbreviation: IONM, intraoperative neuromonitoring.

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Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? A 5-Year, Single-Center Experience With 2210 Screws Placed for Adult Spinal Deformity Reconstruction
Rakesh Kumar, Jean-Christophe Leveque, Philip K. Louie, Rajiv Sethi, Venu M. Nemani
International Journal of Spine Surgery Aug 2024, 18 (S1) S50-S56; DOI: 10.14444/8641
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