Clinical effect of individualized 3D printing guide assisted placement of upper cervical pedicle screw

Abstract

Background: The upper cervical vertebrae are adjacent to important anatomical structures, with high variability and thin pedicle, leading to difficulties in screw placement. We investigate the clinical effect of individualized 3D printing guide assisted upper cervical pedicle screw placement. Methods: Eighteen patients with upper cervical spine injury requiring surgical treatment were included in our hospital from May 2010 to May 2020. These patients were divided into the guide plate assisted screw implantation group ([guide plate assisted screw implantation group] Group A, N = 10) and the traditional operation group (traditional operation group [Group B], N = 8). All patients were followed up for more than 2 years. Screw implant accuracy, cervical spine Japanese orthopaedic association (JOA) score, Ameri can Spinal Injury Association (ASIA) score, visual analogue scale (VAS) score, operation time, and intraoperative blood loss were compared between the two groups. Results: A total of 72 atlantoaxial pedicle screws were implanted, 40 in group A and 32 in group B. The accuracy rate of screw implantation was 97.50% in group A and 81.25% in group B (P < 0.05). The operation time in group A (189.7 ± 16.1 mins) and group B (242.1 ± 23.2 mins), P < 0.05. The intraoperative blood loss in group A (216.0 ± 49.7 mL) and group B (385.0 ± 23.5 mL), P < 0.05. The intraoperative fluoroscopic times were 8.7 ± 1.1 in group A and 30.0 ± 3.3 in group B (P < 0.05). One week after operation, the JOA, Asia and VAS scores of group A were significantly better than those of group B, but there was no significant difference between the two groups at the last follow-up. Conclusion: Individualized 3D printing guide assisted placement of upper cervical pedicle screws can significantly improve the accuracy of screw implantation and postoperative function of patients, and reduce the times of X-ray fluoroscopy, operation time, and intraoperative blood loss, which is a safe and effective approach and worthy of clinical promotion.