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Personalised image-based templates for intra-operative guidance.
1Academic Unit of Medical Physics, University of Leeds, Leeds, UK. e.berry@leeds.ac.uk
Summary
Image-based drilling guide templates offer improved accuracy for pedicle screw placement in spinal surgery. Optimized template designs can ensure successful screw insertion, even in challenging anatomical regions.
Area of Science:
- Orthopaedic surgery
- Medical device engineering
Background:
- Freehand pedicle screw insertion is associated with risks like perforation and nerve injury.
- Image-guided navigation systems enhance accuracy but have limitations.
Purpose of the Study:
- To evaluate the accuracy of image-based drilling guide templates for spinal pedicle screw placement.
- To assess the dimensional stability of duraform polyamide after autoclaving for template manufacturing.
Main Methods:
- A cadaveric study involving 4 spines (lumbar, thoracic, cervical) and 50 planned screw placements.
- Manufacturing of 18 personalized drilling guide templates in four designs.
- Evaluation of screw placement accuracy by experienced surgeons using CT imaging.
Main Results:
- Duraform polyamide demonstrated dimensional stability after sterilization via autoclaving.
- Two template designs achieved 100% accuracy in screw placement (20/20 screws).
- Successful screw placement was possible even in small pedicles with optimized templates.
Conclusions:
- Image-based drilling guide templates can significantly improve pedicle screw placement accuracy.
- Optimized template design, including rotational stabilization, is crucial for success.
- These templates offer a viable alternative to freehand techniques and current navigation systems.