A Modified Personalized Image-Based Drill Guide Template for Atlantoaxial Pedicle Screw Placement: A Clinical Study

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Medical Device Design

Background:

• Posterior pedicle screw fixation is a common treatment for atlantoaxial instability (AAI).
• Precise and safe atlantoaxial pedicle screw insertion presents significant surgical challenges.
• Existing templates require modification to optimize screw placement accuracy.

Purpose of the Study:

• To evaluate the efficacy of a modified drill guide template for posterior atlantoaxial pedicle screw placement.
• To compare the accuracy and safety of screw insertion using the modified template versus the conventional method.
• To assess the impact of the modified template on intraoperative fluoroscopy use.

Main Methods:

• A prospective study involving 54 patients with AAI undergoing posterior atlantoaxial pedicle screw fixation.
• Patients were divided into two groups: modified drill guide template (n=25) and conventional method (n=29).
• Customized drill guide templates were used in conjunction with intraoperative fluoroscopy for the template group.

Main Results:

• The template group demonstrated significantly lower intraoperative fluoroscopy frequency (p<0.001) and higher screw insertion accuracy (p=0.045).
• No significant differences were observed in surgical duration, blood loss, or neurological outcome between groups.
• Follow-up data from 52 patients (96.3%) exceeded 12 months.

Conclusions:

• The modified drill guide template is a feasible and effective tool for atlantoaxial pedicle screw placement.
• Utilizing the template significantly reduces screw malposition rates and the need for intraoperative fluoroscopy.
• This approach enhances the safety and precision of surgical treatment for atlantoaxial instability.