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Updated: Nov 1, 2025
Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP
Published on: October 17, 2019
Occipitocervical instrumented fixation utilising patient-specific C2 3D-printed spinal screw trajectory guides in
Vejay N Vakharia1,2, Luke Smith3, Zubair Tahir3
1Department of Neurosurgery, Great Ormond Street Hospital, UCL Great Ormond Street Institute of Child Health, London, UK. v.vakharia@ucl.ac.uk.
Insights
This study introduces 3D-printed guides for precise C2 screw placement in pediatric skeletal dysplasia patients. This novel technique enhances surgical accuracy and safety for craniocervical instability.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Medical Device Technology
Background:
- Pediatric craniocervical junction instability due to skeletal dysplasia presents surgical challenges.
- Anatomical abnormalities, poor bone quality, and immature skeletal structures complicate screw placement.
- Standard C2 pedicle screw fixation is technically demanding with limited margins of error.
Purpose of the Study:
- To present a novel clinical strategy using 3D-printed spinal screw trajectory guides (3D-SSTG) for pediatric craniocervical fixation.
- To evaluate the accuracy and feasibility of 3D-SSTG in patients with skeletal dysplasia.
- To reduce radiation exposure and operative time associated with intraoperative imaging.
Main Methods:
- Utilized pre-operative CT scans to design patient-specific 3D-SSTGs.
- Planned C2 pedicle and laminar screw trajectories using the 3D-SSTGs.
- Performed instrumented occipitocervical fixation in two pediatric patients with Morquio syndrome.
Main Results:
- Successfully placed C2 pedicle and laminar screws with optimal accuracy, following predefined trajectories.
- Demonstrated the feasibility of incorporating multiple screw trajectories within a single 3D-SSTG.
- Achieved accurate screw placement without the need for intraoperative CT imaging.
Conclusions:
- 3D-printed spinal screw trajectory guides represent a novel and effective approach for craniocervical fixation in pediatric skeletal dysplasia.
- This technique offers intraoperative flexibility and potential bailout options.
- Further research is warranted to explore the full potential of 3D-SSTGs for personalized surgical trajectories.
Purpose:
Instability of the craniocervical junction in paediatric patients with skeletal dysplasia poses a unique set of challenges including anatomical abnormalities, poor bone quality, skeletal immaturity and associated general anaesthetic risks. Instrumented fixation provides optimal stabilisation and fusion rates. The small vertebrae make the placement of C2 pedicle screws technically demanding with low margins of error between the spinal canal and the vertebral artery.
Methods:
We describe a novel clinical strategy utilising 3D-printed spinal screw trajectory guides (3D-SSTG) for individually planned C2 pedicle and laminar screws. The technique is based on a pre-operative CT scan and does not require intraoperative CT imaging. This reduces the radiation burden to the patient and forgoes the associated time and cost. The time for model generation and sterilisation was < 24 h.
Results:
We describe two patients (3 and 6 years old) requiring occipitocervical instrumented fixation for cervical myelopathy secondary to Morquio syndrome with 3D-SSTGs. In the second case, bilateral laminar screw trajectories were also incorporated into the same guide due to the presence of high-riding vertebral arteries. Registration of the postoperative CT to the pre-operative imaging revealed that screws were optimally placed and accurately followed the predefined trajectory.
Conclusion:
To our knowledge, we present the first clinical report of 3D-printed spinal screw trajectory guides at the craniocervical junction in paediatric patients with skeletal dysplasia. The novel combination of multiple trajectories within the same guide provides the intraoperative flexibility of potential bailout options. Future studies will better define the potential of this technology to optimise personalised non-standard screw trajectories.
