title: Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine: clinical article.
abstract: OBJECTIVE
  Pedicle screw fixation is a standard procedure of spinal instrumentation, but accurate screw placement is essential to avoid injury to the adjacent structures, such as the vessels, nerves, and viscera. The authors recently developed an intraoperative screw guiding method in which patient-specific laminar templates were used, and verified the accuracy of the multistep procedure in the thoracic spine.
  
  
  METHODS
  Preoperative bone images of the CT scans were analyzed using 3D/multiplanar imaging software and the trajectories of the screws were planned. Plastic templates with screw guiding structures were created for each lamina by using 3D design and printing technology. Three types of templates were made for precise multistep guidance, and all templates were specially designed to fit and lock on the lamina during the procedure. Plastic vertebra models were also generated and preoperative screw insertion simulation was performed. Surgery was performed using this patient-specific screw guide template system, and the placement of screws was postoperatively evaluated using CT scanning.
  
  
  RESULTS
  Ten patients with thoracic or cervicothoracic pathological entities were selected to verify this novel procedure. Fifty-eight pedicle screws were placed using the screw guide template system. Preoperatively, each template was found to fit exactly and to lock on the lamina of the vertebra models, and screw insertion simulation was successfully performed. Intraoperatively the templates also fit and locked on the patient lamina, and screw insertion was completed successfully. Postoperative CT scans confirmed that no screws violated the cortex of the pedicles, and the mean deviation of the screws from the planned trajectories was 0.87 ± 0.34 mm at the coronal midpoint section of the pedicles.
  
  
  CONCLUSIONS
  The multistep, patient-specific screw guide template system is useful for intraoperative pedicle screw navigation in the thoracic spine. This simple and economical method can improve the accuracy of pedicle screw insertion and reduce the operating time and radiation exposure of spinal fixation surgery.
authors.affiliation: Department of Neurosurgery, Akita University School of Medicine, Akita, Japan. taku@nsg.med.akita-u.ac.jp
authors.forename: Taku
authors.initials: T
authors.lastname: Sugawara
authors.forename: Naoki
authors.initials: N
authors.lastname: Higashiyama
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneyama
authors.forename: Masato
authors.initials: M
authors.lastname: Takabatake
authors.forename: Naoko
authors.initials: N
authors.lastname: Watanabe
authors.forename: Fujio
authors.initials: F
authors.lastname: Uchida
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Sumi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Mizoi
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws / Q000592:standards*; D004867:Equipment Design / Q000295:instrumentation / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D013122:Spinal Diseases / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods / Q000592:standards; D013904:Thoracic Vertebrae / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome