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Accuracy assessment of atlantoaxial pedicle screws assisted by a novel drill guide template

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Posterior atlantoaxial pedicle screw fixation is an effective technique for atlantoaxial instability (AAI). However, because of the complex anatomy of the cranio-cervical junction, it remains challenging to insert atlantoaxial pedicle screw precisely and safely. A novel drill guide template was designed for atlantoaxial pedicle screw placement in this study. The purpose of this study is to quantitatively evaluate the accuracy of atlantoaxial pedicle screw placement using the novel drill guide template.

Materials and methods

Between June 2014 and September 2015, 32 consecutive patients with AAI were included. Using the Mimics v17.0 and 3-matic v9.0 softwares, a novel drill guide template with two location holes and guide rods was designed. All patients underwent posterior atlantoaxial pedicle screw fixation assisted by the novel drill guide template. After surgery, the entry point and directions of actual and ideal screw trajectories were measured and compared.

Results

All patients underwent surgery successfully assisted by the novel drill guide template. A total of 128 atlantoaxial pedicle screws were placed for 32 AAI patients. Postoperative CT scans showed two screws in atlas deviated medially from the pedicle cortex and entered the spinal canal about 1 mm but without symptoms. For both atlas and axis, there were no significant differences in entry point or directions between the ideal and actual screw trajectories (P > 0.05). Significant differences were found in preoperative and postoperative Japanese Orthopaedic Association score and Visual Analogue Score (P < 0.001).

Conclusions

It is feasible to use the novel drill guide template for atlantoaxial pedicle screw placement. The accuracy of screw placement assisted by the novel template is high. More studies are needed to confirm the efficacy of this template.

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Acknowledgments

This work was supported by grants from Capital Characteristic Clinical project of Beijing Municipal Science & Technology Commission (http://www.bjkw.gov.cn/n8785584/index.html) (Grant Nos. Z141107002514058, and Z161100000516009). No individuals employed or contracted by the funders played any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, China

    Lianghai Jiang, Mingsheng Tan, Feng Yang, Ping Yi & Xiangsheng Tang

  2. Graduate School of Peking Union Medical College, Beijing, 100730, China

    Lianghai Jiang & Mingsheng Tan

  3. Department of Spinal Surgery, Hong Hui Hospital, Shanxi, 710054, China

    Liang Dong

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  1. Lianghai Jiang
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Correspondence to Mingsheng Tan.

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Jiang, L., Dong, L., Tan, M. et al. Accuracy assessment of atlantoaxial pedicle screws assisted by a novel drill guide template. Arch Orthop Trauma Surg 136, 1483–1490 (2016). https://doi.org/10.1007/s00402-016-2530-9

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  • DOI: https://doi.org/10.1007/s00402-016-2530-9

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