Top

Published in:

01-12-2011 | Original Paper

Personalised modified osteotomy using computer-aided design–rapid prototyping to correct thoracic deformities

Authors: Jin Cheng Yang, Xiang Yang Ma, Jun Lin, Zeng Hui Wu, Kai Zhang, Qing Shui Yin

Published in: International Orthopaedics | Issue 12/2011

Abstract

The correction of severe thoracic deformities is challenging. However, the usual imaging modalities are not sufficient for performing the surgery. Our objective was to describe the procedure and results of posterior modified wedge osteotomy aided by the techniques of computer-aided design–rapid prototyping (CAD-RP) to correct thoracic deformities. Twenty-one patients with thoracic deformities (eight males; 13 females) formed the study group. All patients underwent computed tomography (CT) scanning and CAD-RP, and a model of thoracic deformities and navigation templates of pedicles were created for each patient and used to analyse the spinal deformities and serve as anatomical reference. Aided by these models, personalised modified wedge osteotomy combining the eggshell technique and posterior vertebral column resection was performed. Using CAD-RP improved the safety and accuracy of surgery and screw placement in the 21 patients in whom 41 vertebrae were removed and 216 pedicle screws were placed. The average operation time was 260 (200–420) min, with an average blood loss of 1,900 ml (range 800–3560 ml). The percentage of deformity correction was 56.3% (from 72.1° to 31.5°) in the coronal plane and 60.4% (from 81.6° to 32.3°) in the sagittal plane. No patient had serious complications or implant failure. Personalised single-stage posterior modified wedge osteotomy is an effective procedure for treating thoracic deformities. Using CAD-RP and the RP models have significant benefits for personalised surgical treatment of complex thoracic deformities.

Guarino J, Tennyson S, McCain G et al (2007) Rapid prototyping technology for surgeries of the pediatric spine and pelvis: benefits analysis. J Pediatr Orthop 27:955–960PubMedCrossRef

Cioccaa L, Crescenziob FD, Scotti MFR et al (2009) CAD/CAM and rapid prototyped scaffold construction for bone regenerative medicine and surgical transfer of virtual planning: A pilot study. Comput Med Imaging Graph 33:58–62CrossRef

Izatt MT, Thorpe PLPJ, Thompson RG et al (2007) The use of physical biomodelling in complex spinal surgery. Eur Spine J 16:1507–1518PubMedCrossRef

Potamianos P, Amis AA, Forester AJ et al (1998) Rapid prototyping for orthopaedic surgery. Proc Inst Mech Eng H J Eng Med 212(5):383–393CrossRef

Salako F, Aubin CE, Fortin C et al (2002) Feasibility study of patient-specific surgical templates for the fixation of pedicle screws. Stud Health Technol Inform 88:419–422PubMed

Owen BD, Christensen GE, Reinhardt JM et al (2007) Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comput Aided Surg 12:303–308PubMed

Berry E, Cuppone M, Porada S et al (2005) Personalised imagebased templates for intra-operative guidance. Proc Inst Mech Eng 219(2):111–118

Facanha-Filho FA, Winter RB, Lonstein JE et al (2001) Measurement accuracy in congenital scoliosis. J Bone Joint Surg Am 83:42–45PubMed

Mao KY, Wang Y, Xiao SH et al (2010) Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot study. Eur Spine J 19:797–802PubMedCrossRef

10.

D’Urso PS, Williamson OD, Thompson RG (2005) Biomodeling as an aid to spinal instrumentation. Spine 30:841–2845CrossRef

11.

Kim YJ, Lenke LG, Bridwell KH et al (2004) Free hand pedicle screw placement in the thoracic spine:is it safe? Spine 29(3):333–342PubMedCrossRef

12.

Kawahara N, Tomita K, Baba H et al (2001) Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine 26:391–402PubMedCrossRef

13.

Suk SI, Kim JH, Kim WJ et al (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382PubMedCrossRef

14.

Bezer M, Kucukdurmaz F et al (2007) Transpedicular decancellation osteotomy in the treatment of posttuberculous kyphosis. J Spinal Disord Tech 20:209–215PubMedCrossRef

15.

Bradford DS, Tribus CB (1997) Vertebral column resection for the treatment of rigid coronal decompensation. Spine 22(14):1590–1599PubMedCrossRef

16.

Bridwell KH, Lewis SJ, Edwards C et al (2003) Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine 28(18):2093–2101PubMedCrossRef

17.

Lenke LG, O’Leary PT, Bridwell KH et al (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty- five consecutive patients. Spine 34:2213–2221PubMedCrossRef

18.

Bridwell KH (2006) Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine 31(19 suppl):S171–S178PubMedCrossRef

19.

Ikenaga M, Shikata J, Takemoto M et al (2007) Clinical outcomes and complications after pedicle subtraction osteotomy for correction of thoracolumbar kyphosis. J Neurosurg Spine 6:330–336PubMedCrossRef

20.

Kiaer T, Gehrchen M (2009) Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Eur Spine J 15:57–64

21.

Mummaneni PV, Dhall SS, Ondra SL et al (2008) Pedicle subtraction osteotomy. Neurosurgery 63(3 Suppl):171–176PubMedCrossRef

22.

Murrey DB, Brigham CD, Kiebzak GM et al (2002) Transpedicular decompression and pedicle subtraction osteotomy (eggshell procedure): a retrospective review of 59 patients. Spine 27:2338–2345PubMedCrossRef

23.

Yang BP, Ondra SL, Chen LA et al (2006) Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine 5:9–17PubMedCrossRef

24.

Buchowski JM, Bridwell KH, Lenke LG et al (2007) Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine 32:2245–2252PubMedCrossRef

25.

Wang Y, Zhang YG, Zhang XS et al (2008) A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J 17:361–372PubMedCrossRef

Title: Personalised modified osteotomy using computer-aided design–rapid prototyping to correct thoracic deformities
Authors: Jin Cheng Yang
Xiang Yang Ma
Jun Lin
Zeng Hui Wu
Kai Zhang
Qing Shui Yin
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 12/2011
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-010-1155-9

At a glance: The STEP trials

Springer Medicine

Personalised modified osteotomy using computer-aided design–rapid prototyping to correct thoracic deformities

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2011

Effects of pulsed electromagnetic fields on cartilage apoptosis signalling pathways in ovariectomised rats

Reply to the comments of Li et al. to the article: Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture

Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial

Comments on Shuzhen Li et al. “Systematic review of patellar resurfacing in total knee arthroplasty”

Biomechanical analysis of a transiliac internal fixator

Symptomatic coracoclavicular joint: incidence, clinical significance and available management options