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T. C. Ryken, B. D. Owen, G. E. Christensen, and J. M. Reinhardt. Image based drill-templates for cervical pedicle screw placement. J Neurosurg Spine, vol. 10, no. 1, pp. 21-26, 2009.

Abstract: OBJECTIVE: Pedicle screws in the cervical spine can provide superior fixation to current fixation methods, however, their implementation is challenging due to the small size of the cervical vertebrae. This study explored and evaluated the use of patient specific rapid prototype drill-templates for placement of pedicle screws in the cervical spine. The goal of the study was to assess the accuracy of a drill-template for the placement of a cervical pedicle screw in a single vertebral level. METHODS: A volumetric computed tomography (CT) scan was performed on a four cadaver cervical spines. Using computer software, drill-templates were constructed with a predefined trajectory that was designed to match the posterior surface of vertebrae C3-C7. Twenty physical templates were created from the computer models using a rapid prototyping machine. The drill-templates were used to guide pilot-hole drilling. CT scans was performed to assess the accuracy of the pilot holes. A 3.5 mm diameter pedicle screws were placed in the pilot holes. The spines were dissected to separate the vertebrae and the trajectory of the screws was visually inspected. RESULTS: The feasibility of this patient-specific rapid prototyping technique was demonstrated. Imaging and visual inspection of pilot holes and cervical pedicle screws revealed the majority of trajectories without cortical violation (19 of 20, 95%). The one cortical violation was judged as non-critical and would likely not have resulted in injury. CONCLUSIONS: The potential of drill-templates to place cervical pedicle screws appears promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the cervical spine.

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Keywords: guidance spine

Other publications by: T. C. Ryken, B. D. Owen, G. E. Christensen, J. M. Reinhardt

Related journal papers:

B. D. Owen, G. E. Christensen, J. M. Reinhardt, and T. C. Ryken. Rapid prototype patient-specific drill template for cervical pedicle screw placement. Computer Aided Surgery, vol. 12, no. 5, pp. 303-308, 2007. (details)
T. C. Ryken, B. D. Owen, G. E. Christensen, and J. M. Reinhardt. Engineering patient-specific drill templates and bioabsorbable posterior cervical plates: a feasibility study. J Neurosurg Spine, vol. 10, no. 2, pp. 129-132, 2009. (details)