[KSCI] Korea Science Citation Index Service

http://dx.doi.org/10.17555/jvc.2022.39.6.294

Accuracy of Thoracolumbar Spine K-Wire Placement in Toy, Small and Medium Breed Dogs: Novice Surgeons with 3D Printed Patient-Specific Guide versus an Experienced Surgeon with Freehand Techniques

Hwa-Joeng Shin (Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University)
Hae-Beom Lee (Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University)
Yoon-Ho Roh (Division of Small Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern)

Publication Information

Journal of Veterinary Clinics / v.39, no.6, 2022 , pp. 294-301 More about this Journal

Abstract

Three-dimensional (3D) printing technique has been widely used for accurate screw and pin placement in orthopedic surgery and neurosurgery. However, there are few reports comparing the accuracy between the patient-specific guides and freehand Kirschner wire (K-wire) placement in toy, small and medium breed dogs. This study aimed to assess the accuracy of 3D printed patient-specific guides (PSGs) in pin insertion in the thoracolumbar vertebrae of toy breed dogs and compare the outcomes between novice and experienced surgeons. The experiment was conducted on the thoracolumbar vertebrae of 21 euthanized toy breed dogs (median weight, 5.95 kg). The optimal insertion angle placement was determined and patient-specific guides for K-wire insertion were designed and 3D printed using computed tomography (CT) and a 3D computer-aided design program of three vertebrae (Thoracic 12-Lumbar 1). K-wire tracts were made by experienced and novice surgeons and compared to assess the accuracy based on postoperative CT. Based on postoperative CT, in the experienced group, 61 out of 63 pins (96.8%) were fully contained inside the vertebral body and lamina, whereas two pins (3.2%) had perforated the vertebral canal (grade 3, 2-4 mm breach). However, all the pins in the novice group were fully contained. The use of 3D printed PSGs for pin insertion in the thoracolumbar region is an accurate and safe alternative to freehand screw placement by novice surgeons in toy, small and medium breed dogs. Operations with 3D printed PSGs allow novice surgeons to achieve better or similar outcomes in accurate placement of pin/screws in vertebrae.

Keywords

patient-specific guide; toy breed dogs; spine; vertebrae;

Citations & Related Records

Reference

1	Aikawa T, Kanazono S, Yoshigae Y, Sharp NJ, Munana KR. Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate, with or without laminectomy, for spinal canal stenosis and vertebral instability caused by congenital thoracic vertebral anomalies. Vet Surg 2007; 36: 432-441. DOI
2	Beer P, Park BH, Steffen F, Smolders DLA, Pozzi A, Knell SC. Influence of a customized three-dimensionally printed drill guide on the accuracy of pedicle screw placement in lumbosacral vertebrae: an ex vivo study. Vet Surg 2020; 49: 977-988. DOI
3	Burleson J, DiPaola C. 3D Printing in spine surgery. In: Dipaola M, Wodajo FM, editors. 3D Printing in orthopaedic surgery. Amsterdam: Elsevier. 2018: 105-122.
4	Chen H, Wu D, Yang H, Guo K. Clinical use of 3D printing guide plate in posterior lumbar pedicle screw fixation. Med Sci Monit 2015; 21: 3948-3954. DOI
5	Cong Y, Bao N, Zhao J, Mao G. Comparing accuracy of cervical pedicle screw placement between a guidance system and manual manipulation: a cadaver study. Med Sci Monit 2015; 21: 2672-2677. DOI
6	Corlazzoli D. Bicortical implant insertion in caudal cervical spondylomyelopathy: a computed tomography simulation in affected Doberman Pinschers. Vet Surg 2008; 37: 178-185. DOI
7	Dockx R, Peremans K, Duprat R, Vlerick L, Van Laeken N, Saunders JH, et al. Accurate external localization of the left frontal cortex in dogs by using pointer based frameless neuronavigation. PeerJ 2017; 5: e3425. DOI
8	Elford JH, Oxley B, Behr S. Accuracy of placement of pedicle screws in the thoracolumbar spine of dogs with spinal deformities with three-dimensionally printed patient-specific drill guides. Vet Surg 2020; 49: 347-353. DOI
9	Farshad M, Betz M, Farshad-Amacker NA, Moser M. Accuracy of patient-specific template-guided vs. free-hand fluoroscopically controlled pedicle screw placement in the thoracic and lumbar spine: a randomized cadaveric study. Eur Spine J 2017; 26: 738-749. DOI
10	Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, et al. 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging 2012; 30: 1323-1341. DOI
11	Fujioka T, Nakata K, Nishida H, Sugawara T, Konno N, Maeda S, et al. A novel patient-specific drill guide template for stabilization of thoracolumbar vertebrae of dogs: cadaveric study and clinical cases. Vet Surg 2019; 48: 336-342. DOI
12	Guevar J, Bleedorn J, Cullum T, Hetzel S, Zlotnick J, Mariani CL. Accuracy and safety of three-dimensionally printed animal-specific drill guides for thoracolumbar vertebral column instrumentation in dogs: bilateral and unilateral designs. Vet Surg 2021; 50: 336-344. DOI
13	Hamilton-Bennett SE, Oxley B, Behr S. Accuracy of a patient-specific 3D printed drill guide for placement of cervical transpedicular screws. Vet Surg 2018; 47: 236-242. DOI
14	Hoekstra H, Rosseels W, Sermon A, Nijs S. Corrective limb osteotomy using patient specific 3D-printed guides: a technical note. Injury 2016; 47: 2375-2380. DOI
15	Hayes GM, Demeter EA, Choi E, Oblak M. Single-stage craniectomy and cranioplasty for multilobular osteochondrosarcoma managed with a custom additive manufactured titanium plate in a dog. Case Rep Vet Med 2019; 2019: 6383591.
16	Hettlich B. Vertebral fracture and luxation repair. In: Shores A, Brisson BA, editors. Current techniques in canine and feline neurosurgery. Hoboken: Wiley-Blackwell. 2017: 209-221.
17	Hettlich BF, Fosgate GT, Levine JM, Young BD, Kerwin SC, Walker M, et al. Accuracy of conventional radiography and computed tomography in predicting implant position in relation to the vertebral canal in dogs. Vet Surg 2010; 39: 680-687.
18	Jeffery ND. Vertebral fracture and luxation in small animals. Vet Clin North Am Small Anim Pract 2010; 40: 809-828. DOI
19	Johnson P, Beltran E, Dennis R, Taeymans O. Magnetic resonance imaging characteristics of suspected vertebral instability associated with fracture or subluxation in eleven dogs. Vet Radiol Ultrasound 2012; 53: 552-559. DOI
20	Kaneyama S, Sugawara T, Sumi M. Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system. Spine (Phila Pa 1976) 2015; 40: E341-E348. DOI
21	Mariani CL, Zlotnick JA, Harrysson O, Marcellin-Little DJ, Malinak K, Gavitt A, et al. Accuracy of three-dimensionally printed animal-specific drill guides for implant placement in canine thoracic vertebrae: a cadaveric study. Vet Surg 2021; 50: 294-302. DOI
22	Oka K, Murase T, Moritomo H, Goto A, Nakao R, Sugamoto K, et al. Accuracy of corrective osteotomy using a custom-designed device based on a novel computer simulation system. J Orthop Sci 2011; 16: 85-92. DOI
23	Shores A, Nichols C, Rochat M, Fox SM, Burt GJ, Fox WR. Combined Kirschner-Ehmer device and dorsal spinal plate fixation technique for caudal lumbar vertebral fractures in dogs. J Am Vet Med Assoc 1989; 195: 335-339.
24	Oxley B. A 3-dimensional-printed patient-specific guide system for minimally invasive plate osteosynthesis of a comminuted mid-diaphyseal humeral fracture in a cat. Vet Surg 2018; 47: 445-453. DOI
25	Oxley B. Bilateral shoulder arthrodesis in a Pekinese using three-dimensional printed patient-specific osteotomy and reduction guides. Vet Comp Orthop Traumatol 2017; 30: 230-236. DOI
26	Roh YH, Cho CW, Ryu CH, Lee JH, Jeong SM, Lee HB. Comparison between novice and experienced surgeons performing corrective osteotomy with patient-specific guides in dogs based on resulting position accuracy. Vet Sci 2021; 8: 40. DOI
27	Shores A. Spinal trauma. Pathophysiology and management of traumatic spinal injuries. Vet Clin North Am Small Anim Pract 1992; 22: 859-888. DOI
28	Sys G, Eykens H, Lenaerts G, Shumelinsky F, Robbrecht C, Poffyn B. Accuracy assessment of surgical planning and three-dimensional-printed patient-specific guides for orthopaedic osteotomies. Proc Inst Mech Eng H 2017; 231: 499-508. DOI
29	Taylor AR, Cohen ND, Fletcher S, Griffin JF, Levine JM. Application and machine accuracy of a new frameless computed tomography-guided stereotactic brain biopsy system in dogs. Vet Radiol Ultrasound 2013; 54: 332-342. DOI
30	Trotter EJ. Cervical spine locking plate fixation for treatment of cervical spondylotic myelopathy in large breed dogs. Vet Surg 2009; 38: 705-718. DOI
31	Watine S, Cabassu JP, Catheland S, Brochier L, Ivanoff S. Computed tomography study of implantation corridors in canine vertebrae. J Small Anim Pract 2006; 47: 651-657. DOI
32	Vallefuoco R, Manassero M, Leperlier D, Scotti S, Viateau V, Moissonnier P. Surgical repair of thoraco-lumbar vertebral fracture-luxations in eight cats using screws and polymethylmethacrylate fixation. Vet Comp Orthop Traumatol 2014; 27: 306-312. DOI
33	Voss K, Montavon PM. Tension band stabilization of fractures and luxations of the thoracolumbar vertebrae in dogs and cats: 38 cases (1993-2002). J Am Vet Med Assoc 2004; 225: 78-83. DOI
34	Wang YT, Yang XJ, Yan B, Zeng TH, Qiu YY, Chen SJ. Clinical application of three-dimensional printing in the personalized treatment of complex spinal disorders. Chin J Traumatol 2016; 19: 31-34. DOI
35	Wininger F. Neuronavigation in small animals: development, techniques, and applications. Vet Clin North Am Small Anim Pract 2014; 44: 1235-1248. DOI
36	Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K. Cervical pedicle screw fixation in 100 cases of unstable cervical injuries: pedicle axis views obtained using fluoroscopy. J Neurosurg Spine 2006; 5: 488-493. DOI
37	Ozak A, Yardimci C, Nisbet HO, Inal KS. Treatment of traumatic thoracal instability with pedicle screw-rod fixation system in a dog. Kafkas Univ Vet Fak Derg 2018; 24: 627-630.