Highlights
- •Biomodelling is a useful tool for pre-surgical planning and intraoperative stereotaxy.
- •Surgeons can develop patient specific tools and titanium implants using 3D printing.
- •Patient specific tools simplify atlantoaxial transarticular screw placement.
- •Pre-surgical planning and 3D printing can improve operative ergonomics.
- •This patient specific process is a viable technique for atlantoaxial fixation.
Abstract
Atlantoaxial transarticular screw fixation is an effective technique for arthrodesis.
Surgical accuracy is critical due to the unique anatomy of the atlantoaxial region.
Intraoperative aids such as computer-assisted navigation and drilling templates offer
trajectory guidance but do not eliminate screw malposition. This study reports the
operative and clinical performance of a novel process utilising biomodelling and 3D
printing to develop patient specific solutions for posterior transarticular atlantoaxial
fixation surgery. Software models and 3D printed 1:1 scale biomodels of the patient's
bony atlantoaxial spine were developed from computed tomography data for surgical
planning. The surgeon collaborated with a local medical device manufacturer using
AnatomicsC3D to design patient specific titanium posterior atlantoaxial fixation implants
using transarticular and posterior C1 arch screws. Software enabled the surgeon to
specify screw trajectories, screw sizes, and simulate corrected atlantoaxial alignment
allowing patient specific stereotactic drill guides and titanium posterior fixation
implants to be manufactured using 3D printing. Three female patients with unilateral
atlantoaxial osteoarthritis were treated using patient specific implants. Transarticular
screws were placed using a percutaneous technique with fluoroscopy and neural monitoring.
No screw malposition and no neural or vascular injuries were observed. Average operating
and fluoroscopy times were 126.0 ± 4.1 min and 36.7 ± 11.5 s respectively. Blood loss
was <50 ml per patient and length of stay was 4–6 days. Clinical and radiographic
follow up data indicate satisfactory outcomes in all patients. This study demonstrates
a safe, accurate, efficient, and relatively inexpensive process to stabilise the atlantoaxial
spine using transarticular screws.
Keywords
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Article info
Publication history
Published online: July 15, 2018
Accepted:
June 24,
2018
Received:
March 21,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
