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Instrumentation of hypoplastic pedicles with patient-specific guides – Lumbar Fusion

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The article discusses the use of patient-specific 3D-printed guides to assist in the instrumentation of hypoplastic pedicles in the thoracolumbar spine. Hypoplastic pedicles, which have a diameter of less than 5 mm, are common in syndromic spinal deformities and can complicate pedicle screw placement. The study assessed the feasibility and outcomes of using these guides in six patients undergoing posterior spinal fusion surgery. Results showed that 88.6% of pedicle screws placed with the guides were successful, with a 9.7% complication rate in hypoplastic pedicles. Complications were only observed when the pedicle-width-to-screw-diameter ratio was less than 0.62. The study concludes that patient-specific guides can be helpful in challenging pedicle instrumentation, particularly when the ratio is greater than 0.62

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established treatment clinic on Harley Street UK

Published article

: Patient-specific 3D-printed guides can aid in challenging instrumentation of hypoplastic pedicles in the thoracolumbar spine, especially if the pedicle-width-to-screw-diameter ratio is greater than 0.62.

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Spine Deform. 2024 Apr 1. doi: 10.1007/s43390-024-00852-9. Online ahead of print. ABSTRACT PURPOSE: Hypoplastic pedicles of the thoracolumbar spine (,

Spine Deform. 2024 Apr 1. doi: 10.1007/s43390-024-00852-9. Online ahead of print.

ABSTRACT

PURPOSE: Hypoplastic pedicles of the thoracolumbar spine (<5 mm diameter) are often found in syndromic deformities of the spine and pose a challenge in pedicle screw instrumentation. 3D-printed patient-specific guides might help overcome anatomical difficulties when instrumenting pedicles with screws, thereby reducing the necessity for less effective fixation methods such as hooks or sublaminar wires. In this study, the surgical feasibility and clinical outcome of patients with hypoplastic pedicles following pedicle screw instrumentation with 3D-printed patient-specific guides were assessed.

METHODS: Hypoplastic pedicles were identified on preoperative computed tomography (CT) scans in six patients undergoing posterior spinal fusion surgery between 2017 and 2020. Based on these preoperative CT scans, patient-specific guides were produced to help with screw instrumentation of these thin pedicles. Postoperatively, pedicle-screw-related complications or revisions were analyzed.

RESULTS: 93/105 (88.6%) pedicle screws placed with patient-specific guides were instrumented. 62/93 (66.7%) of these instrumented pedicles were defined as hypoplastic with a mean width of 3.07 mm (SD ±0.98 mm, 95% CI [2.82-3.32]). Overall, 6 complications in the 62 hypoplastic pedicles (9.7%) were observed and included intraoperatively managed 4 cerebrospinal fluid leaks, 1 pneumothorax and 1 delayed revision due to 2 lumbar screws (2/62, 3.3%) impinging the L3 nerve root causing a painful radiculopathy. The mean follow-up time was 26.7 (SD ±11.7) months. Complications were only noted when the pedicle-width-to-screw-diameter ratio measured less than 0.62.

: Patient-specific 3D-printed guides can aid in challenging instrumentation of hypoplastic pedicles in the thoracolumbar spine, especially if the pedicle-width-to-screw-diameter ratio is greater than 0.62.

PMID:38558382 | DOI:10.1007/s43390-024-00852-9

The London Spine Unit : most established treatment clinic on Harley Street UK

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Instrumentation of hypoplastic pedicles with patient-specific guides

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