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Zhang Y, Yang H, Han C, Zhang Y, Zhou L, Hai Y. Precise execution of personalized surgical planning using three-dimensional printed guide template in severe and complex adult spinal deformity patients requiring three-column osteotomy: a retrospective, comparative matched-cohort study. J Orthop Surg Res 2024; 19:278. [PMID: 38704574 PMCID: PMC11069141 DOI: 10.1186/s13018-024-04712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/01/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The surgical treatment of severe and complex adult spinal deformity (ASD) commonly required three-column osteotomy (3-CO), which was technically demanding with high risk of neurological deficit. Personalized three dimensional (3D)-printed guide template based on preoperative planning has been gradually applied in 3-CO procedure. The purpose of this study was to compare the efficacy, safety, and precision of 3D-printed osteotomy guide template and free-hand technique in the treatment of severe and complex ASD patients requiring 3-CO. METHODS This was a single-centre retrospective comparative cohort study of patients with severe and complex ASD (Cobb angle of scoliosis > 80° with flexibility < 25% or focal kyphosis > 90°) who underwent posterior spinal fusion and 3-CO between January 2020 to January 2023, with a minimum 12 months follow-up. Personalized computer-assisted three-dimensional osteotomy simulation was performed for all recruited patients, who were further divided into template and non-template groups based on the application of 3D-printed osteotomy guide template according to the surgical planning. Patients in the two groups were age- and gender- propensity-matched. The radiographic parameters, postoperative neurological deficit, and precision of osteotomy execution were compared between groups. RESULTS A total of 40 patients (age 36.53 ± 11.98 years) were retrospectively recruited, with 20 patients in each group. The preoperative focal kyphosis (FK) was 92.72° ± 36.77° in the template group and 93.47° ± 33.91° in the non-template group, with a main curve Cobb angle of 63.35° (15.00°, 92.25°) and 64.00° (20.25°, 99.20°), respectively. Following the correction surgery, there were no significant differences in postoperative FK, postoperative main curve Cobb angle, correction rate of FK (54.20% vs. 51.94%, P = 0.738), and correction rate of main curve Cobb angle (72.41% vs. 61.33%, P = 0.101) between the groups. However, the match ratio of execution to simulation osteotomy angle was significantly greater in the template group than the non-template group (coronal: 89.90% vs. 74.50%, P < 0.001; sagittal: 90.45% vs. 80.35%, P < 0.001). The operating time (ORT) was significantly shorter (359.25 ± 57.79 min vs. 398.90 ± 59.48 min, P = 0.039) and the incidence of postoperative neurological deficit (5.0% vs. 35.0%, P = 0.018) was significantly lower in the template group than the non-template group. CONCLUSION Performing 3-CO with the assistance of personalized 3D-printed guide template could increase the precision of execution, decrease the risk of postoperative neurological deficit, and shorten the ORT in the correction surgery for severe and complex ASD. The personalized osteotomy guide had the advantages of 3D insight of the case-specific anatomy, identification of osteotomy location, and translation of the surgical planning or simulation to the real surgical site.
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Affiliation(s)
- Yangpu Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| | - Honghao Yang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| | - Chaofan Han
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| | - Yiqi Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| | - Lijin Zhou
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China.
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China.
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Stephan SR, Hassan FM, Mikhail C, Platt A, Lewerenz E, Lombardi JM, Sardar ZM, Lehman RA, Lenke LG. Revision of Harrington rod constructs: a single-center's experience with this homogenous adult spinal deformity population at a minimum 2-year follow-up. Spine Deform 2024:10.1007/s43390-024-00867-2. [PMID: 38609698 DOI: 10.1007/s43390-024-00867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE To evaluate radiographic and clinical outcomes following revision surgery after HRC fusions. METHODS Single-institution, retrospective study of patients revised following HRC with minimum 2-year follow-up post-revision. Demographics, perioperative information, radiographic parameters, complications, and Oswestry disability index (ODI) scores were collected. Radiographic parameters included global alignment, coronal and sagittal measurements pre and postoperatively, as well as final follow-up time points. RESULTS 26 patients were included with a mean follow-up of 3.3 ± 1.1 years. Mean age was 55.5 ± 7.8 years, BMI 25.2 ± 5.8, and 22 (85%) were females. Instrumented levels increased from 9.7 ± 2.8 to 16.0 ± 2.2. Five (19.2%) patients underwent lumbar pedicle subtraction osteotomies, and 23 (88.4%) had interbody fusions. Patients significantly improved in all radiographic parameters at immediate and final follow-up (p < 0.005), except for thoracic kyphosis and pelvic incidence (p > 0.05). Correction was maintained from immediate postop to final follow-up (p > 0.05). 20 (76.9%) of patients experienced a complication at some point within the follow-up period with the most common being a lumbar nerve root deficit (n = 7). However, only one patient had a nerve root deficit at final follow-up, that being a 4/5 unilateral anterior tibialis function. 5 (19.2%) patients required further revision within a mean of 1.8 ± 1.1 years. On average, patients had an improvement in ODI score by final follow-up (35.6 ± 16.8 vs 25.4 ± 19.8, p = 0.035). CONCLUSION Patients revised for HRCs significantly improve, both clinically and radiographically by final follow-up. This group did have a propensity for distal lumbar root neurological issues, which were common but all patients except for one, recovered to full strength by two-year follow-up.
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Affiliation(s)
- Stephen R Stephan
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
- Department of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
- Department of Orthopaedic Surgery, San Diego Spine Foundation, San Diego, CA, USA
| | - Fthimnir M Hassan
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA.
| | - Christopher Mikhail
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
- Department of Orthopaedic Surgery, Cedars-Sinai Spine Center, Los Angeles, CA, USA
| | - Andrew Platt
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Erik Lewerenz
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
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Helgeson MD, Pisano AJ, Wagner SC. What's New in Spine Surgery. J Bone Joint Surg Am 2022; 104:1039-1045. [PMID: 36149239 DOI: 10.2106/jbjs.22.00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Alfred J Pisano
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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