Comparison of application of 3D-printed personalized guiding template and robot-assisted pedicle screw placement in adult degenerative scoliosis

English Keywords:Adult degenerative scoliosis  3D printed guiding template  Robot assisted  Pedicle screws

English Abstract:

  【Abstract】 Objectives: To compare the effects of 3D-printed personalized guiding template and robot-assisted pedicle screw placements in orthopedic surgery for adult degenerative scoliosis(ADS). Methods: Retrospective analysis was conducted on 18 ADS patients hospitalized and treated with corrective surgery in the department between January 2020 and December 2022. There were 3 males and 15 females, aged 46-73(63.2±8.2) years old. A total of 236 pedicle screws were placed, and the patients were divided into two groups according to the auxiliary screw placement methods: the 3D-printed personalized guiding template group(3D-printed group, 11 cases, 142 pedicle screws were placed) and robot-assisted screw placement group (Robot group, 7 cases, 94 pedicle screws were placed). The patients were followed up for 6 months and more. The vertex rotation angle and scoliosis Cobb angle were measured and compared between groups before operation. All pedicle screws were classified by Gertzbein-Robbins classification standard at 1 week after operation, and the accuracy and satisfaction of screw placement in the two groups were compared; And the operative time and incidence of complications were also analyzed and compared between the two groups. Results: The 3D-printed group was not statistically different from the robot group in terms of age(63.6±9.0 years vs. 62.6±7.3 years), gender ratio(male/female: 2/9 vs. 1/6), number of screws placed(12.91±3.83 vs. 13.43±3.60), Cobb angle(40.36°±11.82° vs. 38.14°±12.84°), and vertex rotation angle(30.27°±7.25° vs. 29.86°±9.65°), respectively(P>0.05). The robot group was longer in operative time than that of 3D-printed group(354.29±53.73min vs. 282.27±73.87min, P<0.05). Of the total 142 pedicle screws placed in the 3D-printed group, 128 screws were of class A, 10 were of class B, and 4 were of class C; Of the total 94 pedicle screws placed in the robot group, 86 screws were of class A, 5 were of class B, and 3 were of class C; No class D or E screws in the two groups. The accuracy rate of screw placement(90.14%) and satisfaction rate(97.18%) of the 3D-printed group were not statistically different from the accuracy rate(91.49%) and satisfaction rate(96.81%) of the robot group, respectively(P>0.05). The incidence of complications in the 3D-printed group(36.36%) was not significantly different from that in the robot group(57.14%, P>0.05). Conclusions: Both auxiliary screw placement methods can assist spinal surgeons to accurately place screws in ADS patients, but 3D-printed personalized guiding template needs less time in screw placement.