Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement

Objective: To develop and validate the efficacy and accuracy of a novel drill template for cervical pedicle instrumentation. Materials and Methods: A CT scan of the cervical vertebrae was performed, and a 3D model of the vertebrae was reconstructed using MIMICS 10.01 software. The 3D vertebral model was then exported in STL format, and opened in a workstation running UGS Imageware 12.0 software to determine the optimal pedicle screw size and orientation. A virtual navigational template was established according to the laminar anatomic trait, and physical navigational templates were manufactured using rapid prototyping. The navigational templates were used intraoperatively to assist in the placement of cervical pedicle screws. Results: In all, 84 pedicle screws were placed, and the accuracy of screw placement was confirmed with postoperative X-rays and CT scans. Eighty-two screws were rated as Grade 0, 2 as Grade 1, and no screws as Grade 2 or 3. Hence, safer screw positioning was accomplished with the drill template technique. Conclusions: This study demonstrates a patient-specific template technique that is easy to use, can simplify the surgical act, and generates highly accurate cervical pedicle screw placement. The advantages of this technology over traditional techniques are that it enables planning of the screw trajectory to be completed prior to surgery, and that the screw can be sized to fit the patient's anatomy.