Background:
The treatment strategy for severe and complex adult spinal deformity (ASD) is tough. The rapid development of three-dimensional (3D) construction and printing techniques in recent years has made their integration with complex spine surgery feasible. We have applied various 3D techniques, including spinal canal reconstruction evaluation, computer-assisted screw inserting planning and 3D surgical simulation, 3D-printed spine model, and 3D-printed guide template of pedicle screw or osteotomy, in the personalized surgical management of severe and complex ASD patients, aiming to optimize clinical decisions, efficacy and safety. This study aims to introduce our experience in personalized digital planning and precise execution using 3D techniques in severe and complex ASD surgery.
Methods:
From 2021.10 to 2023.8, a series of severe and complex ASD patients requiring correction surgery were prospectively recruited. They underwent personalized surgical management by 3D techniques. Briefly, based on the preoperative computer tomography scan, personalized surgical planning and simulation were performed; then, through reverse engineering, the guide template for pedicle screw insertion and osteotomy procedure was designed, manufactured by 3D printing, and applied in surgery. The perioperative radiographic parameters, surgical information, and complications were collected to demonstrate this technique's clinical efficacy, safety, and reliability.
Results:
A total of 23 (M:F 10:13) severe and complex ASD patients were included, with an age of 33.8 ± 5.2 years. Of the included patients, one was idiopathic scoliosis, 10 were congenital scoliosis, four were ankylosing spondylitis, and eight were kyphotic deformity secondary to tuberculosis. Five patients were revision cases. With the assistance of a guide template, pedicle screw placement combined with pedicle subtraction osteotomies (PSO) or vertebral column resection (VCR) was successfully performed for these patients. The main cobb angle was corrected from 105.2° to 38.2°, and the kyphotic deformity was corrected from 112.4° to 43.1°, with a correction rate of 63.7% and 61.6%, respectively. Only two temporary perioperative neurological complications were recorded, with an incidence of 8.7%. The accuracy of screw placement was 93.04%. The execution of osteotomy showed good reliability and agreement with the planning, with a rate of 95.3%.
Conclusions:
The personalized digital planning and precise execution using 3D techniques in severe and complex ASD surgery is feasible, effective, safe, and reliable. The surgical planning could be precisely executed by personalized guide templates. This technique could be applied to facilitate screw placement and high-level osteotomy procedures and reduce the risk of complications in severe and complex ASD surgery.