Name: three-dimensional printing guide template assisted percutaneous vertebroplasty (pvp)
Uploaded: 2019-10-17T12:30:00
Description: Watch this Scientific Journal Video about Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP at JoVE.com

The study was funded by the Beijing Municipal Science &#38; Technology Commission (No.Z181100001718078), China.

The present study was approved by the ethics committee of Beijing Friendship Hospital Capital Medical University.
1. Diagnosis of the osteoporotic vertebral compression fracture (OVCF) by X-ray fluoroscopy, magnetic resonance image (MRI), bone scintigraphy, and symptoms
<ol>
	<li>Identify patients who have OVCF by older patients with back pain, tenderness in the spinous process, paraspinal muscles at back, etc.</li>
	<li>Use posterioanterior X-ray fluoroscopy to check if patient has vertebra...

<ol>
	<li>Orthopaedic Society of the Chinese Medical Association. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+the+diagnosis+and+treatment+of+osteoporotic+fractures.">Guidelines for the diagnosis and treatment of osteoporotic fractures.</a> Chinese Journal of Orthopaedics. 37 (1), 1-10 (2017).</li><li>Yi, H. J., Jeong, J. H., Im, S. B., Lee, J. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+vertebroplasty+versus+conservative+treatment+for+one+level+thoracolumbar+osteoporotic+compression+fracture:+Results+of+an+over+2-year+follow-up.">Percutaneous vertebroplasty versus conservative treatment for one level thoracolumbar osteoporotic compression fracture: Results of an over 2-year follow-up.</a> Pain Physician. 19 (5), (2016).</li><li>Balkarli, H., Demirtas, H., Kilic, M., Ozturk, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+osteoporotic+vertebral+compression+fractures+with+percutaneous+vertebroplasty+under+local+anesthesia:+clinical+and+radiological+results.">Treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty under local anesthesia: clinical and radiological results.</a> International Journal of Clinical &amp; Experimental Medicine. 8 (9), 16287-16293 (2015).</li><li>Woojin, C., Varkey, J. A., Jing, C., Hwan, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Review+of+Current+Clinical+Applications+of+Three+Dimensional+Printing+in+Spine+Surgery.">A Review of Current Clinical Applications of Three Dimensional Printing in Spine Surgery.</a> Asian Spine Journal. 12 (1), 171-177 (2018).</li><li>Laredo, J. D., Hamze, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+percutaneous+vertebroplasty+and+their+prevention.">Complications of percutaneous vertebroplasty and their prevention.</a> Skeletal Radiology. 33 (9), 493-505 (2004).</li><li>Saracen, A., Kotwica, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+percutaneous+vertebroplasty:+An+analysis+of+1100+procedures+performed+in+616+patients.">Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients.</a> Medicine. 95 (24), e3850 (2016).</li><li>Park, H. J., Wang, C., Choi, K. H., Kim, H. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+life-size+three-dimensional-printed+spine+model+for+pedicle+screw+instrumentation+training.">Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training.</a> Journal of Orthopaedic Surgery and Research. 13 (1), 86 (2018).</li><li>Gu, Y. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+vertebroplasty+and+interventional+tumor+removal+for+malignant+vertebral+compression+fractures+and/or+spinal+metastatic+tumor+with+epidural+involvement:+a+prospective+pilot+study.">Percutaneous vertebroplasty and interventional tumor removal for malignant vertebral compression fractures and/or spinal metastatic tumor with epidural involvement: a prospective pilot study.</a> Journal of Pain Research. 10, 211-218 (2017).</li><li>Ruiz, S. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+review+of+vertebroplasty+and+kyphoplasty.">Comparative review of vertebroplasty and kyphoplasty.</a> World Journal of Radiology. 6 (6), 329-343 (2014).</li><li>Cannavale, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+vertebroplasty+with+the+rotational+fluoroscopy+imaging+technique.">Percutaneous vertebroplasty with the rotational fluoroscopy imaging technique.</a> Skeletal Radiology. 43 (11), 1529-1536 (2014).</li><li>Ringer, A. J., Bhamidipaty, S. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+access+to+the+vertebral+bodies:+a+video+and+fluoroscopic+overview+of+access+techniques+for+trans-,+extra-,+and+infrapedicular+approaches.">Percutaneous access to the vertebral bodies: a video and fluoroscopic overview of access techniques for trans-, extra-, and infrapedicular approaches.</a> World Neurosurgery. 80 (3-4), 428-435 (2013).</li><li>Kaneyama, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+screw+guiding+method+with+a+screw+guide+template+system+for+posterior+C-2+fixation.">A novel screw guiding method with a screw guide template system for posterior C-2 fixation.</a> Neurosurgery Spine. 21 (2), 231-238 (2014).</li><li>Sugawara, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multistep+pedicle+screw+insertion+procedure+with+patient-specific+lamina+fit-and-lock+templates+for+the+thoracic+spine.">Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine.</a> Neurosurgery Spine. 19 (2), 185-190 (2013).</li><li>Li, J., Lin, J. 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Percutaneous vertebroplasty (PVP) is considered one of the best methods to treat osteoporotic vertebral compression fracture9 due to some distinct advantages: it is minimally invasive; there is less bleeding, and recovery is rapid. Traditional PVP is primarily guided by a C-arm fluoroscope that requires repeated fluoroscopy to determine safe and ideal puncture points, puncture angles and orientations, which increases the intraoperative radiation dosage and the operation time10</s...

As the most common type fracture among all kinds of osteoporotic fractures, osteoporotic vertebral compression fracture (OVCF) is a highly concerning clinical problem nowadays. As current guidelines recommend, percutaneous vertebroplasty is one of the most effective minimally invasive methods to clinically treat osteoporotic vertebral compression fractures1.
Traditionally, surgeons perform percutaneous vertebroplasty guided by a C-arm fluoroscope to treat a vertebral compression fracture to restore the compressed vertebral body and relieve early-stage pain2. Even experienced surgeons make mistakes in confirming suitable puncturing points by simply relying on their personal experience. This operation could cause some puncture-related complications (e.g., cement leakage into surrounding tissues, nerve root injury, intra-spinal hematoma, etc.3,4,5); moreover, almost 50% of patients have local complications from traditional PVP with 95% of complications coming from cement leakage into surrounding tissue or embolization of paravertebral veins6. With the emergence of precision surgery, a 3-D printing guide template has been used in many spinal surgery operations7 because it can enhance the procedural accuracy, decreasing the difficulties and minimizing the operational risks. Here, we apply a 3-D printing guide template into the PVP to make the surgical procedure more precise and to decrease the rate of puncture-related complications. Compared with the traditional method, operations assisted by the 3D printing guide template have 1) increased surgical puncture accuracy, 2) minimized the radiation exposure during the operation, 3) shortened the surgical procedure time, and 4) decreased the probability of puncture-related complications.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>X-ray machine</td>
			<td>Company Philips</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>Magnetic resonance image machine</td>
			<td>Company GE</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>computer tomography</td>
			<td>Company GE</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>HORI 3D printing machine</td>
			<td>Company of Beijing Huitianwei Technology co. ltd.</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>Geomagic Design X</td>
			<td>3D Systems Company</td>
			<td></td>
			<td>software</td>
		</tr>
		<tr>
			<td>Materialise Interactive Medical Image Control System</td>
			<td>Materialise Company</td>
			<td></td>
			<td>software</td>
		</tr>
		<tr>
			<td>VertePort needle</td>
			<td>Stryker Company</td>
			<td></td>
			<td>operation appliance</td>
		</tr>
		<tr>
			<td>Spineplex</td>
			<td>Stryker Company</td>
			<td></td>
			<td>operation appliance</td>
		</tr>
		<tr>
			<td>Percutaneous Cement Delivery System</td>
			<td>Stryker Company</td>
			<td></td>
			<td>operation appliance</td>
		</tr>
		<tr>
			<td>Spirit Level Plus</td>
			<td>IOS App store</td>
			<td></td>
			<td>gradientor</td>
		</tr>
	</tbody>
</table>

three-dimensional printing guide template assisted percutaneous vertebroplasty (pvp)

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The accuracy of PVP mainly depends on the surgeons&#39; experience and multiple fluoroscopes during a traditional procedure. Puncture related complications were reported all over the world. To make the surgical procedure more precise and decrease the rate of puncture-related complications, our team applied a three-dimensional printing guide template to PVP to modify the traditional procedure. This protocol introduces how to model target vertebrae DICOM imaging data into three-dimensions in the software, how to simulate operation in this 3-D model, and how to use all of the surgical data to reconstruct a patient specific template for application. Using this template, surgeons can identify suitable puncture points accurately to improve the accuracy of the operation. The whole protocol includes: 1) diagnosis of the osteoporotic vertebral compression fracture; 2) acquisition of CT imaging of the target vertebra; 3) simulation of the operation in the software; 4) design and fabrication of the 3-D printing guide template; and 5) application of the template into an operation procedure.

Acquisition of CT images and digital modeling were performed in the hospital, while 3-D printing was performed in a 3-D printing company. Thirty minutes were needed to reconstruct the 3-D model from the CT images for the 3-D printing, and the 3-D printing company needed about 6 hours to print 2 guide templates out and send to the hospital.
The pre-operation images of the target vertebra of the patient were shown in <strong class...

Watch this Scientific Journal Video about Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP at JoVE.com

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

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Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

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