Creation of 3-Dimensional Life Size: Patient-Specific C1 Fracture Models for Screw Fixation

• Published in: World neurosurgery 2018-06, Vol.114, p.e173-e181
• Main Authors: Govsa, Figen, Ozer, Mehmet Asim, Biceroglu, Huseyin, Karakas, Asli Beril, Cagli, Sedat, Eraslan, Cenk, Alagoz, Ahmet Kemal
• Format: Article
• Language: English
• Subjects: 3D neuroanatomical model; Individualized screw insertion; Patient-specific model; Transarticular screw fixation; Vertebral artery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.02.131

Transarticular screw fixation has fatal complications such as vertebral artery (VA), carotid artery, and spinal cord injuries. The landmarks for deciding the entry point for C1 lateral mass screws were clarified by using life-size 3-dimensional (3D) patient-specific spine models. This study included a total of 10 patients with C1 fractures. Dual-energy computed tomography (CT) scan data from C1 pre- and postscrewing were modified into 3D patient-specific life-size cervical spine models. The detailed information, such as bony and vascular elements, of 13 separate parameters of C1 was used as an intraoperative reference. 3D patient-specific models were created preoperatively with the fracture and postoperatively with the screwed vertebrae. After CT scans of the models were measured, the life-size patient-specific models were proven to be individualized. 3D models assisted in determining the fracture locations, pedicle sizes, and positions of the VA. The range of the measurements for ideal point of entry reveals the need for patient-specific intervention was required. 3D models were used in surgical planning maximizing the possibility of ideal screw position and providing individualized information concerning cervical spinal anatomy. The individualized 3D printing screw insertion template was user-friendly, of moderate cost, and it enabled a radiation-free cervical screw insertion. •C1 screws require analysis of the complex osteovascular structures of the personalized anatomical variations.•3D life-size models were assisted in determining the fracture location, pedicle size and VA shapes.•3D invidualized models are useful for neurosurgeons, improving an important supplement to their training and experience.•3D models are helping patients and their families to understand their cases, surgical goals and risks of the operation.