The Effect of a One-to-one Size Patient Model Created with Three-Dimensional Printing Technology on Deformity Understanding Classification and Surgery Planning in Scoliosis Surgery

Project no. 23860 · Status: Kapanmış · 2022

Summary

Objective:Surgical treatment of scoliosis patients is challenging due to the variability of deformities, including complex classification, and accompanying thoracic and abdominal deformities. Despite advances in radiological imaging, three-dimensional (3D) modeling enables a better visualization of spinal problems that present with diverse variations. Extensive surgical interventions negatively impact patients' quality of life, resulting in prolonged hospital stays and economic burdens. The increasing use of 3D models as educational tools has reduced training costs and shortened the learning curves for surgeons. Consequently, the shortened learning curve has been associated with shorter operation times, more effective implant usage, reduced need for blood transfusions, and decreased radiation exposure during surgery. Therefore, besides contributing to surgical education, these practices indirectly benefit the country's economy. The aim of this study is to investigate the impact of preoperative use of digitally designed 3D scoliosis models on surgical planning and to evaluate the assessment of this educational model by practitioners. Additionally, the study aims to compare the surgical skills of residents in different years of training and gain insights into the learning curve required for performing spinal surgeries.Materials and Methods: Radiological images (CT scans, X-rays) obtained before surgery from a patient with de novo scoliosis were used. Twenty life-sized 3D printed models of the lumbar deformity were created for this patient. A group of 20 orthopedic and traumatology resident physicians who performed the procedure using the patient model was divided into three groups: 1) Junior residents (with no prior active participation in vertebral surgery operations), 2) Mid-level residents (actively involved in observing vertebral surgeries), and 3) Senior residents (actively involved in vertebral surgeries and contributed to surgical operations alongside the primary surgeon). Each resident student from the Ege University Department of Orthopedics and Traumatology performed a total of ten pedicle screw applications for five lumbar levels. The length of screws used during the procedure, the duration of the procedure, the placement of pedicle screws, and the opinions of the resident students regarding the materials and surgical techniques were evaluated using pedicle screw measurements and satisfaction surveys previously prepared for practitioners.Results: Various features of the application and the model were evaluated with the questionnaire applied to the participants after the application. In the evaluation of the difficulty of the application steps, it was seen that the most difficult step for the residents was deciding on the direction of the pedicle screw. It was also stated that due to the structure of the model, the feeling of loss of resistance created by the drills as they cross the cortex is not realistic enough. In addition, while they were evaluating the general features of the model with the questions asked, they stated that the simulated environment made a positive contribution to the education and the application steps were realistic, but this evaluation was scored lower because the soft tissue imitation was unrealistic. The participant who completed the pedicle screw simulation in the fastest time completed it in 26 minutes 22 seconds, and the person who completed the slowest completed it in 62 minutes 59 seconds. The average processing time was 34 minutes 36 seconds. At the end of the application, while 77.5% of the screws were placed correctly, the screws penetrating the medial cortex took the first place among the misplaced screws, as expected. A significant difference was found between the groups in terms of the total critical penetration number (p=0.001). In addition, the Odds ratio was calculated and it was shown that being at low seniority from 3 years to the mountain increased the risk of critical cortex penetration by 6,000 times. The distribution of critical cortex penetration according to the lumbar levels was evaluated. The relationship between cortex perforation and lumbar level was compared with the help of the Chi-Square test. A statistically significant difference was found (p=0.001). In addition, the Odds ratio was calculated and it was found that the position of the screw at the level of the deformity increased the risk of screw misplacement 4,667 times.Conclusion: Three-dimensional models aid orthopedists in identifying deformity characteristics and performing better surgical planning, resulting in optimal surgical outcomes. The creation of personalized deformity models is a valuable method for preoperative surgical preparation. With the increasing use of technological advancements in the field of healthcare, research in this area has increased. Three-dimensional modeling has been particularly advantageous in advanced countries. The creation of patient-specific anatomical models for structures with changing anatomy and geometry, such as tumor-like masses, provides surgeons with a different perspective during preoperative planning and surgery. Thus, these models are useful in surgical planning by not only offering patients the ideal treatment but also demonstrating their unique features in a three-dimensional manner. These models assist surgeons in gaining valuable experience in surgical techniques without subjecting patients to the risks associated with real-time surgeries. Experiencing possible scenarios on a patient model before applying them to the actual patient reduces postoperative mortality and morbidity.Keywords: Three-dimensional printing, scoliosis, resident education.

View details