OUTCOMES ARE IMPROVED USING PATIENT-SPECIFIC 3D-PRINTED PEDICLE SCREW GUIDES IN PAEDIATRIC DEFORMITY SURGERY

Customized pedicle screw guidance systems use pre-operative imaging to construct 3-D printed guides that precisely fit the spinal anatomy of an individual patient at a specific level. These patient-specific guides are increasingly used in spinal deformity surgery, but few studies have measured the effectiveness of these systems. We aimed to evaluate whether the use of a patient-specific pedicle screw guidance system would lead to a reduction in operative time, blood loss, need for transfusion, and radiation exposure compared to conventional fusion techniques. We retrospectively reviewed a prospectively collected database to find 47 patients who underwent spinal fusion for scoliosis using patient-specific 3D printed pedicle screw guides (Firefly®, Mighty Oak Medical). A control cohort of forty-seven patients who underwent fusion using conventional techniques was constructed using propensity score matching based on scoliosis type and number of levels fused. All patients received treatment between the years of 2013-2022 by a single surgeon at a tertiary care pediatric center. Spinal deformity parameters, operative time, blood loss, transfusion volume, and intraoperative radiation exposure were compared between treatment groups. Patients who were treated using customized pedicle screw guides and those treated using conventional techniques had similar major curve angles (56° vs. 58°), number of levels fused (14.1 vs. 13.6), and number of screws placed (20.7 vs. 19.5). Those treated with the Firefly system had reduced operative time (302 vs. 359 minutes, p < 0.01), lower blood loss (649 vs. 1134 mL, p < 0.01), lower average blood transfusion given (171 vs. 265 mL, p = 0.04), and reduced intraoperative fluoroscopy exposure time (10.9 vs. 31.7 seconds, p < 0.01). The use of customized pedicle screw guides in pediatric spinal fusion leads to significantly reduced operative time, blood loss, and need for blood transfusion. Radiation exposure can be significantly decreased as well. Patient specific 3D printed guides improved surgical outcomes in this small cohort.