• Jiwon Kim, Jeremy Rajadurai, Wen Jie Choy, Lachlan Cassar, Kevin Phan, Leigh Harris, Meinrad Fiechter, and Ralph J Mobbs.
• Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; NeuroSpine Surgery Research Group, Randwick, New South Wales, Australia.
• World Neurosurg. 2019 Feb 1; 122: 674-679.

BackgroundCortical bone trajectory (CBT) technique for pedicle fixation has been proposed and adopted in recent years. This technique involves a mediolateral direction and a caudocephalad path to maximize screw purchase in cortical bone. Various techniques have been proposed to increase the accuracy of screw placement. A novel technique for CBT screw placement using a three-dimensional printed patient-specific drill guide (PSDG) is presented.MethodsCBT screw fixation combined with posterior lumbar interbody fusion was performed for reduction of an L4-5 spondylolisthesis in a 71-year-old woman. PSDGs (MySpine MC Guides) were designed and printed based on the patient's preoperative computed tomography scan. PSDGs were used intraoperatively to facilitate screw trajectory and placement.ResultsPostoperative imaging performed at 6 weeks and 3 months revealed accurate screw trajectory with excellent reduction of spondylolisthesis. The patient improved clinically with minimal mechanical pain and claudication at 3-month follow-up.ConclusionsPSDG for CBT screw fixation offers significant benefits, including preoperative planning; improved screw placement accuracy while minimizing cortical breach; reduction of operative time; and lower cost compared with intraoperative computed tomography-based neuronavigation, thus expanding the availability of this technique. Drawbacks include time required for PSDG planning and learning curve for surgeons.Copyright © 2018 Elsevier Inc. All rights reserved.

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