{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:03Z","timestamp":1786125843824,"version":"build-2736575974"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ mailto:journals.permissions@oup.com"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Pediatric occipitothoracic fusion can be challenging because of small size pedicles and thin occipital bone. Three-dimensional (3D) printing technology can help with accurate screw insertion but has not been described for occipital keel plate positioning so far.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To describe the novel use of 3D technology to position occipital keel plates during pediatric occipitothoracic fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A young boy with segmental spinal dysgenesis presented with asymmetrical pyramidal paresis in all limbs. Developmental abnormities of the cervical spine caused a thinned spinal cord, and because of progressive spinal cord compression, surgical intervention by means of occipitothoracic fixation was indicated at the age of 3 yr.<\/jats:p>\n                    <jats:p>Because of the small-size pedicles and thin occipital bone, the pedicle screws and occipital plates were planned meticulously using 3D virtual surgical planning technology. The rods were virtually bent in order to properly align with the planned screws. By means of 3D-printed guides, the surgical plan was transferred to the operating theater. For the occipital bone, a novel guide concept was developed, aiming for screw positions at maximal bone thickness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The postoperative course was uneventful, and radiographs showed good cervical alignment. After superimposing the virtual plan with the intraoperative acquired computed tomography, it was confirmed that the occipital plate positions matched the virtual plan and that pedicle screws were accurately inserted without signs of breach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>The use of 3D technology has greatly facilitated the performance of the occipitothoracic fixation and could, in the future, contribute to safer pediatric spinal fixation procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opab060","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:31:37Z","timestamp":1615941097000},"page":"27-33","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Three-Dimensional-Printed Drill Guides for Occipitothoracic Fusion in a Pediatric Patient With Occipitocervical Instability"],"prefix":"10.1227","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9543-1097","authenticated-orcid":false,"given":"Peter A J","family":"Pijpker","sequence":"first","affiliation":[{"name":"3D lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"},{"name":"Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos M A","family":"Kuijlen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart L","family":"Kaptein","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem","family":"Pondaag","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,7]]},"reference":[{"issue":"3","key":"bib1-20251027","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.spinee.2003.10.006","article-title":"Rheumatoid arthritis of the cervical spine","volume":"4","author":"Nguyen","year":"2004","journal-title":"Spine J"},{"issue":"3","key":"bib2-20251027","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.nec.2007.05.004","article-title":"Spinal disorders associated with skeletal dysplasias and syndromes","volume":"18","author":"Song","year":"2007","journal-title":"Neurosurg Clin N Am"},{"issue":"5","key":"bib3-20251027","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1097\/01241398-199009000-00006","article-title":"Instability of the upper cervical spine in Down syndrome","volume":"10","author":"Tredwell","year":"1990","journal-title":"J Pediatr Orthop"},{"issue":"12","key":"bib4-20251027","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1002\/art.25011","article-title":"Neurologic outcome of surgical and conservative treatment of rheumatoid cervical spine subluxation: a systematic review","volume":"61","author":"Wolfs","year":"2009","journal-title":"Arthritis Rheum"},{"issue":"3","key":"bib5-20251027","doi-asserted-by":"crossref","first-page":"296","DOI":"10.3171\/SPI\/2008\/9\/9\/296","article-title":"The cervical end of an occipitocervical fusion: a biomechanical evaluation of 3 constructs","volume":"9","author":"Finn","year":"2008","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"bib6-20251027","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3171\/2010.3.SPINE08143","article-title":"A systematic review of occipital cervical fusion: techniques and outcomes: a review","volume":"13","author":"Winegar","year":"2010","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"bib7-20251027","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3171\/spi.1999.90.1.0084","article-title":"A biomechanical evaluation of occipitocervical instrumentation: screw compared with wire fixation","volume":"90","author":"Hurlbert","year":"1999","journal-title":"J Neurosurg Spine"},{"issue":"5","key":"bib8-20251027","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s00701-020-04287-9","article-title":"Fusion rates support wired allograft combined with instrumented craniocervical fixation in the paediatric population","volume":"162","author":"Groen","year":"2020","journal-title":"Acta Neurochir (Wien)"},{"key":"bib9-20251027","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.wneu.2017.11.042","article-title":"Design and application of a novel patient-specific three-dimensional printed drill navigational guiding in atlantoaxial pedicle screw placement","volume":"114","author":"Pu","year":"2018","journal-title":"World Neurosurg"},{"issue":"23","key":"bib10-20251027","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1097\/BRS.0000000000002810","article-title":"Prospective multicenter study of a multistep screw insertion technique using patient-specific screw guide templates for the cervical and thoracic spine","volume":"43","author":"Sugawara","year":"2018","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"bib11-20251027","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1093\/ons\/opy060","article-title":"Accuracy assessment of pedicle and lateral mass screw insertion assisted by customized 3D-Printed drill guides: a human cadaver study","volume":"16","author":"Pijpker","year":"2019","journal-title":"Oper Neurosurg"},{"issue":"5","key":"bib12-20251027","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1093\/hmg\/ddu534","article-title":"Compound heterozygous mutations in RIPPLY2 associated with vertebral segmentation defects","volume":"24","author":"McInerney-Leo","year":"2015","journal-title":"Hum Mol Genet"},{"issue":"1","key":"bib13-20251027","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.crad.2008.03.012","article-title":"CT evaluation of Chamberlain's, McGregor's, and McRae's skull-base lines","volume":"64","author":"Cronin","year":"2009","journal-title":"Clin Radiol"},{"issue":"2","key":"bib14-20251027","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3171\/2015.6.PEDS1562","article-title":"Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates","volume":"17","author":"Reintjes","year":"2016","journal-title":"J Neurosurg Pediatr"},{"issue":"5","key":"bib15-20251027","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3171\/2012.8.SPINE12770","article-title":"Outcomes of instrumented fusion in the pediatric cervical spine","volume":"17","author":"Hwang","year":"2012","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"bib16-20251027","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3171\/2016.11.SPINE16713","article-title":"Individualized 3D printed model-assisted posterior screw fixation for the treatment of craniovertebral junction abnormality: a retrospective study","volume":"27","author":"Gao","year":"2017","journal-title":"J Neurosurg Spine"},{"issue":"4","key":"bib17-20251027","doi-asserted-by":"crossref","first-page":"e163","DOI":"10.1016\/S2589-7500(19)30067-6","article-title":"Challenges in the design and regulatory approval of 3D-printed surgical implants: a two-case series","volume":"1","author":"Willemsen","year":"2019","journal-title":"Lancet Digit Heal"},{"key":"bib18-20251027","article-title":"Anterior lumbar interbody fusion using a personalized approach: is custom the future of implants for anterior lumbar interbody fusion surgery? [published online ahead of print: January 8, 2019]","author":"Mobbs","journal-title":"World Neurosurg"},{"issue":"2","key":"bib19-20251027","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1177\/229255031502300204","article-title":"A technique for intraoperative creation of patient-specific titanium mesh implants","volume":"23","author":"Sunderland","year":"2015","journal-title":"Plast Surg"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/21\/1\/27\/38595277\/opab060.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:03:00Z","timestamp":1786122180000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,16]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opab060","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,16]]},"assertion":[{"value":"2020-10-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-25","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}