{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T17:32:33Z","timestamp":1790530353338,"version":"4.1.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Traditional cortical bone trajectory (CBT) screws in the lumbar spine offer greater holding strength and are well-suited for patients with osteoporosis. However, the screw implantation procedure is challenging and associated with significant risk. This study aimed to assess whether individualized 3D-printing navigation technology provides higher accuracy and better clinical outcomes compared to the free-hand isthmus method for lumbar CBT screw implantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From September 2020 to August 2023, a total of 41 patients who underwent CBT screw surgery were retrospectively collected. Among them, 23 patients underwent the free-hand isthmus method (Group A), while 18 patients underwent the individualized 3D-printing navigation technique (Group B). All imaging and clinical data for these patients were collected in a blinded manner.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the surgery, 185 CBT screws were implanted into the lumbar spines of 41 patients\u201478 in Group A and 107 in Group B. After the surgery, the majority of implanted screws (86.5%) were classified as grade 0, indicating satisfactory implantation. Compared to Group A, Group B had fewer screws classified as grade 1 or grade 2 (<jats:italic>p<\/jats:italic>\u2009=\u20090.045), indicating higher accuracy in screw implantation. Additionally, Group B also had a shorter operation duration (<jats:italic>p<\/jats:italic>\u2009=\u20090.02), fewer fluoroscopy exposures (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01), and less blood loss (<jats:italic>p<\/jats:italic>\u2009=\u20090.03). In addition, compared to Group A, individuals in Group B showed significant improvement in back pain symptoms at both 3 and 6 months (<jats:italic>p<\/jats:italic>\u2009=\u20090.01 and &amp;lt;0.01), as well as in physical activity at 3 months (<jats:italic>p<\/jats:italic>\u2009=\u20090.02) postoperatively. No significant difference in postoperative complications was observed between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared to the free-hand isthmus method, lumbar CBT screw implantation with individualized 3D-printing navigation technology shows higher accuracy, shorter operative time, reduced intraoperative fluoroscopy and blood loss, and better clinical outcomes at three months post-surgery.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1520481","type":"journal-article","created":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T22:49:36Z","timestamp":1743115776000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative study of individualized 3D-printing navigation technology and free-hand isthmus method in lumbar CBT screw implantation"],"prefix":"10.3389","volume":"12","author":[{"given":"Hanlin","family":"Hu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenghao","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowen","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Ou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1016\/j.spinee.2008.07.008","article-title":"Cortical bone trajectory for lumbar pedicle screws","volume":"9","author":"Santoni","year":"2009","journal-title":"Spine J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"416","DOI":"10.3171\/2014.9.SPINE1484","article-title":"Should we use cortical bone screws for cortical bone trajectory?","volume":"22","author":"Ueno","year":"2015","journal-title":"J Neurosurg Spine"},{"key":"B3","doi-asserted-by":"publisher","first-page":"E1297","DOI":"10.1097\/BRS.0000000000000553","article-title":"Effect of physiological loads on cortical and traditional pedicle screw fixation","volume":"39","author":"Baluch","year":"2014","journal-title":"Spine"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1016\/j.orthres.2004.04.001","article-title":"Effect of cortical thickness and cancellous bone density on the holding strength of internal fixator screws","volume":"22","author":"Seebeck","year":"2004","journal-title":"J Orthop Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1097\/BSD.0b013e318073cc4b","article-title":"Increasing bending strength and pullout strength in conical pedicle screws: biomechanical tests and finite element analyses","volume":"21","author":"Chao","year":"2008","journal-title":"J Spinal Disord Tech"},{"key":"B6","doi-asserted-by":"publisher","first-page":"90","DOI":"10.3171\/SPI\/2008\/9\/7\/090","article-title":"Influence of thread design on pedicle screw fixation. 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