{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:49:52Z","timestamp":1774028992033,"version":"3.50.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T00:00:00Z","timestamp":1718236800000},"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. Vet. Sci."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop and evaluate the safety and accuracy of an open, end-on fluoroscopic guided (EOFG) drill hole position technique in canine cadaveric spinal surgery, in comparison to a traditional free-hand (FH) drilling technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Cadaveric comparison study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Animals<\/jats:title><jats:p>Canine cadaveric vertebral columns (<jats:italic>n<\/jats:italic> = 4).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Computed tomography (CT) scans were performed for <jats:italic>in-silico<\/jats:italic> planning. Ideal implant purchase depth and angulations were determined from previously published data. Plans for end-on fluoroscopic guided drill holes included angled reconstructions in thick slab mode to mimic fluoroscopic images. Following surgical preparation of T8 to S2, holes were drilled by one of two experienced surgeons randomized evenly by operated side, surgeon, and technique. C-arm fluoroscopy was utilized for the end-on technique. CT was repeated after the procedures. Safety was determined categorically using a modified Zdichavsky classification and \u201coptimal\u201d placement was compared between techniques. Continuous data for drill-hole accuracy was calculated as angle and depth deviations from the planned trajectories. Data sets were analyzed at both univariable and multivariable levels with logistic regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Drill hole safety was categorized as optimal (modified Zdichavsky classification 1) in 51\/60 (85%) of drill holes using EOFG and 33\/60 (55%) using FH (<jats:italic>P<\/jats:italic> &amp;lt; 0.001) techniques. There were no \u201cunsafe\u201d holes (modified Zdichavsky classification 3a). Optimal drill hole placement was significantly associated with the EOFG technique and use of the largest cadaver, and was significantly less likely within the thoracic region. Mean angle and depth deviations were significantly lower with the EOFG technique. Angle deviations were significantly lower for EOFG in the lumbar region, whereas bone purchase deviations were significantly lower for EOFG in both the thoracic and lumbar regions. The mean time taken to drill the hole was significantly longer for the EOFG technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Optimal drill hole placement was significantly more likely with the EOFG technique and improved the accuracy of bone purchase in the thoracic region.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical significance<\/jats:title><jats:p>The EOFG technique shows promise for translation into a clinically setting, potentially improving implant purchase and therefore stabilizing construct strength, whilst potentially reducing the likelihood of neurovascular injury and need for surgical revision.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fvets.2024.1419521","type":"journal-article","created":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T13:15:45Z","timestamp":1718284545000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Accuracy and safety of freehand vs. end-on fluoroscopic guided drill-hole placement in canine cadaveric thoracic, lumbar and sacral vertebrae"],"prefix":"10.3389","volume":"11","author":[{"given":"Colin J.","family":"Driver","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor Alves","family":"Nores","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi","family":"Thatcher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Navarro-Carrillo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Rose","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.2460\/javma.1991.198.11.1965","article-title":"Management of vertebral column fractures in dogs and cats: 211 cases (1977\u20131985)","volume":"198","author":"Selcer","year":"1991","journal-title":"J Am Vet Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1111\/j.1532-950X.2007.00289.x","article-title":"Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate, with or without laminectomy, for spinal canal stenosis and vertebral instability caused by congenital thoracic vertebral anomalies","volume":"36","author":"Aikawa","year":"2007","journal-title":"Vet Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1160\/VCOT-06-11-0089","article-title":"Surgical treatment of a vertebral fracture associated with a haematogenous osteomyelitis in a dog","volume":"20","author":"Cabassu","year":"2007","journal-title":"Vet Comp Orthop Traumatol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"245","DOI":"10.5326\/15473317-36-3-245","article-title":"Outcome following treatment of vertebral tumors in 20 dogs (1986\u20131995)","volume":"36","author":"Dernell","year":"2000","journal-title":"J Am Anim Hosp Assoc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1111\/j.1748-5827.2009.00808.x","article-title":"Hemilaminectomy and vertebral stabilisation for the treatment of thoracolumbar disc protrusion in 28 dogs","volume":"50","author":"Downes","year":"2009","journal-title":"J Small Anim Pract."},{"key":"B6","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1111\/j.1532-950X.2014.12268.x","article-title":"Bending strength and stiffness of canine cadaver spines after fixation of a lumbar spinal fracture-luxation using a novel unilateral stabilization technique compared to traditional dorsal stabilization","volume":"44","author":"Hall","year":"2015","journal-title":"Vet Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1111\/j.1532-950X.1994.tb00491.x","article-title":"Biomechanical study of canine spinal fracture fixation using pins or bone screws with polymethylmethacrylate","volume":"23","author":"Garcia","year":"1994","journal-title":"Vet Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1111\/j.1532-950X.1984.tb00790.x","article-title":"Spinal fixation in dogs using Steinmann pins and methylmethacrylate","volume":"13","author":"Blass","year":"1984","journal-title":"Vet Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1111\/j.1748-5827.2008.00582.x","article-title":"Vertebral stabilisation and selective decompression for the management of triple thoracolumbar disc protrusions","volume":"49","author":"McKee","year":"2008","journal-title":"J Small Anim Pract."},{"key":"B10","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1055\/s-0038-1632808","article-title":"The clamp rod internal fixator-application and results in 120 small animal fracture patients","volume":"17","author":"Zahn","year":"2004","journal-title":"Vet Comp Orthop Traumatol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1053\/jvet.2002.33616","article-title":"A comparison of the accuracy and safety of vertebral body pin placement using a fluoroscopically guided versus an open surgical approach: an in vitro study","volume":"31","author":"Wheeler","year":"2002","journal-title":"Vet Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1208593","DOI":"10.3389\/fvets.2023.1208593","article-title":"Instrumented cervical fusion using patient specific end-plate conforming interbody devices with a micro-porous structure in nine dogs with disk-associated cervical spondylomyelopathy","volume":"10","author":"Driver","year":"2023","journal-title":"Front Vet Sci."},{"key":"B13","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1111\/j.1748-5827.2006.00070.x","article-title":"Computed tomography study of implantation corridors in canine vertebrae","volume":"47","author":"Watine","year":"2006","journal-title":"J Small Anim Pract."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1111\/jsap.13400","article-title":"Pedicle screws implantation in polymethylmethacrylate construct to stabilise sixth lumbar vertebral body fracture in dogs: 5 cases (2015\u20132018)","volume":"62","author":"Gougeon","year":"2021","journal-title":"J Small Anim Pract."},{"key":"B15","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1016\/j.cvsm.2010.05.004","article-title":"Vertebral fracture and luxation in small animals","volume":"40","author":"Jeffery","year":"2010","journal-title":"Vet Clin North Am Small Anim Pract."},{"key":"B16","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1055\/s-0041-1731808","article-title":"Accuracy and safety of image-guided freehand pin placement in canine cadaveric vertebrae","volume":"34","author":"Samer","year":"2021","journal-title":"Vet Comp Orthop Traumatol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1111\/vsu.12734","article-title":"Accuracy of a patient-specific 3D printed drill guide for placement of cervical transpedicular screws","volume":"47","author":"Hamilton-Bennett","year":"2018","journal-title":"Vet Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1111\/vsu.13558","article-title":"Accuracy and safety of three-dimensionally printed animal-specific drill guides for thoracolumbar vertebral column instrumentation in dogs: bilateral and unilateral designs","volume":"50","author":"Guevar","year":"2021","journal-title":"Vet Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1055\/s-0042-1750056","article-title":"Accuracy and safety of neuronavigation for minimally invasive stabilization in the thoracolumbar spine using polyaxial screws-rod: a canine cadaveric proof of concept","volume":"35","author":"Guevar","year":"2022","journal-title":"Vet Comp Orthop Traumatol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1111\/j.1532-950X.2007.00290.x","article-title":"Closed fluoroscopic- assisted spinal arch external skeletal fixation for the stabilization of vertebral column injuries in five dogs","volume":"36","author":"Wheeler","year":"2007","journal-title":"Vet Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"982560","DOI":"10.3389\/fvets.2022.982560","article-title":"Accuracy of end-on fluoroscopy in predicting implant position in relation to the vertebral canal in dogs","volume":"9","author":"Goffart","year":"2022","journal-title":"Front Vet Sci."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1097\/00007632-199805010-00021","article-title":"Anatomic considerations of pedicle screw placement in the thoracic spine: Roy-Camille technique versus open-lamina technique","volume":"23","author":"Xu","year":"1998","journal-title":"Spine."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2340","DOI":"10.1097\/00007632-200111010-00010","article-title":"In vivo accuracy of thoracic pedicle screws","volume":"26","author":"Belmont PJ","year":"2001","journal-title":"Spine."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1097\/00007632-199606010-00008","article-title":"Accuracy of pedicle screw placement in lumbar vertebrae","volume":"21","author":"Castro","year":"1996","journal-title":"Spine."},{"key":"B25","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1111\/vsu.14042","article-title":"Ex vivo comparison of pin placement with patient-specific drill guides or freehand technique in canine cadaveric spines","volume":"53","author":"Guevara","year":"2024","journal-title":"Vet Surg."},{"key":"B26","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1111\/vsu.13958","article-title":"Accuracy of pin placement in the canine thoracolumbar spine using a free-hand probing technique versus 3D-printed patient-specific drill guides: an ex-vivo study","volume":"52","author":"Mullins","year":"2023","journal-title":"Vet Surg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.2106\/00004623-199508000-00008","article-title":"Placement of pedicle screws in the thoracic spine. Part I: morphometric analysis of the thoracic vertebrae","volume":"77","author":"Vaccaro","year":"1995","journal-title":"J Bone Joint Surg Am."},{"key":"B28","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1097\/00007632-199901150-00003","article-title":"Pedicle instrumentation in the thoracic spine","volume":"24","author":"Cinotti","year":"1999","journal-title":"Spine."},{"key":"B29","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/vsu.13333","article-title":"Accuracy of placement of pedicle screws in the thoracolumbar spine of dogs with spinal deformities with three-dimensionally printed patient-specific drill guides","volume":"49","author":"Elford","year":"2020","journal-title":"Vet Surg."},{"key":"B30","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1111\/vsu.13557","article-title":"Accuracy of three-dimensionally printed animal-specific drill guides for implant placement in canine thoracic vertebrae: a cadaveric study","volume":"50","author":"Mariani","year":"2021","journal-title":"Vet Surg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1111\/jsap.12469","article-title":"Stabilisation of a cranial cervical vertebral fracture using a 3D-printed patient-specific drill guide","volume":"57","author":"Oxley","year":"2016","journal-title":"J Small Anim Pract."},{"key":"B32","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1111\/vsu.13417","article-title":"Influence of a customized three-dimensionally printed drill guide on the accuracy of pedicle screw placement in lumbosacral vertebrae: an ex vivo study","volume":"49","author":"Beer","year":"2020","journal-title":"Vet Surg."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1097\/00007632-200006150-00013","article-title":"Radiation exposure during fluoroscopically assisted pedicle screw insertion in the lumbar spine","volume":"25","author":"Jones","year":"2000","journal-title":"Spine."}],"container-title":["Frontiers in Veterinary Science"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2024.1419521\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T13:15:48Z","timestamp":1718284548000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2024.1419521\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,13]]},"references-count":33,"alternative-id":["10.3389\/fvets.2024.1419521"],"URL":"https:\/\/doi.org\/10.3389\/fvets.2024.1419521","relation":{},"ISSN":["2297-1769"],"issn-type":[{"value":"2297-1769","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,13]]},"article-number":"1419521"}}