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Fig. 5 The handwritten instrumentation report on the left illustrates the high potential for error
when compared to the automatically generated report coming from the 3D templating tool
automatically generated report from the 3D planning process shown in Fig. 5
requires no manual intervention.
Each vertebral level includes an axial view with screw placement angles
included and a top view 3D rendering, as well as two full spine renderings, illus-
trated in Fig. 6 , with all screws displayed. The report can then be printed, saved, or
added to the patient record as a DICOM object.
While some differences were identi
ed in several comparisons, no strong trends
were found in the pre-operative comparisons or the two pre-operative to post-
operative comparisons. Given the small sample, this is not surprising. However, the
different measurements generated, coupled with the participating surgeon
s pre-
vailing intuition that the 3D planning method was producing more consistent and
more precise measurements, provides impetus for further study. It must also be
recognized that comparison of pre-operative plans to post-operative results that
were originally planned using 2D methods is not going to produce results that
indicate one is
'
than the other. In fact, it could be expected that differences
between 2D pre-operative planning and post-operative results should be small in
these cases, since both were planned using the same method. It turns out that is
exactly what occurred in the case of the experienced surgeon. The chart in Fig. 7
shows his 2D plans deviated less from the post-operative results than his 3D plans
did. Interestingly, the less experienced resident
better
s results were the opposite, as
indicated by the same chart, which might indicate that 3D planning helps him plan
cases that more resemble the expert. The chart in Fig. 7 also suggests that the
resident
'
s templates in the 2D plans tended to be shorter and narrower than those
from the 3D plans. A plausible explanation for this is that residents tend to round
down when using 2D methods since it is recognized as more of an estimate (due to
oblique orientation of vertebra) and wanted to err on the side of safety. 3D planning
gave a better view and provided more con
'
dence in the template choice, thus
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