Novel 3D Navigation Technology for a Personalized Surgical Approach in Diastematomyelia

Background: Type 1 diastematomyelia is a rare congenital spinal anomaly in which the spinal cord is separated by an osseous septum into 2 hemicords. Pediatric patients often present with neurological disorders and spinal deformities, which significantly impair their quality of life. Conventional surgical treatment includes septal resection and osteoplastic laminotomy but is often accompanied by significant traumatization, risks of damage to neural structures, increased intraoperative blood loss, iatrogenic spinal instability, and postlaminectomy spinal deformity progression. Modern 3D technologies enable to improve the accuracy of surgery, ensuring gentler treatment of the posterior spinal structures.
Objective: To compare the effectiveness and safety of an individualized navigation template for osteoplastic laminotomy with those of the traditional surgical approach in patients with type 1 diastematomyelia.
Materials and methods: The retrospective study included 13 patients (age, 4-12 years) with type 1 diastematomyelia. In the main group (n=6), we used individualized 3D navigation templates, whereas the control group (n=7) underwent conventional laminotomy. The data (operation time, blood loss volume, C-reactive protein level, complications) were analyzed using Statistica (TIBCO Software Inc, USA). Quantitative values were compared using a t test, and P < .05 was considered statistically significant.
Results: The application of the navigation template significantly reduced osteotomy duration and blood loss compared with the conventional method (P < .05). The C-reactive protein level on the first postoperative day did not differ significantly between the groups (P > .05), indicating a similar postoperative inflammatory response. One control patient had a neurological complication, which resolved within 3 months.
Conclusions: An individualized navigation template for type 1 diastematomyelia increases the accuracy of bone resection and reduces the traumatic nature of the surgery. This approach holds promise for its widespread implementation in clinical practice, particularly in cases of complex congenital spinal anomalies.

1. Kobets AJ, Oliver J, Cohen A, Jallo GI, Groves ML. Split cord malformation and tethered cord syndrome: case series with long-term follow-up and literature review. Childs Nerv Syst. 2021;37(4):1301–1306. PMID: 33242106. https://doi.org/10.1007/s00381-020-04978-9

2. Narayanan R, Rajshekhar V. Pre-operative clinical deterioration and long-term surgical outcomes in 41 patients with split cord malformation type 1. Childs Nerv Syst. 2024;40(12):4065–4073. PMID: 39361127. https://doi.org/10.1007/s00381-024-06626-y

3. Kancherla V. Neural tube defects: a review of global prevalence, causes, and primary prevention. Childs Nerv Syst. 2023;39(7):1703–1710. PMID: 36882610. https://doi.org/10.1007/s00381-023-05910-7

4. Wallingford JB, Niswander LA, Shaw GM, Finnell RH. The continuing challenge of understanding, preventing, and treating neural tube defects. Science. 2013;339(6123):1222002. PMID: 23449594. PMCID: PMC3677196. https://doi.org/10.1126/science.1222002

5. Sack AM, Khan TW. Diastematomyelia: split cord malformation. Anesthesiology. 2016;125(2):397. PMID: 26771912. https://doi.org/10.1097/aln.0000000000001021

6. Yang N, Luo M, Yu Y, Wang J, Xia L, Wang W. Is it better to resect a bony spur before corrective surgery for congenital scoliosis with type I split cord malformation?. World Neurosurg. 2019;125:e1151–e1159. PMID: 30790730. https://doi.org/10.1016/j.wneu.2019.01.265

7. Meacham WF. Surgical treatment of diastematomyelia. J Neurosurg. 1967;27(1):78–85. PMID: 6028874. https://doi.org/10.3171/jns.1967.27.1.0078

8. Nazarali R, Lyon K, Cleveland J, Garrett D Jr. Split cord malformation associated with scoliosis in adults. Proc (Bayl Univ Med Cent). 2019;32(2):274–276. PMID: 31191152. PMCID: PMC6541173. https://doi.org/10.1080/08998280.2019.1573624

9. Boop FA, Russell A, Chadduck WM. Diagnosis and management of the tethered cord syndrome. J Ark Med Soc. 1992;89(7):328–331. PMID: 1286983.

10. Beuriat PA, Di Rocco F, Szathmari A, Mottolese C. Management of split cord malformation in children: the Lyon experience. Childs Nerv Syst. 2018;34(5):883–891. Published correction appears in Childs Nerv Syst. 2018;34(7):1433. PMID: 29582170. https://doi.org/10.1007/s00381-018-3772-3

11. Xin X, Liu X, Zhu Y, Li J, Yue C, Hao D. 3D-printed guide plate system-assisted thoracolumbar kyphosis osteotomy: a technical case series. World Neurosurg. 2023;173:28–33. PMID: 36780984. https://doi.org/10.1016/j.wneu.2023.02.039

12. Wu AM, Lin JL, Kwan KYH, Wang XY, Zhao J. 3D-printing techniques in spine surgery: the future prospects and current challenges. Expert Rev Med Devices. 2018;15(6):399–401. PMID: 29848086. https://doi.org/10.1080/17434440.2018.1483234

13. Sheha ED, Gandhi SD, Colman MW. 3D printing in spine surgery. Ann Transl Med. 2019;7(Suppl 5):S164. PMID: 31624730. PMCID: PMC6778284. https://doi.org/10.21037/atm.2019.08.88