3D-Printed Patient-Customized Artificial Vertebral Body for Spinal Reconstruction after Total En Bloc Spondylectomy of Complex Multi-Level Spinal Tumors

Abstract

Three dimensional (3D)-printing technology facilitates complex spine surgery with unique advantages in artificial vertebral body design and manufacturing. In this study, we aimed to demonstrate how a 3D-printed spinal implant is utilized in the management of multi-level spinal tumors and integrates with comprehensive oncologic treatment. Eight spinal or paraspinal tumor patients requiring spinal reconstruction after total en bloc spondylectomy were selected as candidates for 3D-printed titanium artificial vertebral body implants. All patients underwent surgery on three or more vertebral segments or complex spinal junction segments. The clinical, oncological, and surgical characteristics of patients were collected. Of the eight candidates, seven suffered from pain and/or limb disorder. Six underwent successful 3D-printed spinal implantation, while two failed due to implant mismatching and were converted to conventional reconstruction. Of the six patients undergoing 3D-printed spinal implant surgery: (i) Five had recurrent tumors; (ii) three underwent neoadjuvant therapy; (iii) the median surgery time was 414 min; (iv) the median blood loss was 2150 ml; (v) the median blood transfusion was 2000 ml; (vi) the median length of hospital stay was 9 days; (vii) four patients received adjuvant therapy after surgery; and (viii) all patients experienced no pain, moved freely, and had no local recurrence at a median of 11.5 months post-operative follow-up. Spinal reconstruction with a 3D-printed titanium artificial vertebral body allows for total en bloc resection of complex multi-level spinal tumors. Combined with neoadjuvant and adjuvant therapy, these patients had excellent postoperative outcomes, long-term normal spinal function, and associated low local recurrence probability.

Powder Bed Fusion 3D Printing in Precision Manufacturing for Biomedical Applications: A Comprehensive Review

“…Patients with spinal stenosis can move more freely and have less discomfort owing to spinal spacers. PBF technology is utilized to manufacture personalized vertebral bodies to replace destroyed bone in cases of severe spinal injuries [167,168]. PBF 3D printing is utilized for the production of personalized sternal plates, which are employed in the mending of fractured chest bone.…”

3D printing metal implants in orthopedic surgery: Methods, applications and future prospects

“…Hardware failures such as loosening, sinking, breaking, and displacement weren't observed during the follow-up period 2022 Hu et al. [ 200 ] Int J Bioprint 8 3D printed artificial vertebral body for multilevel total en bloc spondylectomy (TES) Combined with neoadjuvant and adjuvant therapy, these patients had excellent postoperative outcomes, long-term normal spinal function, and associated low local recurrence probability 2022 Girolami et al. [ 201 ] J Clin Med 2 3D-printed personalized implants for reconstructing the anterior column Three dimensional printing allowed the reported authors to design patient-specific solutions, not only for shape and size of the implants but also for the method to achieve proximal fixation 2022 Zhou et al.…”

“…For reconstruction of bone defects after multilevel total en bloc spondylectomy (TES), 3D printing artificial vertebral bodies could greatly reduce the risk of prosthesis collapse and loosening, and its advantages were more significant [ 199 , 198 ]. Combined with neoadjuvant and adjuvant therapy, these patients had excellent postoperative outcomes, long-term normal spinal function, and associated low local recurrence probability [ 200 ]. A 3D printing Ti microporous prosthesis was designed by He et al.…”

Numerical evaluation of spinal reconstruction using a 3D printed vertebral body replacement implant: effects of material anisotropy

“…Currently, this combination of artificial vertebral body implants and different fixation strategies is usually used to accomplish vertebral replacement and functional reconstruction (Zhang and Guo, 2023). Moreover, some 3D printed patient-specific implants considering fully the differences of individualized defects and anatomical morphology, are also designed and applied to harvest better service performance in clinic (Hu et al, 2022;Palmquist et al, 2023). However, several postoperative complications still existed (Yoshioka et al, 2013), such as subsidence of implants, screw misplacement and pedicle breakage, degeneration of adjacent segments, etc.…”