Clinical Application of Personalized Digital Surgical Planning and Precise Execution for Severe and Complex Adult Spinal Deformity Correction Utilizing 3D Printing Techniques

Abstract

(1) Background: The three-dimensional printing (3DP) technique has been reported to be of great utility in spine surgery. The purpose of this study is to report the clinical application of personalized preoperative digital planning and a 3DP guidance template in the treatment of severe and complex adult spinal deformity. (2) Methods: eight adult patients with severe rigid kyphoscoliosis were given personalized surgical simulation based on the preoperative radiological data. Guidance templates for screw insertion and osteotomy were designed and manufactured according to the planning protocol and used during the correction surgery. The perioperative, and radiological parameters and complications, including surgery duration, estimated blood loss, pre- and post-operative cobb angle, trunk balance, and precision of osteotomy operation with screw implantation were collected retrospectively and analyzed to evaluate the clinical efficacy and safety of this technique. (3) Results: Of the eight patients, the primary pathology of scoliosis included two adult idiopathic scoliosis (ADIS), four congenital scoliosis (CS), one ankylosing spondylitis (AS), and one tuberculosis (TB). Two patients had a previous history of spinal surgery. Three pedicle subtraction osteotomies (PSOs) and five vertebral column resection (VCR) osteotomies were successfully performed with the application of the guide templates. The main cobb angle was corrected from 99.33° to 34.17°, and the kyphosis was corrected from 110.00° to 42.00°. The ratio of osteotomy execution and simulation was 97.02%. In the cohort, the average screw accuracy was 93.04%. (4) Conclusions: The clinical application of personalized digital surgical planning and precise execution via 3D printing guidance templates in the treatment of severe adult rigid deformity is feasible, effective, and easily generalizable. The preoperative osteotomy simulation was executed with high precision, utilizing personalized designed guidance templates. This technique can be used to reduce the surgical risk and difficulty of screw placement and high-level osteotomy.

Three-Dimensionale Printed Individualized Guiding Templates for Surgical Correction of Severe hyperkyphosis: Outcomes of 7 Cases

“…1.Three-dimensional visualization: Computer-assisted navigation allows for the generation of threedimensional images of the spine, providing multi-angle observation and enhanced understanding of the spinal deformity. This technology enables the segmentation of images and reconstruction of the threedimensional shape of each vertebra, providing a more detailed and accurate assessment of the patient's condition [27]. Computer models can be used to simulate the surgical procedure, accurately measure the degree of spinal curvature, and plan the corrective actions.…”

Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models

“…The methodology presented using 3D Slicer software together with 3D models could also be used in planning treatment of other conditions, e.g., in patients with high-riding dislocation developmental dysplasia of the hip [35,39] and even in cases where custom-made implants are used, as software for segmentation of bone structures [40]. Furthermore, the use of these techniques is not limited to pelvic surgery, but could be applied to spinal surgery for the purpose of planning pedicle insertion and osteotomy procedures in cases of spinal deformity [41], craniofacial surgery to prepare custom-made titanium mandibular protheses [42], as well as cancer treatment and the use of MRI-based three-dimensional models, e.g., planning of radical prostatectomy [43].…”

Risk Factors in Administering Spinal Anesthesia: A Comprehensive Review

“…Incidence drops to less than 2% for needles smaller than 26G. The occurrence of PDPH can be minimized by using a needle with a smaller diameter [ 30 , 33 ]. However, although 29G spinal needles can decrease the risk of PDPH complications, their thinness makes them impractical and raises the likelihood of failures in spinal anesthesia procedures [ 34 ].…”