Personalised modified osteotomy using computer-aided design–rapid prototyping to correct thoracic deformities

Abstract

The correction of severe thoracic deformities is challenging. However, the usual imaging modalities are not sufficient for performing the surgery. Our objective was to describe the procedure and results of posterior modified wedge osteotomy aided by the techniques of computeraided design-rapid prototyping (CAD-RP) to correct thoracic deformities. Twenty-one patients with thoracic deformities (eight males; 13 females) formed the study group. All patients underwent computed tomography (CT) scanning and CAD-RP, and a model of thoracic deformities and navigation templates of pedicles were created for each patient and used to analyse the spinal deformities and serve as anatomical reference. Aided by these models, personalised modified wedge osteotomy combining the eggshell technique and posterior vertebral column resection was performed. Using CAD-RP improved the safety and accuracy of surgery and screw placement in the 21 patients in whom 41 vertebrae were removed and 216 pedicle screws were placed. The average operation time was 260 (200-420) min, with an average blood loss of 1,900 ml (range 800-3560 ml). The percentage of deformity correction was 56.3% (from 72.1°to 31.5°) in the coronal plane and 60.4% (from 81.6°to 32.3°) in the sagittal plane. No patient had serious complications or implant failure. Personalised single-stage posterior modified wedge osteotomy is an effective procedure for treating thoracic deformities. Using CAD-RP and the RP models have significant benefits for personalised surgical treatment of complex thoracic deformities.

Additive technologies in surgical treatment of spinal deformities

“…J. Yang и соавт. [28] сообщают об успешном применении трехмерных моделей и направителей для установки винтов и проведения корригирующих операций у 20 пациентов с тяжелыми деформациями грудного отдела позвоночника. Авторы отмечают, что высокая точность биомоделей позволила добиться оптимальных результатов при выполнении операций, точность проведения винтов подтвердилась данными послеоперационных КТ-исследований, продолжительность операций существенно сократилась.…”

The utility of a multimaterial 3D printed model for surgical planning of complex deformity of the skull base and craniovertebral junction

“…3,10,11 In these settings, the models created were of a single material reflecting only at the osseous anatomy. They demonstrated the utility of being able to plan corrective osteotomies and pedicle screw fixation as well as an intraoperative reference.…”

Surgical treatment of a patient with congenital deformity of the spine, the thoracic and lumbar pedicle aplasia, and spinal compression syndrome

“…Кроме того, появляется возможность проведения симуляции операции, а именно объ-ема и характера необходимой кост-ной резекции с целью декомпрессии невральных структур, планирования и проведения корригирующих остео-томий и др. [21]. Не менее важна воз-можность оценки эффективности тех или иных металлофиксаторов.…”