Sacral Reconstruction with a 3D-Printed Implant after Hemisacrectomy in a Patient with Sacral Osteosarcoma: 1-Year Follow-Up Result

Abstract

Pelvic reconstruction after sacral resection is challenging in terms of anatomical complexity, excessive loadbearing, and wide defects. Nevertheless, the technological development of 3D-printed implants enables us to overcome these difficulties. Here, we present a case of sacral osteosarcoma surgically treated with hemisacrectomy and sacral reconstruction using a 3D-printed implant. The implant was printed as a customized titanium prosthesis from a 3D real-sized reconstruction of a patient's CT images. It consisted mostly of a porous mesh and incorporated a dense strut. After 3-months of neoadjuvant chemotherapy, the patient underwent hemisacretomy with preservation of contralateral sacral nerves. The implant was anatomically installed on the defect and fixed with a screw-rod system up to the level of L3. Postoperative pain was significantly low and the patient recovered sufficiently to walk as early as 2 weeks postoperatively. The patient showed left-side foot drop only, without loss of sphincter function. In 1-year follow-up CT, excellent bony fusion was noticed. To our knowledge, this is the first report of a case of hemisacral reconstruction using a custom-made 3D-printed implant. We believe that this technique can be applied to spinal reconstructions after a partial or complete spondylectomy in a wide variety of spinal diseases.

Systematic review of 3D printing in spinal surgery: the current state of play

“…The cases performed thus far are limited to anatomically challenging, rare pathologies where an individualized solution to restore patient-specific anatomy is a key prognostic factor (44,(46)(47)(48)59,60). These range from customised fixation in the upper cervical and lower lumbar spine (44,48,59) to insertion of a 3DP vertebra (46) and sacral reconstructions (45,47).…”

“…These range from customised fixation in the upper cervical and lower lumbar spine (44,48,59) to insertion of a 3DP vertebra (46) and sacral reconstructions (45,47). A summary of PSIs used in spinal surgery in the literature is shown in Table 3.…”

“…A summary of PSIs used in spinal surgery in the literature is shown in Table 3. The lack of specialised implants for reconstruction after tumour resection is evidenced by the majority of cases being oncological in nature (45)(46)(47)(48). The remaining cases utilised 3DP PSIs due to unique anatomy associated with degenerative change and a congenital anomaly (44,48).…”

“…This increases the stability of the implant whilst minimising complications such as stress shielding and subsidence (45)(46)(47). Xu et al (46) created a prosthesis with zero profile anteriorly for this purpose, minimising the risk of dysphagia in their patient.…”

“…This case also noted the minimisation of other morbidities, such as pain and limited function, associated with bone grafts. Another benefit of customised implants is a reduction in operation time (44,(46)(47)(48), with Mobbs et al (48) noting the ability to avoid bone harvesting with intra-operative fashioning to fit complex defects. Wei et al (45) produced three different sized prostheses to fit the intra-operative bone defect.…”