The utility of 3D printing for surgical planning and patient-specific implant design for complex spinal pathologies: case report

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>There has been a recent renewed interest in the use and potential applications of 3D printing in the assistance of surgical planning and the development of personalized prostheses. There have been few reports on the use of 3D printing for implants designed to be used in complex spinal surgery.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors report 2 cases in which 3D printing was used for surgical planning as a preoperative mold, and for a custom-designed titanium prosthesis: one patient with a C-1/C-2 chordoma who underwent tumor resection and vertebral reconstruction, and another patient with a custom-designed titanium anterior fusion cage for an unusual congenital spinal deformity.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In both presented cases, the custom-designed and custom-built implants were easily slotted into position, which facilitated the surgery and shortened the procedure time, avoiding further complex reconstruction such as harvesting rib or fibular grafts and fashioning these grafts intraoperatively to fit the defect. Radiological follow-up for both cases demonstrated successful fusion at 9 and 12 months, respectively.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>These cases demonstrate the feasibility of the use of 3D modeling and printing to develop personalized prostheses and can ease the difficulty of complex spinal surgery. Possible future directions of research include the combination of 3D-printed implants and biologics, as well as the development of bioceramic composites and custom implants for load-bearing purposes.</jats:p></jats:sec>

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

“…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.…”

“…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.…”

“…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).…”

“…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). All customised prostheses were made from titanium alloy (TiV6Al4) due to its biocompatibility and ability to enhance bone healing by porosity optimisation to match trabecular bone structure.…”

Application of a 3D custom printed patient specific spinal implant for C1/2 arthrodesis

“…Having gained much interest in recent years, 3DP has found applications in many surgical and medical fields, with variations in printing solutions permitting various options in the architecture of the final structure across a wide range orthopaedic and facial or plastics procedures (1,2). The application of 3DP in orthopaedics is only recent, with positive early results demonstrating the potential to alter future orthopaedic practice (3,4). Custom 3DP of prosthesis for spinal surgery has a potential significant impact due to customisation of complex shapes and materials to manage complex pathologies (5)(6)(7).…”