Yonsei Med J.  2017 Mar;58(2):453-457. 10.3349/ymj.2017.58.2.453.

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

• Kim D
• Lim JY
• Shim KW
• Han JW
• Yi S
• Yoon DH
• Kim KN
• Ha Y
• Ji GY
• Shin DA

• KMID: 2427137
• DOI: http://doi.org/10.3349/ymj.2017.58.2.453

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.

Keyword

3D-printing; sacrum; instrumentation; spinal fusion

MeSH Terms

Bone Neoplasms/*surgery
Bone Screws
Female
Follow-Up Studies
Humans
Male
Middle Aged
Osteosarcoma/*surgery
Pelvis
*Printing, Three-Dimensional
Reconstructive Surgical Procedures/methods
Sacrum/*surgery
Time Factors

Figure

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  Fig. 1 (A) Preoperative Gd-enhanced T1-weighted pelvic MRI showing a mass with peripheral enhancement at the left side of the sacrum (arrowheads) with soft tissue invasion (asterisk). (B) After three cycles of neoadjuvant chemotherapy for 3 months, the volume of tumor mass (arrowheads) and the extent of extraosseous invasion (asterisk) decreased significantly.

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  Fig. 2 Illustration of 3D-implant design process. A customized implant was designed using 3D software (Mimics, 3-matic, Magics). The design process (dotted box) was performed during neoadjuvant chemotherapy. The design was interactively corrected reflecting the final pelvic MRI and RP models before final printing. RP, rapid prototype.

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  Fig. 3 (A) Custom-made 3D-printed hemisacral construct with a specific porous titanium structure. The screw hole and contact surfaces were made with high-density structure. (B) The left sacrum was excised with en bloc resection. The shape and size of the implant were the same as the resected mass.

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  Fig. 4 (A) Rigid reconstruction achieved with the 3D implant and screw-rod system. (B) Lateral X-ray at postoperative 1 week demonstrates a complete lumbosacral construct. (C) AP X-ray at postoperative 1 week demonstrates a complete lumbosacral construct. AP, anterior-posterior.

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  Fig. 5 Axial CT 1 year postoperatively shows excellent bone ingrowth into the midline strut (asterisk) and porous surface (arrowheads).

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