J Korean Neurosurg Soc.  2021 Jul;64(4):495-504. 10.3340/jkns.2020.0272.

Implications of 3-Dimensional Printed Spinal Implants on the Outcomes in Spine Surgery

Affiliations
  • 1Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
  • 2Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
  • 3Department of Neurology, University of Washington, Seattle, WA, USA
  • 4New York University School of Medicine, New York, NY, USA

Abstract

Three-dimensional printing (3DP) applications possess substantial versatility within surgical applications, such as complex reconstructive surgeries and for the use of surgical resection guides. The capability of constructing an implant from a series of radiographic images to provide personalized anatomical fit is what makes 3D printed implants most appealing to surgeons. Our objective is to describe the process of integration of 3DP implants into the operating room for spinal surgery, summarize the outcomes of using 3DP implants in spinal surgery, and discuss the limitations and safety concerns during pre-operative consideration. 3DP allows for customized, light weight, and geometrically complex functional implants in spinal surgery in cases of decompression, tumor, and fusion. However, there are limitations such as the cost of the technology which is prohibitive to many hospitals. The novelty of this approach implies that the quantity of longitudinal studies is limited and our understanding of how the human body responds long term to these implants is still unclear. Although it has given surgeons the ability to improve outcomes, surgical strategies, and patient recovery, there is a need for prospective studies to follow the safety and efficacy of the usage of 3D printed implants in spine surgery.

Keyword

3D printed; Spinal implants; Spine surgery; Innovation; Biologics

Cited by  1 articles

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Reference

References

1. Ahmed AK, Pennington Z, Molina CA, Xia Y, Goodwin CR, Sciubba DM. Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases. J Neurosurg Spine. 30:417–550. 2019.
2. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 354:581–585. 1999.
Article
3. Atala A, Forgacs G. Three-dimensional bioprinting in regenerative medicine: reality, hype, and future. Stem Cells Transl Med. 8:744–745. 2019.
Article
5. Burleson J, DiPaola C. 3D printing in spine surgery. In : Dipaola M, Wodajo FM, editors. 3D Printing in Orthopaedic Surgery. ed 1. Philadelphia: Elsevier;2019. p. 105–122.
6. Chen CS, Shih SL. Biomechanical analysis of a new lumbar interspinous device with optimized topology. Med Biol Eng Comput. 56:1333–1341. 2018.
Article
7. Chin BZ, Ji T, Tang X, Yang R, Guo W. Three-level lumbar en bloc spondylectomy with three-dimensional-printed vertebrae reconstruction for recurrent giant cell tumor. World Neurosurg. 129:531–537.e1. 2019.
8. Choy WJ, Mobbs RJ, Wilcox B, Phan S, Phan K, Sutterlin CE 3rd. Reconstruction of thoracic spine using a personalized 3D-printed vertebral body in adolescent with T9 primary bone tumor. World Neurosurg. 105:1032.e13–1032.e17. 2017.
Article
9. Choy WJ, Parr WCH, Phan K, Walsh WR, Mobbs RJ. 3-dimensional printing for anterior cervical surgery: a review. J Spine Surg. 4:757–769. 2018.
Article
10. Conformis. Conformis hip system. Available at : https://www.conformis.com/conformis-hip-system/.
11. D’Urso PS, Askin G, Earwaker JS, Merry GS, Thompson RG, Barker TM, et al. Spinal biomodeling. Spine (Phila Pa 1976). 24:1247–1251. 1999.
Article
12. Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, et al. 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging. 30:1323–1341. 2012.
Article
13. Garg B, Mehta N. Current status of 3D printing in spine surgery. J Clin Orthop Trauma. 9:218–225. 2018.
Article
14. Guo LX, Yin JY. Finite element analysis and design of an interspinous device using topology optimization. Med Biol Eng Comput. 57:89–98. 2019.
Article
15. Hollister SJ. Scaffold design and manufacturing: from concept to clinic. Adv Mater. 21:3330–3342. 2009.
Article
16. Kim D, Lim JY, Shim KW, Han JW, Yi S, Yoon DH, et al. Sacral reconstruction with a 3D-printed implant after hemisacrectomy in a patient with sacral osteosarcoma: 1-year follow-up result. Yonsei Med J. 58:453–457. 2017.
Article
17. Landi A, Delfini R, Ricci A, Barbanera A, Anichini G, Brogna C. New trends in instrumentation and complex techniques in spine surgery. Biomed Res Int. 2015:216384. 2015.
Article
18. Li X, Wang Y, Zhao Y, Liu J, Xiao S, Mao K. Multilevel 3D printing implant for reconstructing cervical spine with metastatic papillary thyroid carcinoma. Spine (Phila Pa 1976). 42:E1326–E1330. 2017.
Article
19. Lin HM, Liu CL, Pan YN, Huang CH, Shih SL, Wei SH, et al. Biomechanical analysis and design of a dynamic spinal fixator using topology optimization: a finite element analysis. Med Biol Eng Comput. 52:499–508. 2014.
Article
20. Ling Q, He E, Ouyang H, Guo J, Yin Z, Huang W. Design of mulitlevel OLF approach (“V”-shaped decompressive laminoplasty) based on 3D printing technology. Eur Spine J. 27(Suppl 3):323–329. 2018.
Article
21. Lu T, Liu C, Yang B, Liu J, Zhang F, Wang D, et al. Single-level anterior cervical corpectomy and fusion using a new 3D-printed anatomyadaptive titanium mesh cage for treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: a retrospective case series study. Med Sci Monit. 23:3105–3114. 2017.
Article
22. Martelli N, Serrano C, van den Brink H, Pineau J, Prognon P, Borget I, et al. Advantages and disadvantages of 3-dimensional printing in surgery: a systematic review. Surgery. 159:1485–1500. 2016.
Article
23. Materialise. Always There. Empowering your 3D printing applications. Available at : https://www.materialise.com/.
24. Mobbs RJ, Coughlan M, Thompson R, Sutterlin CE 3rd, Phan K. The utility of 3D printing for surgical planning and patient-specific implant design for complex spinal pathologies: case report. J Neurosurg Spine. 26:513–518. 2017.
Article
25. Mobbs RJ, Parr WCH, Choy WJ, McEvoy A, Walsh WR, Phan K. Anterior lumbar interbody fusion using a personalized approach : is custom the future of implants for anterior lumbar interbody fusion surgery? World Neurosurg. 124:452–458.e1. 2019.
26. Mokawem M, Katzouraki G, Harman CL, Lee R. Lumbar interbody fusion rates with 3D-printed lamellar titanium cages using a silicatesubstituted calcium phosphate bone graft. J Clin Neurosci. 68:134–139. 2019.
Article
27. Popov VV Jr, Muller-Kamskii G, Kovalevsky A, Dzhenzhera G, Strokin E, Kolomiets A, et al. Design and 3D-printing of titanium bone implants: brief review of approach and clinical cases. Biomed Eng Lett. 8:337–344. 2018.
Article
28. Provaggi E, Leong JJH, Kalaskar DM. Applications of 3D printing in the management of severe spinal conditions. Proc Inst Mech Eng H. 231:471–486. 2017.
Article
29. Pucci JU, Christophe BR, Sisti JA, Connolly ES Jr. Three-dimensional printing: technologies, applications, and limitations in neurosurgery. Biotechnol Adv. 35:521–529. 2017.
Article
30. Roopavath UK, Kalaskar DM. Introduction to 3D printing in medicine. In : Kalaskar DM, editor. 3D Printing in Medicine. ed 1. Woodhead Publishing: Cambridge;2017. p. 1–20.
31. Rosenzweig DH, Carelli E, Steffen T, Jarzem P, Haglund L. 3D-printed ABS and PLA scaffolds for cartilage and nucleus pulposus tissue regeneration. Int J Mol Sci. 16:15118–15135. 2015.
Article
32. Sigmund O. Topology optimization: a tool for the tailoring of structures and materials. Philos Trans R Soc Lond A. 358:211–227. 2000.
Article
33. Siu TL, Rogers JM, Lin K, Thompson R, Owbridge M. Custom-made titanium 3-dimensional printed interbody cages for treatment of osteoporotic fracture-related spinal deformity. World Neurosurg. 111:1–5. 2018.
Article
34. Spetzger U, Frasca M, König SA. Surgical planning, manufacturing and implantation of an individualized cervical fusion titanium cage using patient-specific data. Eur Spine J. 25:2239–2246. 2016.
Article
35. Tetsworth K, Block S, Glatt V. Putting 3D modelling and 3D printing into practice: virtual surgery and preoperative planning to reconstruct complex post-traumatic skeletal deformities and defects. SICOT J. 3:16. 2017.
Article
36. Thayaparan GK, Owbridge MG, Thompson RG, D’Urso PS. Designing patient-specific 3D printed devices for posterior atlantoaxial transarticular fixation surgery. J Clin Neurosci. 56:192–198. 2018.
Article
37. Tu Q, Ding HW, Chen H, Miao QJ, Yang X, Li K, et al. Three-dimensional-printed individualized guiding templates for surgical correction of severe kyphoscoliosis secondary to ankylosing spondylitis: outcomes of 9 cases. World Neurosurg. 130:e961–e970. 2019.
Article
38. Wei R, Guo W, Ji T, Zhang Y, Liang H. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J. 26:1902–1909. 2017.
Article
39. Whitaker M. The history of 3D printing in healthcare. The Bulletin of the Royal College of Surgeons of England. 96:228–229. 2014.
Article
40. Wilcox B, Mobbs RJ, Wu AM, Phan K. Systematic review of 3D printing in spinal surgery: the current state of play. J Spine Surg. 3:433–443. 2017.
Article
41. Xiao JR, Huang WD, Yang XH, Yan WJ, Song DW, Wei HF, et al. En bloc resection of primary malignant bone tumor in the cervical spine based on 3-dimensional printing technology. Orthop Surg. 8:171–178. 2016.
Article
42. Xu N, Wei F, Liu X, Jiang L, Cai H, Li Z, et al. Reconstruction of the upper cervical spine using a personalized 3D-printed vertebral body in an adolescent with Ewing sarcoma. Spine (Phila Pa 1976). 41:E50–E54. 2016.
Article
43. Yang M, Li C, Li Y, Zhao Y, Wei X, Zhang G, et al. Application of 3D rapid prototyping technology in posterior corrective surgery for Lenke 1 adolescent idiopathic scoliosis patients. Medicine (Baltimore). 94:e582. 2015.
Article
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