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Lewandrowski KU, Vira S, Elfar JC, Lorio MP. Advancements in Custom 3D-Printed Titanium Interbody Spinal Fusion Cages and Their Relevance in Personalized Spine Care. J Pers Med 2024; 14:809. [PMID: 39202002 PMCID: PMC11355268 DOI: 10.3390/jpm14080809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024] Open
Abstract
3D-printing technology has revolutionized spinal implant manufacturing, particularly in developing personalized and custom-fit titanium interbody fusion cages. These cages are pivotal in supporting inter-vertebral stability, promoting bone growth, and restoring spinal alignment. This article reviews the latest advancements in 3D-printed titanium interbody fusion cages, emphasizing their relevance in modern personalized surgical spine care protocols applied to common clinical scenarios. Furthermore, the authors review the various printing and post-printing processing technologies and discuss how engineering and design are deployed to tailor each type of implant to its patient-specific clinical application, highlighting how anatomical and biomechanical considerations impact their development and manufacturing processes to achieve optimum osteoinductive and osteoconductive properties. The article further examines the benefits of 3D printing, such as customizable geometry and porosity, that enhance osteointegration and mechanical compatibility, offering a leap forward in patient-specific solutions. The comparative analysis provided by the authors underscores the unique challenges and solutions in designing cervical, and lumbar spine implants, including load-bearing requirements and bioactivity with surrounding bony tissue to promote cell attachment. Additionally, the authors discuss the clinical outcomes associated with these implants, including the implications of improvements in surgical precision on patient outcomes. Lastly, they address strategies to overcome implementation challenges in healthcare facilities, which often resist new technology acquisitions due to perceived cost overruns and preconceived notions that hinder potential savings by providing customized surgical implants with the potential for lower complication and revision rates. This comprehensive review aims to provide insights into how modern 3D-printed titanium interbody fusion cages are made, explain quality standards, and how they may impact personalized surgical spine care.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, Division Personalized Pain Research and Education, Tucson, AZ 85712, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas Bogotá, Bogotá 111321, Colombia
| | - Shaleen Vira
- Orthopedic and Sports Medicine Institute, Banner-University Tucson Campus, 755 East McDowell Road, Floor 2, Phoenix, AZ 85006, USA;
| | - John C. Elfar
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ 85721, USA
| | - Morgan P. Lorio
- Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA;
- Orlando College of Osteopathic Medicine, Orlando, FL 34787, USA
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Shang P, Ma B, Hou G, Zhang Y, Cui L, Song W, Liu Y. A novel artificial vertebral implant with Gyroid porous structures for reducing the subsidence and mechanical failure rate after vertebral body replacement. J Orthop Surg Res 2023; 18:828. [PMID: 37924130 PMCID: PMC10623881 DOI: 10.1186/s13018-023-04310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Prosthesis subsidence and mechanical failure were considered significant threats after vertebral body replacement during the long-term follow-up. Therefore, improving and optimizing the structure of vertebral substitutes for exceptional performance has become a pivotal challenge in spinal reconstruction. METHODS The study aimed to develop a novel artificial vertebral implant (AVI) with triply periodic minimal surface Gyroid porous structures to enhance the safety and stability of prostheses. The biomechanical performance of AVIs under different loading conditions was analyzed using the finite element method. These implants were fabricated using selective laser melting technology and evaluated through static compression and subsidence experiments. RESULTS The results demonstrated that the peak stress in the Gyroid porous AVI was consistently lower than that in the traditional porous AVI under all loading conditions, with a maximum reduction of 73.4%. Additionally, it effectively reduced peak stress at the bone-implant interface of the vertebrae. Static compression experiments demonstrated that the Gyroid porous AVI was about 1.63 times to traditional porous AVI in terms of the maximum compression load, indicating that Gyroid porous AVI could meet the safety requirement. Furthermore, static subsidence experiments revealed that the subsidence tendency of Gyroid porous AVI in polyurethane foam (simulated cancellous bone) was approximately 15.7% lower than that of traditional porous AVI. CONCLUSIONS The Gyroid porous AVI exhibited higher compressive strength and lower subsidence tendency than the strut-based traditional porous AVI, indicating it may be a promising substitute for spinal reconstruction.
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Affiliation(s)
- Peng Shang
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China.
| | - Benyuan Ma
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Guanghui Hou
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Yihai Zhang
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Lunxu Cui
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Wanzhen Song
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Yancheng Liu
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China.
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Ruiz-Cardozo MA, Trevino G, Pando A, Brehm S, Olufawo M, Barot K, Carey-Ewend A, Yahanda AT, Perdomo-Pantoja A, Jauregui JJ, Cadieux M, Costa M, Coenen J, Dorward I, Anolik RA, Sacks JM, Molina CA. Rapid Implementation of a 3-Dimensional-Printed Patient-Specific Titanium Sacrum Implant for Severe Neuropathic Spinal Arthropathy and Guide to Compassionate US Regulatory Approval. Oper Neurosurg (Hagerstown) 2023; 25:469-477. [PMID: 37584482 DOI: 10.1227/ons.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/31/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Rapid design and production of patient-specific 3-dimensional-printed implants (3DPIs) present a novel opportunity to restore the biomechanically demanding integrity of the lumbopelvic junction. We present a unique case of a 61-year-old patient with severe neuropathic spinal arthropathy (Charcot spine) who initially underwent a T4-to-sacrum spinal fusion. Massive bone destruction led to dissociation of his upper body from his pelvis and legs. Reconstruction of the spinopelvic continuity was planned with the aid of a personalized lumbosacral 3DPI. METHOD Using high-resolution computed tomography scans, the custom 3DPI was made using additive titanium manufacturing. The unique 3DPI consisted of (1) a sacral platform with iliac screws, (2) modular corpectomy device with rigid connection to the sacral platform, and (3) anterior plate connection with screws for proximal fixation. The procedures to obtain compassionate use Food and Drug Administration approval were followed. The patient underwent debridement of a chronically open wound before undertaking the 3-stage reconstructive procedure. The custom 3DPI and additional instrumentation were inserted as part of a salvage rebuilding procedure. RESULTS The chronology of the rapid implementation of the personalized sacral 3DPI from decision, design, manufacturing, Food and Drug Administration approval, and surgical execution lasted 28 days. The prosthesis was positioned in the defect according to the expected anatomic planes and secured using a screw-rod system and a vascularized fibular bone strut graft. The prosthesis provided an ideal repair of the lumbosacral junction and pelvic ring by merging spinal pelvic fixation, posterior pelvic ring fixation, and anterior spinal column fixation. CONCLUSION To the best of our knowledge, this is the first case of a multilevel lumbar, sacral, and sacropelvic neuropathic (Charcot) spine reconstruction using a 3DPI sacral prosthesis. As the prevalence of severe spine deformities continues to increase, adoption of 3DPIs is becoming more relevant to offer personalized treatment for complex deformities.
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Affiliation(s)
- Miguel A Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alejandro Pando
- Department of Neurological Surgery, Rutgers New Jersey Medical School, New Jersey, New Jersey, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Michael Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Abigail Carey-Ewend
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alexander T Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alexander Perdomo-Pantoja
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Julio J Jauregui
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Magalie Cadieux
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Megan Costa
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Julie Coenen
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Ian Dorward
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Rachel A Anolik
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Camilo A Molina
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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Sharma S, Pahuja S, Gupta V, Singh G, Singh J. 3D printing for spine pathologies: a state-of-the-art review. Biomed Eng Lett 2023; 13:579-589. [PMID: 37872993 PMCID: PMC10590361 DOI: 10.1007/s13534-023-00302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 10/25/2023] Open
Abstract
Three-Dimensional Printing has advanced throughout the years in the field of biomedical science with applications, especially in spine surgeries. 3D printing has the ability of fabricating highly complex structures with ease and high dimensional accuracy. The complexity of the spine's architecture and the inherent dangers of spinal surgery bring the evaluation of 3D printed models into consideration. This article summarizes the benefits of 3D printing based models for application in spine pathology. 3D printing technique is extensively used for fabrication of anatomical models, surgical guides and patient specific implants (PSI). The 3D printing based anatomical models assist in preoperative planning and training of students. Furthermore, 3D printed models can be used for improved communication and understanding of patients about the spinal disorders. The use of 3D printed surgical guides help in the stabilization of the spine during surgery, improving post procedural outcomes. Improved surgical results can be achieved by using PSIs that are tailored for patient specific needs. Finally, this review discusses the limitations and potential future scope of 3D printing in spine pathologies. 3D printing is still in its infancy, and further research would provide better understanding of the technology's true potential in spinal procedures.
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Affiliation(s)
- Shrutika Sharma
- Department of Mechanical Engineering, Thapar Institute of Engineering and Technology, Patiala, Punjab 147004 India
| | - Sanchita Pahuja
- Biomedical Engineering, Thapar Institute of Engineering and Technology, Patiala, Punjab 147004 India
| | - Vishal Gupta
- Department of Mechanical Engineering, Thapar Institute of Engineering and Technology, Patiala, Punjab 147004 India
| | - Gyanendra Singh
- Physical Sciences, Inter University Centre for Teacher Education, Varanasi, 221005 India
| | - Jaskaran Singh
- Department of Mechanical Engineering, Thapar Institute of Engineering and Technology, Patiala, Punjab 147004 India
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Morris JM, Wentworth A, Houdek MT, Karim SM, Clarke MJ, Daniels DJ, Rose PS. The Role of 3D Printing in Treatment Planning of Spine and Sacral Tumors. Neuroimaging Clin N Am 2023; 33:507-529. [PMID: 37356866 DOI: 10.1016/j.nic.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Three-dimensional (3D) printing technology has proven to have many advantages in spine and sacrum surgery. 3D printing allows the manufacturing of life-size patient-specific anatomic and pathologic models to improve preoperative understanding of patient anatomy and pathology. Additionally, virtual surgical planning using medical computer-aided design software has enabled surgeons to create patient-specific surgical plans and simulate procedures in a virtual environment. This has resulted in reduced operative times, decreased complications, and improved patient outcomes. Combined with new surgical techniques, 3D-printed custom medical devices and instruments using titanium and biocompatible resins and polyamides have allowed innovative reconstructions.
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Affiliation(s)
- Jonathan M Morris
- Division of Neuroradiology, Department of Radiology, Anatomic Modeling Unit, Biomedical and Scientific Visualization, Mayo Clinic, 200 1st Street, Southwest, Rochester, MN, 55905, USA.
| | - Adam Wentworth
- Department of Radiology, Anatomic Modeling Unit, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - S Mohammed Karim
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Peter S Rose
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Wu Y, Liu J, Kang L, Tian J, Zhang X, Hu J, Huang Y, Liu F, Wang H, Wu Z. An overview of 3D printed metal implants in orthopedic applications: Present and future perspectives. Heliyon 2023; 9:e17718. [PMID: 37456029 PMCID: PMC10344715 DOI: 10.1016/j.heliyon.2023.e17718] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
With the ability to produce components with complex and precise structures, additive manufacturing or 3D printing techniques are now widely applied in both industry and consumer markets. The emergence of tissue engineering has facilitated the application of 3D printing in the field of biomedical implants. 3D printed implants with proper structural design can not only eliminate the stress shielding effect but also improve in vivo biocompatibility and functionality. By combining medical images derived from technologies such as X-ray scanning, CT, MRI, or ultrasonic scanning, 3D printing can be used to create patient-specific implants with almost the same anatomical structures as the injured tissues. Numerous clinical trials have already been conducted with customized implants. However, the limited availability of raw materials for printing and a lack of guidance from related regulations or laws may impede the development of 3D printing in medical implants. This review provides information on the current state of 3D printing techniques in orthopedic implant applications. The current challenges and future perspectives are also included.
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Affiliation(s)
- Yuanhao Wu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jieying Liu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lin Kang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jingjing Tian
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xueyi Zhang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jin Hu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yue Huang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Fuze Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hai Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhihong Wu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
- Beijing Key Laboratory for Genetic Research of Bone and Joint Disease, Beijing, China
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Orłowska A, Szewczenko J, Kajzer W, Goldsztajn K, Basiaga M. Study of the Effect of Anodic Oxidation on the Corrosion Properties of the Ti6Al4V Implant Produced from SLM. J Funct Biomater 2023; 14:jfb14040191. [PMID: 37103281 PMCID: PMC10145819 DOI: 10.3390/jfb14040191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Additive technologies allowed for the development of medicine and implantology, enabling the production of personalized and highly porous implants. Although implants of this type are used clinically, they are usually only heat treated. Surface modification using electrochemical methods can significantly improve the biocompatibility of biomaterials used for implants, including printed ones. The study examined the effect of anodizing oxidation on the biocompatibility of a porous implant made of Ti6Al4V by the SLM method. The study used a proprietary spinal implant intended for the treatment of discopathy in the c4–c5 section. As part of the work, the manufactured implant was assessed in terms of compliance with the requirements for implants (structure testing—metallography) and the accuracy of the pores produced (pore size and porosity). The samples were subjected to surface modification using anodic oxidation. The research was carried out for 6 weeks in in vitro conditions. Surface topographies and corrosion properties (corrosion potential, ion release) were compared for unmodified and anodically oxidized samples. The tests showed no effect of anodic oxidation on the surface topography and improved corrosion properties. Anodic oxidation stabilized the corrosion potential and limited the release of ions to the environment.
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Preliminary application of three-dimensional printing in congenital uterine anomalies based on three-dimensional transvaginal ultrasonographic data. BMC Womens Health 2022; 22:290. [PMID: 35836228 PMCID: PMC9284698 DOI: 10.1186/s12905-022-01873-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The three-dimensional (3D) printing technology has remarkable potential as an auxiliary tool for representing anatomical structures, facilitating diagnosis and therapy, and enhancing training and teaching in the medical field. As the most available diagnostic tool and it is routinely used as the first approach in diagnosis of the uterine anomalies, 3D transvaginal ultrasonography (3D-TVS) has been proposed as non-invasive “gold standard” approach for these malformations due to high diagnostic accuracy. Despite holding promise of manufacturing 3D printed models based on 3D-TVS data, relevant reports about 3D-TVS derived gynecological 3D printing haven’t been reported to the best of our knowledge. We found an opportunity to explore the feasibility of building 3D printed models for the abnormal uterus based on the data acquired by 3D-TVS. Methods The women suspected with congenital uterine anomalies (CUAs) were enrolled in the study. The diagnose of CUAs were made by 3D-TVS scanning and further confirmed under the hysteroscopy examination. One volunteer with normal uterus was enrolled as control. All subjects underwent 3D-TVS scanning for 3D printing data collection. Acquired images were stored and extracted as DICOM files, then processed by professional software to portray and model the boundary of the uterine inner and outer walls separately. After the computer 3D models were constructed, the data were saved and output as STL files for further surface restoration and smoothing. The colors of endometrium and uterine body were specified, respectively, in the print preview mode. Then the uncured photosensitive resin was cleaned and polished to obtain a smooth and transparent solid model after printed models were cooled down. Results 3D printing models of normal uterus, incomplete septate uterus, complete septate uterus, uterus didelphys and unicornuate uterus were produced on ultrasonographic data of 3D-TVS. Conclusions Our research and practice made the first try in modeling CUAs successfully based on ultrasonographic data entirely, verifying that it’s a feasible way to build 3D printed models of high-quality through 3D-TVS scanning.
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Xu H, Wang X, Han Y, Jiang Y, Wang J, Zhang X, Miao J. Biomechanical comparison of different prosthetic reconstructions in total en bloc spondylectomy: a finite element study. BMC Musculoskelet Disord 2022; 23:955. [PMID: 36329424 PMCID: PMC9635202 DOI: 10.1186/s12891-022-05919-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To analyse and compare the biomechanical differences between 3D-printed prostheses, titanium mesh cages and poorly matched titanium mesh cages in total en bloc spondylectomy (TES). Methods The finite element model of T10-L2 for healthy adults was modified to make three models after T12 total spondylectomy. These models were a 3D-printed prosthesis, titanium mesh cage and prosthesis-endplate mismatched titanium mesh cage for reconstruction. The range of motion (ROM), stress distribution of the endplate and internal fixation system of three models in flexion and extension, lateral bending and axial rotation were simulated and analysed by ABAQUS. Result In flexion, due to the support of the anterior prosthesis, the fixation system showed the maximum fixation strength. The fixation strength of the 3D-printed prosthesis model was 26.73 N·m /°, that of the TMC support model was 27.20 N·m /°, and that of the poorly matched TMC model was 24.16 N·m /°. In flexion, the L1 upper endplate stress of the poorly matched TMC model was 35.5% and 49.6% higher than that of the TMC and 3D-printed prosthesis, respectively. It was 17% and 28.1% higher in extension, 39.3% and 42.5% higher in lateral bending, and 82.9% and 91.2% higher in axial rotation, respectively. The lower endplate of T11 showed a similar trend, but the magnitude of the stress change was reduced. In the stress analysis of the 3D-printed prosthesis and TMC, it was found that the maximum stress was in flexion and axial rotation, followed by left and right bending, and the least stress was in extension. However, the mismatched TMC withstood the maximum von Mises stress of 418.7 MPa (almost twice as much as the buckling state) in rotation, 3 times and 5.83 times in extension, and 1.29 and 2.85 times in lateral bending, respectively. Conclusion Different prostheses with good endplate matching after total spondylectomy can obtain effective postoperative stable support, and the reduction in contact area caused by mismatch will affect the biomechanical properties and increase the probability of internal fixation failure.
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Affiliation(s)
- Hanpeng Xu
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xiaodong Wang
- Department of Orthopaedics, Affiliated Hospital of Hebei University, Baoding, China
| | - Ye Han
- Department of Orthopaedics, Affiliated Hospital of Hebei University, Baoding, China
| | - Yuanyuan Jiang
- Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding, China
| | - Jianzhong Wang
- Department of Orthopaedics, Affiliated Hospital of Hebei University, Baoding, China
| | - Xiong Zhang
- Department of Orthopaedics, Affiliated Hospital of Hebei University, Baoding, China
| | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China. .,Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, 300210, China.
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Zhou H, Liu S, Li Z, Liu X, Dang L, Li Y, Li Z, Hu P, Wang B, Wei F, Liu Z. 3D-printed vertebral body for anterior spinal reconstruction in patients with thoracolumbar spinal tumors. J Neurosurg Spine 2022; 37:274-282. [PMID: 35213828 DOI: 10.3171/2022.1.spine21900] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A 3D-printed vertebral prosthesis can be used to reconstruct a bone defect more precisely because of its tailored shape, with its innermost porous structure inducing bone ingrowth. The aim of this study was to evaluate the clinical outcomes of using a 3D-printed artificial vertebral body for spinal reconstruction after en bloc resection of thoracolumbar tumors. METHODS This was a retrospective analysis of 23 consecutive patients who underwent surgical treatment for thoracolumbar tumors at our hospital. En bloc resection was performed in all cases, based on the Weinstein-Boriani-Biagini surgical staging system, and anterior reconstruction was performed using a 3D-printed artificial vertebral body. Prosthesis subsidence, fusion status, and instrumentation-related complications were evaluated. Stability of the anterior reconstruction method was evaluated by CT, and CT Hounsfield unit (HU) values were measured to evaluate fusion status. RESULTS The median follow-up was 37 (range 24-58) months. A customized 3D-printed artificial vertebral body was used in 10 patients, with an off-the-shelf 3D-printed artificial vertebral body used in the other 13 patients. The artificial vertebral body was implanted anteriorly in 5 patients and posteriorly in 18 patients. The overall fusion rate was 87.0%. The average prosthesis subsidence at the final follow-up was 1.60 ± 1.79 mm. Instrument failure occurred in 2 patients, both of whom had substantial subsidence (8.47 and 3.69 mm, respectively). At 3 months, 6 months, and 1 year postoperatively, the mean CT HU values within the artificial vertebral body were 1930 ± 294, 1997 ± 336, and 1994 ± 257, respectively, with each of these values being significantly higher than the immediate postoperative value of 1744 ± 321 (p < 0.05). CONCLUSIONS The use of a 3D-printed artificial vertebral body for anterior reconstruction after en bloc resection of the thoracolumbar spinal tumor may be a feasible and reliable option. The low incidence of prosthesis subsidence of 3D-printed endoprostheses can provide good stability instantly. Measurement of HU values with CT is a valuable method to evaluate the osseointegration at the bone-metal interface of a 3D-printed vertebral prosthesis.
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Affiliation(s)
- Hua Zhou
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Shanshan Liu
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Zhehuang Li
- 4Department of Bone and Soft Tumor, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoguang Liu
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Lei Dang
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Yan Li
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Zihe Li
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Panpan Hu
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Ben Wang
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Feng Wei
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
| | - Zhongjun Liu
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing
- 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
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Sun Z, Yin M, Sun Y, Cheng M, Fang M, Huang W, Ma J, Yan W. Customized Multilevel 3D Printing Implant for Reconstructing Spine Tumor: A Retrospective Case Series Study in a Single Center. Orthop Surg 2022; 14:2016-2022. [PMID: 35894154 PMCID: PMC9483039 DOI: 10.1111/os.13357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the clinical efficacy and safety of 3D printed artificial vertebral body for patients who underwent multilevel total en bloc spondylectomy (TES) and analyze whether it could reduce the incidence of implant subsidence. Methods This is a retrospective study. From January 2017 to May 2018, eight consecutive cases with spine tumor undergoing multilevel TES were analyzed. All patients underwent X‐ray and CT examinations to evaluate the stability of internal fixation during the postoperative follow‐up. Demographic, surgical details, clinical data, and perioperative complications was collected. Visual analog scale, Frankel score, and spinal instability neoplastic score (SINS) classification were also recorded. Results There were six cases of primary spinal tumor and two cases of metastatic spinal tumor. All patients achieved remarkable pain relief and improvement in neurological function. Five patients underwent operation through the posterior approach, one patient underwent operation through the anterior approach and the remaining two patients through a combined anterior and posterior approach. At the last follow‐up period, X‐rays showed that the 3D printed artificial vertebral body of all cases matched well, and the fixation was reliable. Hardware failure such as loosening, sinking, breaking, and displacement wasn't observed during the follow‐up period. Conclusion 3D printed customized artificial vertebral body can provide satisfying good clinical and radiological outcomes for patients who have undergone multilevel TES.
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Affiliation(s)
- Zhengwang Sun
- Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Mengchen Yin
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yueli Sun
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mo Cheng
- Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | | | - Wending Huang
- Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Junming Ma
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
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12
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Habib A, Jovanovich N, Muthiah N, Alattar A, Alan N, Agarwal N, Ozpinar A, Hamilton DK. 3D printing applications in spine surgery: an evidence-based assessment toward personalized patient care. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1682-1690. [PMID: 35590016 DOI: 10.1007/s00586-022-07250-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Spine surgery entails a wide spectrum of complicated pathologies. Over the years, numerous assistive tools have been introduced to the modern neurosurgeon's armamentarium including neuronavigation and visualization technologies. In this review, we aimed to summarize the available data on 3D printing applications in spine surgery as well as an assessment of the future implications of 3D printing. METHODS We performed a comprehensive review of the literature on 3D printing applications in spine surgery. RESULTS Over the past decade, 3D printing and additive manufacturing applications, which allow for increased precision and customizability, have gained significant traction, particularly spine surgery. 3D printing applications in spine surgery were initially limited to preoperative visualization, as 3D printing had been primarily used to produce preoperative models of patient-specific deformities or spinal tumors. More recently, 3D printing has been used intraoperatively in the form of 3D customizable implants and personalized screw guides. CONCLUSIONS Despite promising preliminary results, the applications of 3D printing are so recent that the available data regarding these new technologies in spine surgery remains scarce, especially data related to long-term outcomes.
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Affiliation(s)
- Ahmed Habib
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicolina Jovanovich
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nallammai Muthiah
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
| | - Ali Alattar
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
| | - Nima Alan
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
| | - Alp Ozpinar
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA.
| | - David Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
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Zhao Y, Wang Z, Zhao J, Hussain M, Wang M. Additive Manufacturing in Orthopedics: A Review. ACS Biomater Sci Eng 2022; 8:1367-1380. [PMID: 35266709 DOI: 10.1021/acsbiomaterials.1c01072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Additive manufacturing is an advanced manufacturing manner that seems like the industrial revolution. It has the inborn benefit of producing complex formations, which are distinct from traditional machining technology. Its manufacturing strategy is flexible, including a wide range of materials, and its manufacturing cycle is short. Additive manufacturing techniques are progressively used in bone research and orthopedic operation as more innovative materials are developed. This Review lists the recent research results, analyzes the strengths and weaknesses of diverse three-dimensional printing strategies in orthopedics, and sums up the use of varying 3D printing strategies in surgical guides, surgical implants, surgical predictive models, and bone tissue engineering. Moreover, various postprocessing methods for additive manufacturing for orthopedics are described.
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Affiliation(s)
- Yingchao Zhao
- Xiangya School of Medicine, Central South University, No.172 Yinpenling Street, Tongzipo Road, Changsha 410013, China
| | - Zhen Wang
- Xiangya School of Medicine, Central South University, No.172 Yinpenling Street, Tongzipo Road, Changsha 410013, China
| | - Jingzhou Zhao
- Department of Chemical & Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, Singapore 117585, Singapore
| | - Mubashir Hussain
- Postdoctoral Innovation Practice, Shenzhen Polytechnic, No.4089 Shahe West Road, Xinwei Nanshan District, Shenzhen 518055, China
| | - Maonan Wang
- Department of Chemical & Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, Singapore 117585, Singapore
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14
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Costanzo R, Ferini G, Brunasso L, Bonosi L, Porzio M, Benigno UE, Musso S, Gerardi RM, Giammalva GR, Paolini F, Palmisciano P, Umana GE, Sturiale CL, Di Bonaventura R, Iacopino DG, Maugeri R. The Role of 3D-Printed Custom-Made Vertebral Body Implants in the Treatment of Spinal Tumors: A Systematic Review. Life (Basel) 2022; 12:life12040489. [PMID: 35454979 PMCID: PMC9030237 DOI: 10.3390/life12040489] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022] Open
Abstract
In spinal surgery, 3D prothesis represents a useful instrument for spinal reconstruction after the removal of spinal tumors that require an “en bloc” resection. This represents a complex and demanding procedure, aiming to restore spinal length, alignment and weight-bearing capacity and to provide immediate stability. Thus, in this systematic review the authors searched the literature to investigate and discuss the advantages and limitations of using 3D-printed custom-made vertebral bodies in the treatment of spinal tumors. A systematic literature review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, with no limits in terms of date of publication. The collected studies were exported to Mendeley. The articles were selected according to the following inclusion criteria: availability of full articles, full articles in English, studies regarding the implant of 3D custom-made prothesis after total or partial vertebral resection, studies regarding patients with a histologically confirmed diagnosis of primary spinal tumor or solitary bone metastasis; studies evaluating the implant of 3d custom-made prothesis in the cervical, thoracic, and lumbar spine. Nineteen published studies were included in this literature review, and include a total of 87 patients, 49 males (56.3%) and 38 females (43.7%). The main tumoral location and primary tumor diagnosis were evaluated. The 3D custom-made prothesis represents a feasible tool after tumor en-bloc resection in spinal reconstruction. This procedure is still evolving, and long-term follow-ups are mandatory to assess its safeness and usefulness.
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Affiliation(s)
- Roberta Costanzo
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
- Correspondence: ; Tel.: +39-0916554656
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia s.r.l., 95125 Catania, Italy;
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Lapo Bonosi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Massimiliano Porzio
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Umberto Emanuele Benigno
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Sofia Musso
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Rosa Maria Gerardi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Giuseppe Roberto Giammalva
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Federica Paolini
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Paolo Palmisciano
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95100 Catania, Italy; (P.P.); (G.E.U.)
| | - Giuseppe Emmanuele Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95100 Catania, Italy; (P.P.); (G.E.U.)
| | - Carmelo Lucio Sturiale
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy; (C.L.S.); (R.D.B.)
| | - Rina Di Bonaventura
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy; (C.L.S.); (R.D.B.)
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (L.B.); (M.P.); (U.E.B.); (S.M.); (R.M.G.); (G.R.G.); (F.P.); (D.G.I.); (R.M.)
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15
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Abstract
The technique of 3D printing offers a high potential for further optimization of spinal surgery. This new technology has been published for different areas in the field of spinal surgery, e.g. in preoperative planning, intraoperative use as well as to create patient-specific implants. For example, it has been demonstrated that preoperative 3‑dimensional visualization of spinal deformities is helpful in planning procedures. Moreover, insertion of pedicle screws seems to be more accurate when using individualized templates to guide the drill compared to freehand techniques. This review summarizes the current literature dealing with 3D printing in spinal surgery with special consideration of the current applications, the limitations and the future potential.
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Jin Z, He C, Fu J, Han Q, He Y. Balancing the customization and standardization: exploration and layout surrounding the regulation of the growing field of 3D-printed medical devices in China. Biodes Manuf 2022; 5:580-606. [PMID: 35194519 PMCID: PMC8853031 DOI: 10.1007/s42242-022-00187-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/17/2022] [Indexed: 12/23/2022]
Abstract
Medical devices are instruments and other tools that act on the human body to aid clinical diagnosis and disease treatment, playing an indispensable role in modern medicine. Nowadays, the increasing demand for personalized medical devices poses a significant challenge to traditional manufacturing methods. The emerging manufacturing technology of three-dimensional (3D) printing as an alternative has shown exciting applications in the medical field and is an ideal method for manufacturing such personalized medical devices with complex structures. However, the application of this new technology has also brought new risks to medical devices, making 3D-printed devices face severe challenges due to insufficient regulation and the lack of standards to provide guidance to the industry. This review aims to summarize the current regulatory landscape and existing research on the standardization of 3D-printed medical devices in China, and provide ideas to address these challenges. We focus on the aspects concerned by the regulatory authorities in 3D-printed medical devices, highlighting the quality system of such devices, and discuss the guidelines that manufacturers should follow, as well as the current limitations and the feasible path of regulation and standardization work based on this perspective. The key points of the whole process quality control, performance evaluation methods and the concept of whole life cycle management of 3D-printed medical devices are emphasized. Furthermore, the significance of regulation and standardization is pointed out. Finally, aspects worthy of attention and future perspectives in this field are discussed.
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Affiliation(s)
- Zhongboyu Jin
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027 China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Chaofan He
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027 China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Jianzhong Fu
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027 China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Qianqian Han
- National Institutes for Food and Drug Control, Beijing, 102629 China
| | - Yong He
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027 China
- Key Laboratory of Materials Processing and Mold, Zhengzhou University, Zhengzhou, 450002 China
- Cancer Center, Zhejiang University, Hangzhou, 310058 China
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17
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Jian Q, Liu Z, Duan W, Guan J, Jian F, Chen Z. Reconstruction of the cervical lateral mass using 3D-printed prostheses. Neurospine 2022; 19:202-211. [PMID: 35130422 PMCID: PMC8987545 DOI: 10.14245/ns.2143008.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to investigate the outcome of using 3-dimensional (3D)-printed prostheses to reconstruct a cervical lateral mass to maintain cervical stability.
Methods We retrospectively analyzed data of 7 patients who underwent cervical lateral mass reconstruction using a 3D-printed prosthesis, comprising axial and subaxial lateral mass reconstruction in 2 and 5 patients, respectively. Bilateral mass was reconstructed in 1 patient and unilateral mass in the remaining 6 patients.
Results Using a 3D-printed lateral mass prosthesis, internal fixation was stable for all 7 patients postoperatively. No implant-related complications such as prosthesis loosening, displacement, and compression were observed at the last follow-up.
Conclusion Reconstruction of the lateral mass structure is beneficial in restoring load transfer in the cervical spine under physiological conditions. A 3D-printed prosthesis can be considered a good option for reconstruction of the lateral mass as fusion was achieved, with no subsequent complications observed.
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Affiliation(s)
- Qiang Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Corresponding Author Zan Chen https://orcid.org/0000-0002-0104-115X Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
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McGregor M, Patel S, McLachlin S, Vlasea M. Data related to architectural bone parameters and the relationship to Ti lattice design for powder bed fusion additive manufacturing. Data Brief 2021; 39:107633. [PMID: 34917699 PMCID: PMC8646123 DOI: 10.1016/j.dib.2021.107633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
The data included in this article provides additional supporting information on our publication (McGregor et al. [1]) on the review of the natural lattice architecture in human bone and its implication towards titanium (Ti) lattice design for laser powder bed fusion and electron beam powder bed fusion. For this work, X-ray computed tomography was deployed to understand and visualize a Ti-6Al-4V lattice structure manufactured by laser powder bed fusion. This manuscript includes details about the manufacturing of the lattice structure using laser powder bed fusion and computed tomography methods used for analyzing the lattice structure. Additionally, a comprehensive literature review was conducted to understand how lattice parameters are controlled in additively manufactured Ti and Ti-alloy parts aimed at replacing or augmenting human bone. From this literature review, lattice design information was collected and is summarized in tabular form in this manuscript.
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Affiliation(s)
- Martine McGregor
- University of Waterloo, Department of Mechanical and Mechatronics Engineering, Waterloo, ON N2L 3G1, Canada
| | - Sagar Patel
- University of Waterloo, Department of Mechanical and Mechatronics Engineering, Waterloo, ON N2L 3G1, Canada
| | - Stewart McLachlin
- University of Waterloo, Department of Mechanical and Mechatronics Engineering, Waterloo, ON N2L 3G1, Canada
| | - Mihaela Vlasea
- University of Waterloo, Department of Mechanical and Mechatronics Engineering, Waterloo, ON N2L 3G1, Canada
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19
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Meena VK, Kumar P, Kalra P, Sinha RK. Additive manufacturing for metallic spinal implants: A systematic review. ANNALS OF 3D PRINTED MEDICINE 2021. [DOI: 10.1016/j.stlm.2021.100021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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20
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Girolami M, Sartori M, Monopoli-Forleo D, Ghermandi R, Tedesco G, Evangelisti G, Pipola V, Pesce E, Falzetti L, Fini M, Gasbarrini A. Histological examination of a retrieved custom-made 3D-printed titanium vertebra : Do the fine details obtained by additive manufacturing really promote osteointegration? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2775-2781. [PMID: 34279722 DOI: 10.1007/s00586-021-06926-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In the present report it is described the design, the manufacturing and the successful surgical implant of one of the first 3D custom titanium vertebra realized with Additive Manufacturing technique and its use for the spinal reconstruction after en-bloc resection for primary osteogenic sarcoma. METHODS Clinical case presentation and the design of the 3D custom titanium vertebra was reported. It was also described the complex procedures adopted to evaluate the retrieved device from the histological point of view, as a tumor relapse hit the patient, one year after the reconstruction procedure. RESULTS The histological evaluation confirmed that the resection technique exerts an important role in promoting bone formation: vertebral body osteotomies favored the reconstruction procedure and maximized the contact area between host bone/vertebral prosthesis thus favoring the bone tissue penetration and device colonization. CONCLUSION The sharing of these results is very important as they represent the starting point for improving the knowledge starting from the evidence obtained in a challenging clinical condition and with post-operative treatments that could be never reproduced in preclinical model.
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Affiliation(s)
- Marco Girolami
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Maria Sartori
- Surgical Sciences and Technologies Complex Structure, IRCCS - Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | | | - Riccardo Ghermandi
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Tedesco
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Gisberto Evangelisti
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Valerio Pipola
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Eleonora Pesce
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Luigi Falzetti
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Milena Fini
- Surgical Sciences and Technologies Complex Structure, IRCCS - Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
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21
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Endoscopic Endonasal Approach for Clipping Anterior Communicating Artery Aneurysms From Cadaver Studies and Three-Dimensional Printed Models to a Clinical Case. J Craniofac Surg 2021; 32:2854-2858. [PMID: 34238881 DOI: 10.1097/scs.0000000000007848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Anterior communicating artery (ACoA) aneurysm is one of the most common intracranial aneurysms, and it is also the aneurysm with the highest rupture rate. With the improvement of endoscopic techniques, it is possible to use an endoscopic endonasal approach (EEA) to clip ACoA aneurysms. For further analysis of the EEA for clipping ACoA aneurysms, we used cadaver heads and three-dimensional (3D)-printed models to finish the anatomical study, and we finally selected 1 clinical case to complete the clipping through the EEA. MATERIALS AND METHODS We first collected 3 cadaver heads to simulate the EEA. Then, the imaging data of 29 real cases of ACoA aneurysm were collected, and the model of an aneurysm was prepared by 3D printing technology; then, the EEA was used to simulate the clipping of the aneurysm model. Finally, a clinical case with 2 ACoA aneurysms was selected to adopt the EEA for clipping. RESULTS Both the cadaver head and 3D-printed aneurysm model could simulate aneurysm clipping with the EEA. The clinical case of the selected ACoA aneurysm can successfully complete the clipping through the EEA. CONCLUSIONS 3D-printed models are a good method to study the anatomical characteristics of a surgical approach. For specially selected ACoA aneurysms, the EEA is relatively simple method that can be used to clip the aneurysm successfully. The EEA for clipping ACoA aneurysms is a useful complement to the current traditional craniotomy approaches and endovascular embolization.
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In vivo analysis of post-joint-preserving surgery fracture of 3D-printed Ti-6Al-4V implant to treat bone cancer. Biodes Manuf 2021. [DOI: 10.1007/s42242-021-00147-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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23
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Fiani B, Newhouse A, Cathel A, Sarhadi K, Soula M. Implications of 3-Dimensional Printed Spinal Implants on the Outcomes in Spine Surgery. J Korean Neurosurg Soc 2021; 64:495-504. [PMID: 34139795 PMCID: PMC8273772 DOI: 10.3340/jkns.2020.0272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/07/2020] [Indexed: 12/31/2022] Open
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.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Alexander Newhouse
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Kasra Sarhadi
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Marisol Soula
- New York University School of Medicine, New York, NY, USA
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Kumar Gupta D, Ali MH, Ali A, Jain P, Anwer MK, Iqbal Z, Mirza MA. 3D printing technology in healthcare: applications, regulatory understanding, IP repository and clinical trial status. J Drug Target 2021; 30:131-150. [PMID: 34047223 DOI: 10.1080/1061186x.2021.1935973] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mass consumerization of three-dimensional (3D) printing innovation has revolutionised admittance of 3D-printing in an expansive scope of ventures. When utilised predominantly for industrial manufacturing, 3D-printing strategies have rapidly attained acquaintance in different parts of health care industry. 3D-printing is a moderately new technology that has discovered promising applications in the medication conveyance and clinical areas. This review intends to explore different parts of 3D- printing innovation concerning pharmaceutical and clinical applications. Review on pharmaceutical products like tablets, caplets, films, polypills, microdots, biodegradable patches, medical devices (uterine and subcutaneous), patient specific implants, cardiovascular stents, etc. and prosthetics/anatomical structures, surgical models, organs and tissues created utilising 3D-printing is being presented. In addition, the regulatory understanding and current IP and clinical trial status pertaining to 3D fabricated products/medical applications have also been funnelled, garnering information from different web portals of regulatory agencies and databases. It is additionally certain that for such new innovations, there would be difficulties and questions before these are acknowledged as protected and viable. The circumstance demands purposeful and wary endeavours to acquire regulations which would at last prompt the accomplishment of this progressive innovation, thus various regulatory challenges faced have been conscientiously discussed.
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Affiliation(s)
- Dipak Kumar Gupta
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Mohd Humair Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Asad Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Pooja Jain
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Md Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Zeenat Iqbal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Mohd Aamir Mirza
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
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Amin T, Parr WC, Mobbs RJ. Opinion Piece: Patient-Specific Implants May Be the Next Big Thing in Spinal Surgery. J Pers Med 2021; 11:jpm11060498. [PMID: 34199467 PMCID: PMC8228233 DOI: 10.3390/jpm11060498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/08/2021] [Accepted: 05/30/2021] [Indexed: 12/13/2022] Open
Abstract
The emergence of 3D-Printing technologies and subsequent medical applications have allowed for the development of Patient-specific implants (PSIs). There have been increasing reports of PSI application to spinal surgery over the last 5 years, including throughout the spine and to a range of pathologies, though largely for complex cases. Through a number of potential benefits, including improvements to the implant–bone interface and surgical workflow, PSIs aim to improve patient and surgical outcomes, as well as potentially provide new avenues for combating challenges routinely faced by spinal surgeons. However, obstacles to widespread acceptance and routine application include the lack of quality long-term data, research challenges and the practicalities of production and navigating the regulatory environment. While recognition of the significant potential of Spinal PSIs is evident in the literature, it is clear a number of key questions must be answered to inform future clinical and research practices. The spinal surgical community must selectively and ethically continue to offer PSIs to patients, simultaneously allowing for the necessary larger, comparative studies to be conducted, as well as continuing to provide optimal patient care, thereby ultimately determining the exact role of this technology and potentially improving outcomes.
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Affiliation(s)
- Tajrian Amin
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney 2000, Australia
| | - William C.H. Parr
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick 2031, Australia
- 3DMorphic Pty Ltd., Matraville 2036, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney 2000, Australia
- Correspondence: ; Tel.: +61-(02)-9650-4766
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Comparison in clinical performance of surgical guides for mandibular surgery and temporomandibular joint implants fabricated by additive manufacturing techniques. J Mech Behav Biomed Mater 2021; 119:104512. [PMID: 33930652 DOI: 10.1016/j.jmbbm.2021.104512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/01/2020] [Accepted: 04/07/2021] [Indexed: 01/27/2023]
Abstract
Additive manufacturing (AM) offers great design freedom that enables objects with desired unique and complex geometry and topology to be readily and cost-effectively fabricated. The overall benefits of AM are well known, such as increased material and resource efficiency, enhanced design and production flexibility, the ability to create porous structures and on-demand manufacturing. When AM is applied to medical devices, these benefits are naturally assumed. However, hard clinical evidence collected from clinical trials and studies seems to be lacking and, as a result, systematic assessment is yet difficult. In the present work, we have reviewed 23 studies on the clinical use of AM patient-specific surgical guides (PSGs) for the mandible surgeries (n = 17) and temporomandibular joint (TMJ) patient-specific implants (PSIs) (n = 6) with respect to expected clinical outcomes. It is concluded that the data published on these AM medical devices are often lacking in comprehensive evaluation of clinical outcomes. A complete set of clinical data, including those on time management, costs, clinical outcomes, range of motion, accuracy of the placement with respect to the pre-operative planning, and extra complications, as well as manufacturing data are needed to demonstrate the real benefits gained from applying AM to these medical devices and to satisfy regulatory requirements.
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Yao Y, Mo Z, Wu G, Guo J, Li J, Wang L, Fan Y. A personalized 3D-printed plate for tibiotalocalcaneal arthrodesis: Design, fabrication, biomechanical evaluation and postoperative assessment. Comput Biol Med 2021; 133:104368. [PMID: 33864971 DOI: 10.1016/j.compbiomed.2021.104368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 12/11/2022]
Abstract
Personalized plates (P-Plates) could provide improved clinical outcomes in joint fusion by enabling perfect geometric matching between irregular bone and implants. However, there is no unified application framework for P-Plates for joint fusion. The objective of this study was to develop such a framework for P-Plates for tibiotalocalcaneal arthrodesis. A patient-specific bone model was constructed based on CT images, and the P-Plate was preliminarily designed to match the bones. Finite element method was used to optimize the stress distribution and to evaluate the biomechanical performance of the P-Plate by comparing it with a traditional plate (T-Plate). Then, the P-Plate was manufactured via electron beam melting and implanted into the foot of a patient. Increasing the size of the preliminary designed plate alleviated the stress concentration and reduced the risk of failure. The maximum stresses of the plate and screw (214.3 MPa, 99.05 MPa) and the maximum tensile force of the screw in the P-Plate (181.4 N) fixation system were lower than those in the T-Plate (217.4 MPa, 255.4 MPa, and 230.1 N, respectively). The P-Plate was well-matched to the bone, and no complications occurred. The P-Plate achieved American Orthopaedic Foot & Ankle Society and Short-Form-36 scores of 64 and 75, respectively, 36 months post operation, which suggests that it could improve clinical outcomes. The design and fabrication methods, as well as mechanical and postoperative performance evaluation methods, for the P-Plate were systematically developed and provide a reference for constructing a unified application framework for P-Plate use in tibiotalocalcaneal arthrodesis.
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Affiliation(s)
- Yan Yao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.
| | - Zhongjun Mo
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China.
| | - Gang Wu
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China; Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, 100176, Beijing, China.
| | - Junchao Guo
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China.
| | - Jian Li
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China.
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China; Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China; Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, 100176, Beijing, China; School of Engineering Medicine, Beihang University, 100191, Beijing, China.
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Chen G, Muheremu A, Yang L, Wu X, He P, Fan H, Liu J, Chen C, Li Z, Wang F. Three-dimensional printed implant for reconstruction of pelvic bone after removal of giant chondrosarcoma: a case report. J Int Med Res 2021; 48:300060520917275. [PMID: 32290744 PMCID: PMC7160782 DOI: 10.1177/0300060520917275] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Three-dimensional (3D) reconstruction has been used for various diseases, but
few reports have described its application in pelvic reconstruction after
removal of giant chondrosarcoma. Case reports describing the clinical
application of personalized 3D-printed titanium implants are needed for
future clinical reference. Case presentation: We herein describe a 29-year-old woman with a
giant chondrosarcoma treated with a personalized 3D titanium implant. The
surgery was successful, and the patient recovered with significant pain
relief and good functional recovery after the surgery. No implant-related
complications occurred during the 12-month follow-up. The current case
represents successful application of 3D printing technology to the treatment
of a massive bone defect due to the removal of a giant osteoporotic
tumor. Conclusions Personalized 3D titanium implants can be used in the reconstruction of
massive bone defects after the removal of giant pelvic sarcomas. The
methodology and results described in the current case report can be a used
as reference in the treatment of similar cases in future.
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Affiliation(s)
- Ge Chen
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P.R. China
| | | | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Xianzhe Wu
- Chongqing Institute of Optics and Mechanics, Chongqing, P.R. China
| | - Peng He
- Chongqing ITMDC Technology Co., Ltd., Chongqing, P.R. China
| | - Huaquan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Juncai Liu
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P.R. China
| | - Chang Chen
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P.R. China
| | - Zhong Li
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P.R. China
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
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Wang X, Xu H, Han Y, Wu J, Song Y, Jiang Y, Wang J, Miao J. Biomechanics of artificial pedicle fixation in a 3D-printed prosthesis after total en bloc spondylectomy: a finite element analysis. J Orthop Surg Res 2021; 16:213. [PMID: 33761991 PMCID: PMC7988983 DOI: 10.1186/s13018-021-02354-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/10/2021] [Indexed: 01/18/2023] Open
Abstract
Background This study compared the biomechanics of artificial pedicle fixation in spine reconstruction with a 3-dimensional (3D)-printed prosthesis after total en bloc spondylectomy (TES) by finite element analysis. Methods A thoracolumbar (T10–L2) finite element model was developed and validated. Two models of T12 TES were established in combination with different fixation methods: Model A consisted of long-segment posterior fixation (T10/11, L1/2) + 3D-printed prosthesis; and Model B consisted of Model A + two artificial pedicle fixation screws. The models were evaluated with an applied of 7.5 N·m and axial force of 200 N. We recorded and analyzed the following: (1) stiffness of the two fixation systems, (2) hardware stress in the two fixation systems, and (3) stress on the endplate adjacent to the 3D-printed prosthesis. Results The fixation strength of Model B was enhanced by the screws in the artificial pedicle, which was mainly manifested as an improvement in rotational stability. The stress transmission of the artificial pedicle fixation screws reduced the stress on the posterior rods and endplate adjacent to the 3D-printed prosthesis in all directions of motion, especially in rotation. Conclusions After TES, the posterior long-segment fixation combined with the anterior 3D printed prosthesis could maintain postoperative spinal stability, but adding artificial pedicle fixation increased the stability of the fixation system and reduced the risk of prosthesis subsidence and instrumentation failure.
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Affiliation(s)
- Xiaodong Wang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hanpeng Xu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Ye Han
- Department of Orthopaedics, Affiliated Hospital of Hebei University, Baoding, China
| | - Jincheng Wu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Yang Song
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Yuanyuan Jiang
- Department of Orthopaedics, Affiliated Hospital of Hebei University, Baoding, China
| | - Jianzhong Wang
- Department of Orthopaedics, Affiliated Hospital of Hebei University, Baoding, China
| | - Jun Miao
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
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Charbonnier B, Hadida M, Marchat D. Additive manufacturing pertaining to bone: Hopes, reality and future challenges for clinical applications. Acta Biomater 2021; 121:1-28. [PMID: 33271354 DOI: 10.1016/j.actbio.2020.11.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
For the past 20 years, the democratization of additive manufacturing (AM) technologies has made many of us dream of: low cost, waste-free, and on-demand production of functional parts; fully customized tools; designs limited by imagination only, etc. As every patient is unique, the potential of AM for the medical field is thought to be considerable: AM would allow the division of dedicated patient-specific healthcare solutions entirely adapted to the patients' clinical needs. Pertinently, this review offers an extensive overview of bone-related clinical applications of AM and ongoing research trends, from 3D anatomical models for patient and student education to ephemeral structures supporting and promoting bone regeneration. Today, AM has undoubtably improved patient care and should facilitate many more improvements in the near future. However, despite extensive research, AM-based strategies for bone regeneration remain the only bone-related field without compelling clinical proof of concept to date. This may be due to a lack of understanding of the biological mechanisms guiding and promoting bone formation and due to the traditional top-down strategies devised to solve clinical issues. Indeed, the integrated holistic approach recommended for the design of regenerative systems (i.e., fixation systems and scaffolds) has remained at the conceptual state. Challenged by these issues, a slower but incremental research dynamic has occurred for the last few years, and recent progress suggests notable improvement in the years to come, with in view the development of safe, robust and standardized patient-specific clinical solutions for the regeneration of large bone defects.
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31
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Wallace N, Schaffer NE, Aleem IS, Patel R. 3D-printed Patient-specific Spine Implants: A Systematic Review. Clin Spine Surg 2020; 33:400-407. [PMID: 32554986 DOI: 10.1097/bsd.0000000000001026] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To review the current clinical use of 3-dimensional printed (3DP) patient-specific implants in the spine. SUMMARY OF BACKGROUND DATA Additive manufacturing is a transformative manufacturing method now being applied to spinal implants. Recent innovations in technology have allowed the production of medical-grade implants with unprecedented structure and customization, and the complex anatomy of the spine is ideally suited for patient-specific devices. Improvement in implant design through the process of 3DP may lead to improved osseointegration, lower subsidence rates, and faster operative times. METHODS A comprehensive search of the literature was conducted using Ovid MEDLINE, EMBASE, Scopus, and other sources that resulted in 1842 unique articles. All manuscripts describing the use of 3DP spinal implants in humans were included. Two independent reviewers (N.W. and N.E.S.) assessed eligibility for inclusion. The following outcomes were collected: pain score, Japanese Orthopedic Association (JOA) score, subsidence, fusion, Cobb angle, vertebral height, and complications. No conflicts of interest existed. No funding was received for this work. RESULTS A total of 17 studies met inclusion criteria with a total of 35 patients. Only case series and case reports were identified. Follow-up times ranged from 3 to 36 months. Implant types included vertebral body replacement cages, interbody cages, sacral reconstruction prostheses, iliolumbar rods, and a posterior cervical plate. All studies reported improvement in both clinical and radiographic outcomes. 11 of 35 cases showed subsidence >3 mm, but only 1 case required a revision procedure. No migration, loosening, or pseudarthrosis occurred in any patient on the basis of computed tomography or flexion-extension radiographs. CONCLUSIONS Results of the systematic review indicate that 3DP technology is a viable means to fabricate patient-matched spinal implants. The effects on clinical and radiographic outcome measures are still in question, but these devices may produce favorable subsidence and pseudoarthrosis rates. Currently, the technology is ideally suited for complex tumor pathology and atypical bone defects. Future randomized controlled trials and cost analyses are still needed. LEVEL OF EVIDENCE IV-systematic review.
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Affiliation(s)
- Nicholas Wallace
- Department of Orthopedic Surgery, Division of Spine Surgery, University of Michigan, Ann Arbor, MI
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Leary OP, Crozier J, Liu DD, Niu T, Pertsch NJ, Camara-Quintana JQ, Svokos KA, Syed S, Telfeian AE, Oyelese AA, Woo AS, Gokaslan ZL, Fridley JS. Three-Dimensional Printed Anatomic Modeling for Surgical Planning and Real-Time Operative Guidance in Complex Primary Spinal Column Tumors: Single-Center Experience and Case Series. World Neurosurg 2020; 145:e116-e126. [PMID: 33010507 DOI: 10.1016/j.wneu.2020.09.145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Three-dimensional (3D) printing has emerged as a visualization tool for clinicians and patients. We sought to use patient-specific 3D-printed anatomic modeling for preoperative planning and live intraoperative guidance in a series of complex primary spine tumors. METHODS Over 9 months, patients referred to a single neurosurgical provider for complex primary spinal column tumors were included. Most recent spinal magnetic resonance and computed tomography (CT) imaging were semiautomatically segmented for relevant anatomy and models were printed using polyjet multicolor printing technology. Models were available to surgical teams before and during the operative procedure. Patients also viewed the models preoperatively during surgeon explanation of disease and surgical plan to aid in their understanding. RESULTS Tumor models were prepared for 9 patients, including 4 with chordomas, 2 with schwannomas, 1 with osteosarcoma, 1 with chondrosarcoma, and 1 with Ewing-like sarcoma. Mean age was 50.7 years (range, 15-82 years), including 6 males and 3 females. Mean tumor volume was 129.6 cm3 (range, 3.3-250.0 cm3). Lesions were located at cervical, thoracic, and sacral levels and were treated by various surgical approaches. Models were intraoperatively used as patient-specific anatomic references throughout 7 cases and were found to be technically useful by the surgical teams. CONCLUSIONS We present the largest case series of 3D-printed spine tumor models reported to date. 3D-printed models are broadly useful for operative planning and intraoperative guidance in spinal oncology surgery.
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Affiliation(s)
- Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Joseph Crozier
- Department of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David D Liu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nathan J Pertsch
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Konstantina A Svokos
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sohail Syed
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert S Woo
- Department of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Wang B, Ke W, Hua W, Zeng X, Yang C. Biomechanical Evaluation and the Assisted 3D Printed Model in the Patient-Specific Preoperative Planning for Thoracic Spinal Tuberculosis: A Finite Element Analysis. Front Bioeng Biotechnol 2020; 8:807. [PMID: 32766226 PMCID: PMC7379841 DOI: 10.3389/fbioe.2020.00807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022] Open
Abstract
Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability for the treatment of thoracic spinal tuberculosis. However, the process of selecting the appropriate spinal fixation method remains controversial, and preoperative biomechanical evaluation has not yet been investigated. In this study, we aimed to analyze the application of the assisted finite element analysis (FEA) and the three-dimensional (3D) printed model for the patient-specific preoperative planning of thoracic spinal tuberculosis. An adult patient with thoracic spinal tuberculosis was included. A finite element model of the T7−T11 thoracic spine segments was reconstructed to analyze the biomechanical effect of four different operative constructs. The von Mises stress values of the implants in the vertical axial load and flexion and extension conditions under a 400-N vertical axial pre-load and a 10-N⋅m moment were calculated and compared. A 3D printed model was used to describe and elucidate the patient’s condition and simulate the optimal surgical design. According to the biomechanical evaluation, the patient-specific preoperative surgical design was prepared for implementation. The anterior column, which was reconstructed with titanium alloy mesh and a bone graft with posterior fixation using seven pedicle screws (M+P) and performed at the T7–T11 level, decreased the von Mises stress placed on the right rod, T7 pedicle screw, and T11 pedicle. Moreover, the M+P evaded the left T9 screw without load bearing. The 3D printed model and preoperative surgical simulation enhanced the understanding of the patient’s condition and facilitated patient-specific preoperative planning. Good clinical results, including no complication of implants, negligible loss of the Cobb angle, and good bone fusion, were achieved using the M+P surgical design. In conclusion, M+P was recommended as the optimal method for preoperative planning since it enabled the preservation of the normal vertebra and prevented unnecessary internal fixation. Our study indicated that FEA and the assisted 3D printed model are tools that could be extremely useful and effective in the patient-specific preoperative planning for thoracic spinal tuberculosis, which can facilitate preoperative surgical simulation and biomechanical evaluation, as well as improve the understanding of the patient’s condition.
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Tong Y, Kaplan DJ, Spivak JM, Bendo JA. Three-dimensional printing in spine surgery: a review of current applications. Spine J 2020; 20:833-846. [PMID: 31731009 DOI: 10.1016/j.spinee.2019.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 02/03/2023]
Abstract
In recent years, the use of three-dimensional printing (3DP) technology has gained traction in orthopedic spine surgery. Although research on this topic is still primarily limited to case reports and small cohort studies, it is evident that there are many avenues for 3DP innovation in the field. This review article aims to discuss the current and emerging 3DP applications in spine surgery, as well as the challenges of 3DP production and limitations in its use. 3DP models have been presented as helpful tools for patient education, medical training, and presurgical planning. Intraoperatively, 3DP devices may serve as patient-specific surgical guides and implants that improve surgical outcomes. However, the time, cost, and learning curve associated with constructing a 3DP model are major barriers to widespread use in spine surgery. Considering the costs and benefits of 3DP along with the varying risks associated with different spine procedures, 3DP technology is likely most valuable for complex or atypical spine disorder cases. Further research is warranted to gain a better understanding of how 3DP can and will impact spine surgery.
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Affiliation(s)
- Yixuan Tong
- New York University Grossman School of Medicine, 550 1st Ave, New York, NY 10016, USA
| | - Daniel James Kaplan
- Spine Division, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10010, USA
| | - Jeffrey M Spivak
- Spine Division, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10010, USA
| | - John A Bendo
- Spine Division, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10010, USA.
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Abstract
PURPOSE OF REVIEW Biologic bone graft materials continue to be an important component of various spinal fusion procedures. Given the known risks and morbidity of harvesting iliac crest bone graft, the historical gold standard for spinal fusion, these biologic materials serve the purpose of improving both the efficacy and safety of spinal fusion procedures. Recent advances in biomedical and materials sciences have enabled the design of many novel materials that have shown promise as effective bone graft materials. This review will discuss current research pertaining to several of these materials, including functionalized peptide amphiphiles and other nanocomposites, novel demineralized bone matrix applications, 3D-printed materials, and Hyperelastic Bone®, among others. RECENT FINDINGS Recent investigation has demonstrated that novel technologies, including nanotechnology and 3D printing, can be used to produce biomaterials with significant osteogenic potential. Notably, peptide amphiphile nanomaterials functionalized to bind BMP-2 have demonstrated significant bone regenerative capacity in a pre-clinical rodent posterolateral lumbar fusion (PLF) model. Additionally, 3D-printed Hyperelastic Bone® has demonstrated promising bone regenerative capacity in several in vivo animal models. Composite materials such as TrioMatrix® (demineralized bone matrix, hydroxyapatite, and nanofiber-based collagen scaffold) have also demonstrated significant osteogenic potential in both in vitro and in vivo settings. Advances in materials science and engineering have allowed for the design and implementation of several novel biologic materials, including nanocomposites, 3D-printed materials, and various biologic composites. These materials provide significant bone regenerative capacity and have the potential to be alternatives to other bone graft materials, such as autograft and BMP-2, which have known complications.
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Affiliation(s)
- Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University - Feinberg School of Medicine, 676 N. St. Clair St. #1350, Chicago, IL, 60611, USA
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Northwestern University - Feinberg School of Medicine, 676 N. St. Clair St. #1350, Chicago, IL, 60611, USA
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Abstract
Additive manufacturing (AM) processes have undergone significant progress in recent years, having been implemented in sectors as diverse as automotive, aerospace, electrical component manufacturing, etc. In the medical sector, different devices are printed, such as implants, surgical guides, scaffolds, tissue engineering, etc. Although nowadays some implants are made of plastics or ceramics, metals have been traditionally employed in their manufacture. However, metallic implants obtained by traditional methods such as machining have the drawbacks that they are manufactured in standard sizes, and that it is difficult to obtain porous structures that favor fixation of the prostheses by means of osseointegration. The present paper presents an overview of the use of AM technologies to manufacture metallic implants. First, the different technologies used for metals are presented, focusing on the main advantages and drawbacks of each one of them. Considered technologies are binder jetting (BJ), selective laser melting (SLM), electron beam melting (EBM), direct energy deposition (DED), and material extrusion by fused filament fabrication (FFF) with metal filled polymers. Then, different metals used in the medical sector are listed, and their properties are summarized, with the focus on Ti and CoCr alloys. They are divided into two groups, namely ferrous and non-ferrous alloys. Finally, the state-of-art about the manufacture of metallic implants with AM technologies is summarized. The present paper will help to explain the latest progress in the application of AM processes to the manufacture of implants.
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Li Y, Zheng G, Liu T, Liang Y, Huang J, Liu X, Huang J, Cheng Z, Lu S, Huang L. Surgical Resection of Solitary Bone Plasmacytoma of Atlas and Reconstruction with 3-Dimensional-Printed Titanium Patient-Specific Implant. World Neurosurg 2020; 139:322-329. [PMID: 32311548 DOI: 10.1016/j.wneu.2020.04.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Solitary plasmacytoma of bone (SPB) is a rare malignancy of localized osseous lesion consisting of neoplastic monoclonal plasma cells. Recommended treatment of SPB includes a combination of surgery and radiation therapy. We present a rare case of SPB lesion in the atlas requiring surgical resection, followed by restoration of atlas stability with a custom 3-dimensional-printed (3DP) patient-specific implant (PSI). CASE DESCRIPTION A 57-year-old man presented with severe neck pain. Assessment by radiographs, computed tomography, and magnetic resonance imaging was found to harbor a single osteolytic lesion at the C1 (atlas) vertebra. Diagnostic tumor screening returned negative results. Transoral biopsy suggested solitary plasmacytoma. Spinal instability was apparent-hence the decision for surgical intervention via the retropharyngeal external approach to resect the lesion. Atlas reconstruction and stabilization were achieved using a custom 3DP titanium PSI. Subsequent pathologic findings confirmed plasma cell infiltration of the atlas. Histologic evaluations and cytogenetic risk analysis indicated a non-high-risk SPB. The patient was given localized radiation therapy at 57 Gy in 27 fractions. Her neurologic complaints were subsequently relieved, and mobility was restored 7 days postoperatively. CONCLUSIONS No consensus on the appropriate surgical approaches and perioperative strategies for spinal SPB exists. Surgical intervention is recommended when vertebral instability is evident, followed by radiation therapy to minimize local recurrence and/or progression to multiple myeloma. The use of 3D modeling for preoperative planning improves intraoperative accuracy and avoids iatrogenic injuries to vital anatomic structures. Customized 3DP-PSI to restore atlas stability is an effective option for the treatment of spinal SPBs.
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Affiliation(s)
- Yuxi Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guan Zheng
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Ting Liu
- Department of Anesthesia, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuwei Liang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiajun Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangge Liu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junshen Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziying Cheng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shixin Lu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Liptak JM, Veytsman S, Kerr S, Klasen J. Multiple segment total en bloc vertebrectomy and chest wall resection in a dog with an invasive myxosarcoma. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-001033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Stan Veytsman
- VCA Canada ‐ Alta Vista Animal HospitalOttawaOntarioCanada
| | - Shanna Kerr
- VCA Canada ‐ Alta Vista Animal HospitalOttawaOntarioCanada
| | - Jan Klasen
- Tierklinik GermersheimGermersheimGermany
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Mooney MA, Cavallo C, Zhou JJ, Bohl MA, Belykh E, Gandhi S, McBryan S, Stevens SM, Lawton MT, Almefty KK, Nakaji P. Three-Dimensional Printed Models for Lateral Skull Base Surgical Training: Anatomy and Simulation of the Transtemporal Approaches. Oper Neurosurg (Hagerstown) 2020; 18:193-201. [PMID: 31172189 DOI: 10.1093/ons/opz120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) printing holds great potential for lateral skull base surgical training; however, studies evaluating the use of 3D-printed models for simulating transtemporal approaches are lacking. OBJECTIVE To develop and evaluate a 3D-printed model that accurately represents the anatomic relationships, surgical corridor, and surgical working angles achieved with increasingly aggressive temporal bone resection in lateral skull base approaches. METHODS Cadaveric temporal bones underwent thin-slice computerized tomography, and key anatomic landmarks were segmented using 3D imaging software. Corresponding 3D-printed temporal bone models were created, and 4 stages of increasingly aggressive transtemporal approaches were performed (40 total approaches). The surgical exposure and working corridor were analyzed quantitatively, and measures of face validity, content validity, and construct validity in a cohort of 14 participants were assessed. RESULTS Stereotactic measurements of the surgical angle of approach to the mid-clivus, residual bone angle, and 3D-scanned infill volume demonstrated comparable changes in both the 3D temporal bone models and cadaveric specimens based on the increasing stages of transtemporal approaches (PANOVA <.003, <.007, and <.007, respectively), indicating accurate representation of the surgical corridor and working angles in the 3D-printed models. Participant assessment revealed high face validity, content validity, and construct validity. CONCLUSION The 3D-printed temporal bone models highlighting key anatomic structures accurately simulated 4 sequential stages of transtemporal approaches with high face validity, content validity, and construct validity. This strategy may provide a useful educational resource for temporal bone anatomy and training in lateral skull base approaches.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - James J Zhou
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sirin Gandhi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Shawn M Stevens
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Parr WCH, Burnard JL, Singh T, McEvoy A, Walsh WR, Mobbs RJ. C3-C5 Chordoma Resection and Reconstruction with a Three-Dimensional Printed Titanium Patient-Specific Implant. World Neurosurg 2019; 136:226-233. [PMID: 31811966 DOI: 10.1016/j.wneu.2019.11.167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND With this case report, we aim to add to the clinical literature on the use of three-dimensional printed patient-specific implants in spinal surgery, show the current state of the art in patient-specific implant device design, present thorough clinical and radiographic outcomes, and discuss the suitability of titanium alloy as an implant material for patients with cancer. CASE DESCRIPTION A 45-year-old man presented with neck and left arm pain combined with shoulder weakness. Imaging revealed significant destruction of the C3-C5 vertebrae, and chordoma diagnosis was confirmed by biopsy. Gross total tumor resection including multilevel corpectomy was performed in combination with reconstruction using a three-dimensional printed titanium custom implant. Custom-designed features aimed to reduce reconstruction time and result in good clinical and radiographic outcomes. Clinical scores improved postoperatively and remained improved at 17-month postoperative follow-up: visual analog scale score 10/10 preoperatively improved to 2-6/10 at 17 months; Neck Disability Index 46% preoperatively improved to 32% at 17 months. Neither dysphagia nor dysphonia remained after surgical soft tissue swelling subsided. The patient was successfully treated with proton beam therapy after surgery, with no tumor recurrence at 17-month follow-up. Radiographic assessment showed incomplete fusion at 3 months, with clinically insignificant implant subsidence (2.7 mm) and no implant migration or failure at 14 months. CONCLUSIONS Computer-aided preoperative planning with three-dimensional printed biomodels and custom implant resulted in relatively quick and simple reconstruction after tumor resection, with good clinical and radiographic outcomes at 17 and 14 months, respectively. For patients with primary tumors who may require follow-up radiotherapy or postoperative magnetic resonance imaging, metals used in the devices cause significant imaging artifact.
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Affiliation(s)
- William C H Parr
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia; 3DMorphic Pty Ltd., Sydney, Australia.
| | - Joshua L Burnard
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia
| | - Telvinderjit Singh
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia
| | - Aidan McEvoy
- Matrix Medical Innovations Pty Ltd., Sydney, Australia
| | - William R Walsh
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Ralph J Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia; Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
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3D-printed spine surgery implants: a systematic review of the efficacy and clinical safety profile of patient-specific and off-the-shelf devices. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1248-1260. [DOI: 10.1007/s00586-019-06236-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/05/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023]
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Maharubin S, Hu Y, Sooriyaarachchi D, Cong W, Tan GZ. Laser engineered net shaping of antimicrobial and biocompatible titanium-silver alloys. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 105:110059. [DOI: 10.1016/j.msec.2019.110059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023]
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Mobbs RJ, Choy WJ, Singh T, Cassar L, Davidoff C, Harris L, Phan K, Fiechter M. Three-Dimensional Planning and Patient-Specific Drill Guides for Repair of Spondylolysis/L5 Pars Defect. World Neurosurg 2019; 132:75-80. [DOI: 10.1016/j.wneu.2019.08.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022]
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Parr WCH, Burnard JL, Wilson PJ, Mobbs RJ. 3D printed anatomical (bio)models in spine surgery: clinical benefits and value to health care providers. JOURNAL OF SPINE SURGERY 2019; 5:549-560. [PMID: 32043006 DOI: 10.21037/jss.2019.12.07] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The applications of three-dimensional printing (3DP) for clinical purposes have grown rapidly over the past decade. Recent advances include the fabrication of patient specific instrumentation, such as drill and cutting guides, patient specific/custom long term implants and 3DP of cellular scaffolds. Spine surgery in particular has seen enthusiastic early adoption of these applications. 3DP as a manufacturing method can be used to mass produce objects of the same design, but can also be used as a cost-effective method for manufacturing unique one-off objects, such as patient specific models and devices. Perhaps the first, and currently most widespread, application of 3DP for producing patient specific devices is the production of patient specific anatomical models, often termed biomodels. The present manuscript focuses on the current state of the art in anatomical (bio)models as used in spinal clinical practice. The biomodels shown and discussed include: translucent and coloured models to aid in identification of extent and margins of pathologies such as bone tumours; dynamic models for implant trial implantation and pre-operative sizing; models that can be disassembled to simulate surgical resection of diseased tissue and subsequent reconstruction. Biomodels can reduce risk to the patient by decreasing surgery time, reducing the probability of the surgical team encountering unexpected anatomy or relative positioning of structures and/or devices, and better pre-operative planning of the surgical workflow including ordered preparation of the necessary instrumentation for multi-step and revision procedures. Conversely, risks can be increased if biomodels are not accurate representations of the anatomy, which can occur if MRI/CT scan data is simply converted into 3DP format without interpretation of what the scan represents in terms of patient anatomy. A review and analysis of the cost-benefits of biomodels shows that biomodels can potentially reduce cost to health care providers if operating room time is reduced by 14 minutes or more.
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Affiliation(s)
- William C H Parr
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.,3DMorphic Pty Ltd, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Joshua L Burnard
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Peter John Wilson
- Department of Neurosurgery, Prince of Wales Private, Sydney, Australia
| | - Ralph J Mobbs
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Department of Neurosurgery, Prince of Wales Private, Sydney, Australia
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Abstract
PURPOSE OF REVIEW To summarize the recent advances in 3D printing technology as it relates to spine surgery and how it can be applied to minimally invasive spine surgery. RECENT FINDINGS Most early literature about 3D printing in spine surgery was focused on reconstructing biomodels based on patient imaging. These biomodels were used to simulate complex pathology preoperatively. The focus has shifted to guides, templates, and implants that can be used during surgery and are specific to patient anatomy. However, there continues to be a lack of long-term outcomes or cost-effectiveness analyses. 3D printing also has the potential to revolutionize tissue engineering applications in the search for the optimal scaffold material and structure to improve bone regeneration without the use of other grafting materials. 3D printing has many potential applications to minimally invasive spine surgery requiring more data for widespread adoption.
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Affiliation(s)
- Jonathan T Yamaguchi
- Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Sheha ED, Gandhi SD, Colman MW. 3D printing in spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S164. [PMID: 31624730 DOI: 10.21037/atm.2019.08.88] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The applications of three-dimensional (3D) printing, or additive manufacturing, to the field of spine surgery continue to grow in number and scope especially in recent years as improved manufacturing techniques and use of sterilizable materials have allowed for creation of 3D printed implants. While 3D printing in spine surgery was initially limited to use as visual aids in preoperative planning for complex pathology, it has more recently been used to create intraoperative patient-specific screw guides and templates and is increasingly being used in surgical education and training. As patient-specific treatment and personalized medicine gains popularity in medicine, 3D printing provides a similar option for the surgical fields, particularly in the creation of customizable implants. 3D printing is a relatively new field as it pertains to spine surgery, and as such, it lacks long-term data on clinical outcomes and cost effectiveness; however, the apparent benefits and seemingly boundless applications of this growing technology make it an attractive option for the future of spine surgery.
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Affiliation(s)
- Evan D Sheha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sapan D Gandhi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Bohl MA, McBryan S, Nakaji P, Chang SW, Turner JD, Kakarla UK. Development and first clinical use of a novel anatomical and biomechanical testing platform for scoliosis. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:329-336. [PMID: 31663044 PMCID: PMC6787359 DOI: 10.21037/jss.2019.09.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have demonstrated that, by using various three-dimensional (3D) printing technologies, synthetic spine models can be manufactured to mimic a human spine in its gross and radiographic anatomy and the biomechanical performance of bony and ligamentous tissue. These manufacturing processes have not, however, been used in combination to create a long-segment, biomimetic model of a patient with scoliosis. The purpose of this study was to describe the development of a biomimetic scoliosis model and early clinical experience using this model as a surgical planning and education platform. METHODS Synthetic spine models were printed to mimic the anatomy and biomechanical performance of 2 adult patients with scoliosis. Preoperatively, the models were surgically corrected by the attending surgeon of each patient. Patients then underwent surgical correction of their spinal deformities. Correction of the models was compared to the surgical correction in the patients. RESULTS Patient 1 had a preoperative coronal Cobb angle of 40° from L1 to S1, as did the patient's synthetic spine model. The patient's spine model was corrected to 17.6°, and the patient achieved a correction of 17.3°. Patient 2 had a preoperative mid-thoracic Cobb angle of 88° and an upper thoracic Cobb angle of 43°. Preoperatively, the patient's spine model was corrected to 19.5° and 9.2° for the mid-thoracic and upper thoracic curves, respectively. Immediately after surgery, the patient's mid-thoracic and upper thoracic Cobb angles measured 18.7° and 9.5°, respectively. In both cases, the use of the spine models preoperatively changed the attending surgeon's operative plan. CONCLUSIONS A novel synthetic spine model for corrective scoliosis procedures is presented, along with early clinical experience using this model as a surgical planning platform. This model has tremendous potential not only as a surgical planning platform but also as an adjunct to patient consent, surgical education, and biomechanical research.
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Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Liu Y, Yu Q, Chang J, Wu C. Nanobiomaterials: from 0D to 3D for tumor therapy and tissue regeneration. NANOSCALE 2019; 11:13678-13708. [PMID: 31292580 DOI: 10.1039/c9nr02955a] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Nanobiomaterials have attracted tremendous attention in the biomedical field. Especially in the past few years, a large number of low dimensional nanobiomaterials, including 0D nanostructures, 1D nanotubes and 2D nanosheets, were employed for tumor therapy due to their optically triggered tumor therapy effects and drug loading capacities. However, these low dimensional nanobiomaterials cannot support cell adhesion and possess poor tissue regeneration ability, thus they are not suitable for application in regenerative medicine. Three dimensional (3D) nanofiber scaffolds have attracted extensive attention in tissue regeneration, including bone, skin, nerve and cardiac tissues, due to their similar extracellular matrix structures. Additionally, many 3D scaffolds displayed bone and cartilage regeneration abilities. Therefore, to obtain materials with both tumor therapy and tissue regeneration abilities, it is meaningful and necessary to develop 3D nanobiomaterials with multifunctions. In this review, we systematically review the research progress of nanobiomaterials with varied dimensional structures including 0D, 1D, 2D and 3D, as well as evolutional functions from single tumor therapy to simultaneous tumor therapy and tissue regeneration. This review may pave the way for developing an interdisciplinary research of nanobiomaterials in combination of tumor therapy and regenerative medicine.
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Affiliation(s)
- Yaqin Liu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China. and Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Qingqing Yu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China. and Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Jiang Chang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China. and Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Chengtie Wu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China. and Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
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Willemsen K, Nizak R, Noordmans HJ, Castelein RM, Weinans H, Kruyt MC. Challenges in the design and regulatory approval of 3D-printed surgical implants: a two-case series. LANCET DIGITAL HEALTH 2019; 1:e163-e171. [PMID: 33323186 DOI: 10.1016/s2589-7500(19)30067-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Additive manufacturing or three-dimensional (3D) printing of metal implants can provide novel solutions for difficult-to-treat conditions, yet legislation concerning patient-specific implants complicates the implementation of these techniques in daily practice. In this Article, we share our acquired knowledge of the logistical and legal challenges associated with the use of patient-specific 3D-printed implants to treat spinal instabilities. METHODS Two patients with semiurgent cases of spinal instability presented to our hospital in the Netherlands. In case 1, severe kyphotic deformity of the thoracic spine due to neurofibromatosis type 1 had led to incomplete paralysis, and a strong metallic strut extending from C6 to T11 was deemed necessary to provide long-term anterior support. In case 2, the patient presented with progressive paralysis caused by cervicothoracic dissociation due to vanishing bone disease. As the C5-T1 vertebral bodies had mostly vanished, an implant spanning the anterior spine from C4 to T2 was required. Because of the complex and challenging nature of both cases, conventional approaches were deemed inadequate; instead, patient-specific implants were designed with use of CT scans and computer-aided design software, and 3D printed in titanium with direct metal printing. For each implant, to ensure patient safety, a comprehensive technical file (describing the clinical substantiation, technical and design considerations, risk analysis, manufacturing process, and labelling) was produced in collaboration with a university department certified for the development and manufacturing of medical devices. Because the implants were categorised as custom-made or personalised devices under the EU Medical Device Regulation, the usual procedures for review and approval of medical devices by a notified body were not required. Finite-element analyses, compression strength tests, and cadaveric experiments were also done to ensure the devices were safe to use. FINDINGS The planning, design, production, and insertion of the 3D-printed personalised implant took around 6 months in the first patient, but, given the experience from the first case, only took around 6 weeks in the second patient. In both patients, the surgeries went as planned and good positioning of each implant was confirmed. Both patients were discharged home within 1 week after the surgery. In the first patient, a fatigue fracture occured in one of the conventional posterior fusion rods after 10 months, which we repaired, without any deformation of the spine or signs of failure of the personalised implant observed. No other adverse events occurred up to 25 months of follow-up in case 1 and 6 months of follow-up in case 2. INTERPRETATION Patient-specific treatment approaches incorporating 3D-printed implants can be helpful in carefully selected cases when conventional methods are not an option. Comprehensive and efficient interactions between medical engineers and physicians are essential to establish well designed frameworks to navigate the logistical and regulatory aspects of technology development to ensure the safety and legal validity of patient-specific treatments. The framework described here could encourage physicians to treat (once untreatable) patients with novel personalised techniques. FUNDING Interreg VA Flanders-The Netherlands programme, Applied and Engineering Sciences research programme, the Netherlands Organisation for Scientific Research, and the Dutch Arthritis Foundation VIDEO ABSTRACT.
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Affiliation(s)
- Koen Willemsen
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands.
| | - Razmara Nizak
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Herke Jan Noordmans
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - René M Castelein
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Moyo C Kruyt
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands
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Choy WJ, Mobbs RJ. Current state of 3D-printed custom-made spinal implants. LANCET DIGITAL HEALTH 2019; 1:e149-e150. [PMID: 33323180 DOI: 10.1016/s2589-7500(19)30081-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Wen Jie Choy
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia; NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia; NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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