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Scheuermann LM, Lewis DD, Johnson MD, Biedrzycki AH, Kim SE. Virtual surgical planning and use of a 3D-printed, patient-specific reduction system for minimally invasive plate osteosynthesis of diaphyseal tibial fractures in dogs: A historic case control study. Vet Surg 2024; 53:1052-1061. [PMID: 39088191 DOI: 10.1111/vsu.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/22/2024] [Accepted: 05/05/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE To compare the efficacy and clinical outcomes of computed tomography (CT)-based virtual surgical planning (VSP) and a three-dimensional (3D)-printed, patient-specific reduction system to conventional indirect reduction techniques for diaphyseal tibial fractures stabilized using minimally invasive plate osteosynthesis (MIPO) in dogs. STUDY DESIGN A prospective clinical study with a historic control cohort. SAMPLE POPULATION Dogs undergoing MIPO stabilization of diaphyseal tibial fractures using a custom 3D-printed reduction system (3D-MIPO; n = 15) or conventional indirect reduction techniques (c-MIPO; n = 14). METHODS Dogs were prospectively enrolled to the 3D-MIPO group and CT scans were used to design and fabricate a custom 3D-printed reduction system to facilitate MIPO. Medical records were searched to identify dogs for the c-MIPO group. Pre-, intra- and postoperative parameters were compared between groups. RESULTS The duration from presentation until surgery was 23 h longer in the 3D-MIPO group (p = .002). Fewer intraoperative fluoroscopic images were acquired (p < .001) and mean surgical duration was 34 min shorter in the 3D-MIPO group (p = .014). Median postoperative tibial length, frontal alignment, and sagittal alignment were within 4 mm, 3° and 3°, respectively, of the contralateral tibia in both groups and did not differ between reduction groups (p > .1). Postoperative complications occurred in 27% and 14% of fractures in the 3D-MIPO and c-MIPO groups, respectively. CONCLUSION Both reduction methods yielded comparable results. Although the preoperative planning and guide preparation was time consuming, surgery times were shorter and fluoroscopy use was less in the 3D-MIPO group. CLINICAL SIGNIFICANCE VSP and the custom 3D-printed reduction system facilitated efficient MIPO.
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Affiliation(s)
- Logan M Scheuermann
- Department of Small Animal Clinical Sciences and the Jeff and Jo Godwin Advanced Small Animal Surgical Training Center and Canine Gait Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Daniel D Lewis
- Department of Small Animal Clinical Sciences and the Jeff and Jo Godwin Advanced Small Animal Surgical Training Center and Canine Gait Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Matthew D Johnson
- Department of Small Animal Clinical Sciences and the Jeff and Jo Godwin Advanced Small Animal Surgical Training Center and Canine Gait Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Adam H Biedrzycki
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Stanley E Kim
- Department of Small Animal Clinical Sciences and the Jeff and Jo Godwin Advanced Small Animal Surgical Training Center and Canine Gait Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Huang AZB, Mobbs RJ. Application of three-dimensional printed biomodels in endoscopic spinal surgery. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:1-7. [PMID: 38567013 PMCID: PMC10982922 DOI: 10.21037/jss-23-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/07/2024] [Indexed: 04/04/2024]
Abstract
Background Three-dimensional printing (3DP) is increasingly used to individualise surgery and may be an effective tool for representing patient anatomy. Current literature on patient-specific anatomical models (biomodels) for minimally invasive spinal surgery is a limited number of case series and cohort studies. However, studies investigating 3DP in other specialties have reported multiple benefits. Methods This prospective study considered a series of patients (n=33) undergoing elective endoscopic spinal surgery, including combinations of microdiscectomy (n=27), foraminotomy (n=7), and laminectomy (n=3). These surgeries were conducted at vertebral levels ranging from L2/3 to L5/S1. The surgeon then recorded the impact on preoperational planning, intraoperative decision-making and accelerating the learning curve with a qualitative questionnaire. Results There were benefits to planning in 54.5% of cases (n=18), improved intraoperative decision-making in 60.6% of cases (n=20). These benefits were reported more frequently earlier in the cases, with improvements to learning reported in 60% of the first five cases and not in subsequent cases. The surgeon commented that the biomodels were more useful on. Conclusions The rates of preoperative and intraoperative benefits are consistent with existing studies, and the early benefit to the learning curve may be suitable for applications to surgical training. Additional research is required to determine the practicality of biomodels and their impact on patient outcomes for endoscopic spinal surgery.
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Affiliation(s)
- Aaron Z. B. Huang
- NeuroSpine Surgery Research Group (NSURG), Randwick, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Randwick, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
- NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia
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Tappa K, Bird JE, Arribas EM, Santiago L. Multimodality Imaging for 3D Printing and Surgical Rehearsal in Complex Spine Surgery. Radiographics 2024; 44:e230116. [PMID: 38386600 PMCID: PMC10924222 DOI: 10.1148/rg.230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 02/24/2024]
Abstract
Surgery is the mainstay treatment of symptomatic spinal tumors. It aids in restoring functionality, managing pain and tumor growth, and improving overall quality of life. Over the past decade, advancements in medical imaging techniques combined with the use of three-dimensional (3D) printing technology have enabled improvements in the surgical management of spine tumors by significantly increasing the precision, accuracy, and safety of the surgical procedures. For complex spine surgical cases, the use of multimodality imaging is necessary to fully visualize the extent of disease, including both soft-tissue and bone involvement. Integrating the information provided by these examinations in a cohesive manner to facilitate surgical planning can be challenging, particularly when multiple surgical specialties work in concert. The digital 3-dimensional (3D) model or 3D rendering and the 3D printed model created from imaging examinations such as CT and MRI not only facilitate surgical planning but also allow the placement of virtual and physical surgical or osteotomy planes, further enhancing surgical planning and rehearsal. The authors provide practical information about the 3D printing workflow, from image acquisition to postprocessing of a 3D printed model, as well as optimal material selection and incorporation of quality management systems, to help surgeons utilize 3D printing for surgical planning. The authors also highlight the process of surgical rehearsal, how to prescribe digital osteotomy planes, and integration with intraoperative surgical navigation systems through a case-based discussion. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Karthik Tappa
- From the Department of Breast Imaging, Division of Diagnostic Imaging
(K.T.), Department of Orthopedic Oncology, Division of Surgery (J.E.B.), and
Department of Breast Imaging, Division of Diagnostic Imaging (E.M.A., L.S.), The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030
| | - Justin E. Bird
- From the Department of Breast Imaging, Division of Diagnostic Imaging
(K.T.), Department of Orthopedic Oncology, Division of Surgery (J.E.B.), and
Department of Breast Imaging, Division of Diagnostic Imaging (E.M.A., L.S.), The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030
| | - Elsa M. Arribas
- From the Department of Breast Imaging, Division of Diagnostic Imaging
(K.T.), Department of Orthopedic Oncology, Division of Surgery (J.E.B.), and
Department of Breast Imaging, Division of Diagnostic Imaging (E.M.A., L.S.), The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030
| | - Lumarie Santiago
- From the Department of Breast Imaging, Division of Diagnostic Imaging
(K.T.), Department of Orthopedic Oncology, Division of Surgery (J.E.B.), and
Department of Breast Imaging, Division of Diagnostic Imaging (E.M.A., L.S.), The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030
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Katiyar P, Boddapati V, Coury J, Roye B, Vitale M, Lenke L. Three-Dimensional Printing Applications in Pediatric Spinal Surgery: A Systematic Review. Global Spine J 2024; 14:718-730. [PMID: 37278022 PMCID: PMC10802521 DOI: 10.1177/21925682231182341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVE 3DP technology use has become increasingly more common in the field of medicine and is notable for its growing utility in spine surgery applications. Many studies have evaluated the use of pedicle screw placement guides and spine models in adult spine patients, but there is little evidence assessing its efficacy in pediatric spine patient populations. This systematic review identifies and evaluates the current applications and surgical outcomes of 3-Dimensional Printing (3DP) technology in pediatric spinal surgery. METHODS A search of publications was conducted using literature databases and relevant keywords in concordance with PRISMA guidelines. Inclusion criteria consisted of original studies, and studies focusing on the use of 3DP technology in pediatric spinal surgery. Studies with a focus on adult populations, non-deformity surgery, animal subjects, systematic or literature reviews, editorials, or non-English studies were excluded from further analysis. RESULTS After application of inclusion/exclusion criteria, we identified 25 studies with 3DP applications in pediatric spinal surgery. Overall, the studies found significantly improved screw placement accuracy using 3DP pedicle screw placement guides but did not identify significant differences in operative time or blood loss. All studies that utilized 3D spine models in preoperative planning found it helpful and noted an increased screw placement accuracy rate of 89.9%. CONCLUSIONS 3DP applications and techniques are currently used in pre-operative planning using pedicle screw drill guides and spine models to improve patient outcomes in pediatric spinal deformity patients.
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Affiliation(s)
- Prerana Katiyar
- Columbia UniversityVagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Benjamin Roye
- Columbia UniversityIrving Medical Center, New York, NY, USA
| | - Michael Vitale
- Columbia UniversityIrving Medical Center, New York, NY, USA
| | - Lawrence Lenke
- Columbia UniversityIrving Medical Center, New York, NY, USA
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY, USA
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Jiang Z, Wang H, Cui R, Wang X, Wang Y, Sun M, Peng F, Li T, Zhang W, Zhang W. Correlation analysis and clinical significance of changes in upper thoracic vertebra tilt and clavicle angle pre- and post-operation. Front Surg 2024; 11:1264966. [PMID: 38456171 PMCID: PMC10917990 DOI: 10.3389/fsurg.2024.1264966] [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: 07/21/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024] Open
Abstract
The imbalance of the lateral shoulder is reflected by the clavicle angle (CA) in radiology. It remains unclear how to achieve postoperative lateral shoulder balance (LSB) after spinal deformity correction surgery. A retrospective analysis was conducted on AIS patients who underwent surgery by the same spine surgeon at our hospital from 2016 to 2020. A total of 110 patients with spinal deformity were included in the study to verify the correlation between the T1-T5 tilt angle and CA before and after surgery, as well as the relation-ship between the change in T1-T5 tilt angle before and after surgery and the change in CA before and after surgery. By comparing the correlation coefficients, it was found that there may not be a direct relationship between the pre- and postoperative tilt angles of T1-5 and CA, but their changes were closely related to the changes in CA. The change in T1 tilt angle after orthopaedic surgery was significantly correlated with the change in CA, with a correlation coefficient of 0.976, indicating a close relationship between T1 and the clavicle. As the vertebrae moved down, the correlation gradually decreased. In summary, this study suggests that there is a close relationship between T1-T5 and the clavicle and that the change in T1 tilt angle after spinal scoliosis correction surgery is significantly correlated with CA, which decreases as the vertebra moves down.
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Affiliation(s)
- Zhensong Jiang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Haoyu Wang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Ran Cui
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xingpeng Wang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yunhui Wang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Mingtong Sun
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fushuai Peng
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Tao Li
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Weimin Zhang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wen Zhang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Laskay NMB, Parr MS, Mooney J, Farber SH, Knowlin LT, Chang T, Uribe JS, Johnston JM, Godzik J. Optimizing Surgical Efficiency in Complex Spine Surgery Using Virtual Reality as a Communication Technology to Promote a Shared Mental Model: A Case Series and Review. Oper Neurosurg (Hagerstown) 2024; 26:213-221. [PMID: 37729632 DOI: 10.1227/ons.0000000000000899] [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: 03/21/2023] [Accepted: 06/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Virtual reality (VR) is an emerging technology that can be used to promote a shared mental model among a surgical team. We present a case series demonstrating the use of 3-dimensional (3D) VR models to visually communicate procedural steps to a surgical team to promote a common operating objective. We also review the literature on existing uses of VR for preoperative communication and planning in spine surgery. METHODS Narrations of 3 to 4-minute walkthroughs were created in a VR visualization platform, converted, and distributed to team members through text and email the night before surgical intervention. A VR huddle was held immediately before the intervention to refine surgical goals. After the intervention, the participating team members' perceptions on the value of the tool were assessed using a survey that used a 5-point Likert scale. MEDLINE, Google Scholar, and Dimensions AI databases were queried from July 2010 to October 2022 to examine existing literature on preoperative VR use to plan spine surgery. RESULTS Three illustrative cases are presented with accompanying video. Postoperative survey results demonstrate a positive experience among surgical team members after reviewing preoperative plans created with patient-specific 3D VR models. Respondents felt that preoperative VR video review was "moderately useful" or more useful in improving their understanding of the operational sequence (71%, 5/7), in enhancing their ability to understand their role (86%, 6/7), and in improving the safety or efficiency of the case (86%, 6/7). CONCLUSION We present a proof of concept of a novel preoperative communication tool used to create a shared mental model of a common operating objective for surgical team members using narrated 3D VR models. Initial survey results demonstrate positive feedback among respondents. There is a paucity of literature investigating VR technology as a means for preoperative surgical communication in spine surgery. ETHICS Institutional review board approval (IRB-300009785) was obtained before this study.
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Affiliation(s)
- Nicholas M B Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Matthew S Parr
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA
| | - Laquanda T Knowlin
- Department of Surgery, Children's Hospital Los Angeles, Los Angeles , California , USA
| | - Todd Chang
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles , California , USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Jakub Godzik
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
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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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Betancourt MC, Araújo C, Marín S, Buriticá W. The Quantitative Impact of Using 3D Printed Anatomical Models for Surgical Planning Optimization: Literature Review. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:1130-1139. [PMID: 37886412 PMCID: PMC10599434 DOI: 10.1089/3dp.2021.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
3D printing has entered the medical field as a visualization tool that allows the manufacture of three-dimensional (3D) models that physically represent the anatomy of a patient in need of analysis to improve surgical results. This article analyzes the literature around reported study cases that make use of anatomical models for their surgical processes' planning, focusing on obtaining the quantitative results of each one of them. A search of case studies was carried out in the main medical databases such as PubMed, ScienceDirect, SpringerLink, among others; to obtain the most relevant results of the 56 selected articles, the information of each study was analyzed and categorized. These articles presented figures and data about the benefits that are considered more representative to measure the positive impact of this technology. These benefits are summarized in variables such as the decrease in surgical time, greater accuracy in the diagnosis of pathology, blood loss reduction, and decreasing operating room costs; owed to an improvement in the surgery planning. It was found that in all the cases analyzed there was an improvement in the surgical results related to these variables, which were summarized in macro figures that combine this improvement quantitatively. In the analyzed studies, it was evident that there is great potential in the use of 3D printing for presurgical planning, being as the results of these analyzed interventions were better when using this technology. In addition, it was found that the results obtained initially, before applying the inclusion and exclusion criteria, were mostly of a qualitative nature; expressing the perception of researchers regarding the positive use of this tool in the field and evidencing an opportunity for this research to focus on concrete and technical information to show in numerical terms the effectiveness of this tool, to demonstrate the cost-benefit that it has for the field.
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Zhou X, Zhang D, Xie Z, Yang Y, Feng L, Hou C, Chen M, Liang Z, Zhang G, Lu H. Application of preoperative 3D printing in the internal fixation of posterior rib fractures with embracing device: a cohort study. BMC Surg 2023; 23:237. [PMID: 37580688 PMCID: PMC10426142 DOI: 10.1186/s12893-023-02128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND To explore the impact of preoperative 3D printing on the fixation of posterior rib fractures utilizing a memory alloy embracing device of rib under thoracoscopy. METHODS The enrolled patients were divided into the 3D printing (11 patients) and the non-3D printing (18 patients) groups, based on whether a 3D model of ribs was prepared prior to surgery. Analysis was conducted comparing the average fixation time per fracture, postoperative fixation loss, and poor reduction of fractured end between the two groups. RESULTS The average fixation time of each fracture was 27.2 ± 7.7 min in the 3D printing group and 29.3 ± 8.2 min in the non-3D printing group, with no statistically significant difference observed between the two groups (P > 0.05). The incidence of poor fracture fixation in the 3D printing group was statistically lower than that in the non-3D printing group (12.9% vs. 44.7%, P < 0.05). Further stratified analysis revealed that the off-plate rate in the 3D printing group and the non-3D group was (3.2% vs. 12.8%, P > 0.05), and the dislocation rate of the fractured end was (9.7% vs. 31.9%, P < 0.05). CONCLUSIONS The application of 3D printing technology to prepare the rib model before surgery is proves beneficial in reducing the occurrence of poor fixation of fractures and achieving precise and individualized treatment.
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Affiliation(s)
- Xuetao Zhou
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Dongsheng Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China.
| | - Zexin Xie
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Lei Feng
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Chunjuan Hou
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Menghui Chen
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Guoliang Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Huiqing Lu
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
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Pan A, Ding H, Hai Y, Liu Y, Hai JJ, Yin P, Han B. The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery. Global Spine J 2023; 13:787-795. [PMID: 33973487 DOI: 10.1177/21925682211008830] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE We aimed to evaluate the value of 3-dimensional printing (3DP) spine model in the surgical treatment of severe spinal deformity since the prosperous development of 3DP technology. METHODS Severe scoliosis or hyper-kyphosis patients underwent posterior fixation and fusion surgery using the 3DP spine models were reviewed (3DP group). Spinal deformity surgeries operated by free-hand screw implantation during the same period were selected as the control group after propensity score matching (PSM). The correction rate, pedicle screw accuracy, and complications were analyzed. Class A and B screws were defined as accurate according to Gertzbein and Robbins criteria. RESULTS 35 patients were enrolled in the 3DP group and 35 matched cases were included in the control group. The perioperative baseline data and deformity correction rate were similar between both groups (P > .05). However, the operation time and blood loss were significantly less in the 3DP group (296.14 ± 66.18 min vs. 329.43 ± 67.16 min, 711.43 ± 552.28 mL vs. 1322.29 ± 828.23 mL, P < .05). More three-column osteotomies (Grade 3-6) were performed in the 3DP group (30/35, 85.7% vs. 21/35, 60.0%. P = .016). The screw placement accuracy was significantly higher in the 3DP group (422/582, 72.51% vs. 397/575, 69.04%. P = .024). The screw misplacement related complication rate was significantly higher in the free-hand group (6/35 vs. 1/35, P = .046). CONCLUSIONS The study provided solid evidence that 3DP spine models can enhance surgeons' confidence in performing higher grade osteotomies and improve the safety and efficiency in severe spine deformity correction surgery. 3D printing technology has a good prospect in spinal deformity surgery.
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Affiliation(s)
- Aixing Pan
- Department of Orthopedic Surgery, 74639Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Hongtao Ding
- Department of Orthopedic Surgery, 74639Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, 74639Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, 74639Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Junrui Jonathan Hai
- 261768The High School Affiliated to Renmin University of China, Haidian District, Beijing, China
| | - Peng Yin
- Department of Orthopedic Surgery, 74639Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Bo Han
- Department of Orthopedic Surgery, 74639Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
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Ding H, Hai Y, Zhou L, Liu Y, Zhang Y, Han C, Zhang Y. Clinical Application of Personalized Digital Surgical Planning and Precise Execution for Severe and Complex Adult Spinal Deformity Correction Utilizing 3D Printing Techniques. J Pers Med 2023; 13:jpm13040602. [PMID: 37108989 PMCID: PMC10143551 DOI: 10.3390/jpm13040602] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/19/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
(1) Background: The three-dimensional printing (3DP) technique has been reported to be of great utility in spine surgery. The purpose of this study is to report the clinical application of personalized preoperative digital planning and a 3DP guidance template in the treatment of severe and complex adult spinal deformity. (2) Methods: eight adult patients with severe rigid kyphoscoliosis were given personalized surgical simulation based on the preoperative radiological data. Guidance templates for screw insertion and osteotomy were designed and manufactured according to the planning protocol and used during the correction surgery. The perioperative, and radiological parameters and complications, including surgery duration, estimated blood loss, pre- and post-operative cobb angle, trunk balance, and precision of osteotomy operation with screw implantation were collected retrospectively and analyzed to evaluate the clinical efficacy and safety of this technique. (3) Results: Of the eight patients, the primary pathology of scoliosis included two adult idiopathic scoliosis (ADIS), four congenital scoliosis (CS), one ankylosing spondylitis (AS), and one tuberculosis (TB). Two patients had a previous history of spinal surgery. Three pedicle subtraction osteotomies (PSOs) and five vertebral column resection (VCR) osteotomies were successfully performed with the application of the guide templates. The main cobb angle was corrected from 99.33° to 34.17°, and the kyphosis was corrected from 110.00° to 42.00°. The ratio of osteotomy execution and simulation was 97.02%. In the cohort, the average screw accuracy was 93.04%. (4) Conclusions: The clinical application of personalized digital surgical planning and precise execution via 3D printing guidance templates in the treatment of severe adult rigid deformity is feasible, effective, and easily generalizable. The preoperative osteotomy simulation was executed with high precision, utilizing personalized designed guidance templates. This technique can be used to reduce the surgical risk and difficulty of screw placement and high-level osteotomy.
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12
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Lu C, Ma L, Wang X, Yao Q, Zhang C, Du Y, Li W, Jian F. Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis. J Neurol Surg A Cent Eur Neurosurg 2023; 84:188-197. [PMID: 36070792 DOI: 10.1055/a-1938-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a lack of attention to screw placement techniques for surgical treatment of scoliosis in children and adolescents. This meta-analysis aims to compare the accuracy and safety of pedicle screw placement between the 3D-printed navigation template technique and the freehand technique during corrective surgery for scoliosis in children and adolescents. METHODS A comprehensive search was conducted for relevant articles up to December 2021 in databases including PubMed, Embase, MEDLINE, Cochrane, and Web of Science. The systematic meta-analysis compared the efficacy of pedicle screw placement between the two techniques, including accuracy of pedicle screw placement, complication rate, operation time, blood loss, mean placement time per screw, and mean times for fluoroscopy. RESULTS The seven articles analyzed in this study involved 229 patients altogether. A total of 2,805 pedicle screws were placed by the two methods. Our results revealed that the 3D-printed guide template technique was more accurate than the freehand technique in pedicle screw placement (odds ratio [OR] =2.96; 95% confidence interval [CI]: 2.24-3.91; p < 0.000) with a lower complication rate (OR = 0.21; 95% CI: 0.06-0.78; p = 0.02). The operation time (mean difference [MD] = -34.37; 95% CI: -67.47 to -1.28; p = 0.04) and mean placement time per screw (MD = -3.11; 95% CI: -6.13 to -0.09; p = 0.04) and mean times for fluoroscopy (MD = -6.60; 95% CI: -8.66 to -4.55; p < 0.000) significantly decreased among patients in the 3D-printed navigation template group compared with those in the freehand technique group. In addition, the two techniques had no significant statistical difference in blood loss. CONCLUSIONS Compared with the traditional freehand technique, the 3D-printed guide template is a promising technique with higher accuracy and safety in screw placement for surgical treatment of scoliosis in children and adolescents, and is worth popularizing and validating through more prospective clinical studies.
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Affiliation(s)
- Chunli Lu
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Longbing Ma
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Xinyu Wang
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Qingyu Yao
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Can Zhang
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Yueqi Du
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Wei Li
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Fengzeng Jian
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
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Joarder I, Taniguchi S, Mendoza A, Snow ME. Defining "successful" treatment outcomes in adolescent idiopathic scoliosis: a scoping review. 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 2023; 32:1204-1244. [PMID: 36847911 DOI: 10.1007/s00586-023-07592-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/07/2023] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis that affects children aged 10-18 years old, manifesting in a three-dimensional spinal deformity. This study aimed to explore outcome measures used in defining AIS treatment success. Particularly, analyzing the extent of qualitative and quantitative (radiographic and quality of life domains) measures to evaluate AIS and whether AIS treatment approaches (surgical, bracing and physiotherapy) influences outcomes used as proxies of treatment success. METHODS EMBASE and MEDLINE databases were used to conduct a systematic scoping review with 654 search queries. 158 papers met the inclusion criteria and were screened for data extraction. Extractable variables included: study characteristics, study participant characteristics, type of study, type of intervention approach and outcome measures. RESULTS All 158 studies measured quantitative outcomes. 61.38% of papers used radiographic outcomes whilst 38.62% of papers used quantitative quality of life outcomes to evaluate treatment success. Irrespective of treatment intervention utilized, the type of quantitative outcome measure recorded were similar in proportion. Moreover, of the radiographic outcome measures, the subcategory Cobb angle was predominantly used across all intervention approaches. For quantitative quality of life measures, questionnaires investigating multiple domains such as SRS were primarily used as proxies of AIS treatment success across all intervention approaches. CONCLUSION This study identified that no articles employed qualitative measures of describing the psychosocial implications of AIS in defining treatment success. Although quantitative measures have merit in clinical diagnoses and management, there is increasing value in using qualitative methods such as thematic analysis in guiding clinicians to develop a biopsychosocial approach for patient care.
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Affiliation(s)
- Ishraq Joarder
- Faculty of Medicine, University of British Columbia, #908 - 2233 Allison Road, Vancouver, BC, V6T 1T7, Canada.
| | - Seika Taniguchi
- Faculty of Medicine, University of British Columbia, #908 - 2233 Allison Road, Vancouver, BC, V6T 1T7, Canada
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Nguyen P, Stanislaus I, McGahon C, Pattabathula K, Bryant S, Pinto N, Jenkins J, Meinert C. Quality assurance in 3D-printing: A dimensional accuracy study of patient-specific 3D-printed vascular anatomical models. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1097850. [PMID: 36824261 PMCID: PMC9941637 DOI: 10.3389/fmedt.2023.1097850] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023] Open
Abstract
3D printing enables the rapid manufacture of patient-specific anatomical models that substantially improve patient consultation and offer unprecedented opportunities for surgical planning and training. However, the multistep preparation process may inadvertently lead to inaccurate anatomical representations which may impact clinical decision making detrimentally. Here, we investigated the dimensional accuracy of patient-specific vascular anatomical models manufactured via digital anatomical segmentation and Fused-Deposition Modelling (FDM), Stereolithography (SLA), Selective Laser Sintering (SLS), and PolyJet 3D printing, respectively. All printing modalities reliably produced hand-held patient-specific models of high quality. Quantitative assessment revealed an overall dimensional error of 0.20 ± 3.23%, 0.53 ± 3.16%, -0.11 ± 2.81% and -0.72 ± 2.72% for FDM, SLA, PolyJet and SLS printed models, respectively, compared to unmodified Computed Tomography Angiograms (CTAs) data. Comparison of digital 3D models to CTA data revealed an average relative dimensional error of -0.83 ± 2.13% resulting from digital anatomical segmentation and processing. Therefore, dimensional error resulting from the print modality alone were 0.76 ± 2.88%, + 0.90 ± 2.26%, + 1.62 ± 2.20% and +0.88 ± 1.97%, for FDM, SLA, PolyJet and SLS printed models, respectively. Impact on absolute measurements of feature size were minimal and assessment of relative error showed a propensity for models to be marginally underestimated. This study revealed a high level of dimensional accuracy of 3D-printed patient-specific vascular anatomical models, suggesting they meet the requirements to be used as medical devices for clinical applications.
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Affiliation(s)
- Philip Nguyen
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ivan Stanislaus
- Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Clover McGahon
- Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Krishna Pattabathula
- Vascular Surgery Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia
| | - Samuel Bryant
- Vascular Surgery Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia
| | - Nigel Pinto
- Vascular Surgery Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia
| | - Jason Jenkins
- Vascular Surgery Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia
| | - Christoph Meinert
- Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Faculty of Engineering, Architecture and Information Technology, University of Queensland, Brisbane, QLD, Australia,Correspondence: Christoph Meinert
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15
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Impact of 3D printed models on quantitative surgical outcomes for patients undergoing robotic-assisted radical prostatectomy: a cohort study. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1401-1408. [PMID: 36749368 DOI: 10.1007/s00261-023-03815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Three-dimensional (3D) printed anatomic models can facilitate presurgical planning by providing surgeons with detailed knowledge of the exact location of pertinent anatomical structures. Although 3D printed anatomic models have been shown to be useful for pre-operative planning, few studies have demonstrated how these models can influence quantitative surgical metrics. OBJECTIVE To prospectively assess whether patient-specific 3D printed prostate cancer models can improve quantitative surgical metrics in patients undergoing robotic-assisted radical prostatectomy (RARP). METHODS Patients with MRI-visible prostate cancer (PI-RADS V2 ≥ 3) scheduled to undergo RARP were prospectively enrolled in our IRB approved study (n = 82). Quantitative surgical metrics included the rate of positive surgical margins (PSMs), operative times, and blood loss. A qualitative Likert scale survey to assess understanding of anatomy and confidence regarding surgical approach was also implemented. RESULTS The rate of PSMs was lower for the 3D printed model group (8.11%) compared to that with imaging only (28.6%), p = 0.128. The 3D printed model group had a 9-min reduction in operating time (213 ± 42 min vs. 222 ± 47 min) and a 5 mL reduction in average blood loss (227 ± 148 mL vs. 232 ± 114 mL). Surgeon anatomical understanding and confidence improved after reviewing the 3D printed models (3.60 ± 0.74 to 4.20 ± 0.56, p = 0.62 and 3.86 ± 0.53 to 4.20 ± 0.56, p = 0.22). CONCLUSIONS 3D printed prostate cancer models can positively impact quantitative patient outcomes such as PSMs, operative times, and blood loss in patients undergoing RARP.
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Hou C, Yang H, Chen Y, Yang Y, Zhang B, Chen K, Li M, Yang M, Chen K. Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery: A retrospective study. Front Surg 2023; 9:1085580. [PMID: 36756658 PMCID: PMC9899830 DOI: 10.3389/fsurg.2022.1085580] [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: 10/31/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to explore whether a robot-assisted (RA) technique has advantages over the conventional fluoroscopy-assisted (FA) technique in clinical and radiological outcomes and whether it could decrease the incidence of mis-implantations of pedicle screws in adolescent idiopathic scoliosis (AIS) correction surgery. A total of 101 patients with AIS were recruited (RA group: 45 patients underwent RA screw insertion; FA group: 56 patients underwent FA screw insertion). When comparing the radiological data between the two groups, the major and secondary curves were both corrected proficiently with no difference in Cobb angle comparison at the last follow-up, suggesting that both the RA technique and the FA technique could lead to efficient radiographic correction and similar clinical outcomes (all, p > 0.05). In the RA group, operation time, blood loss, and transfusion volume were significantly greater than those in the FA group, while the accuracy of screw implantations in patients with AIS with a thoracic scoliotic curve in the RA group was higher than that in the FA group. In conclusion, both the RA and FA techniques could approach proficient radiographic correction and similar clinical outcomes in AIS surgery. Compared with the conventional fluoroscopy technique, the RA technique might improve the accuracy of screw implantations in patients with AIS with a thoracic scoliotic curve, while the increased operation time, blood loss, and transfusion volume might be the disadvantages due to the preliminary stage of the learning curve.
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Affiliation(s)
- Canglong Hou
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, China
| | - Huan Yang
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, China
| | - Yu Chen
- Department of Orthopedics, Hua shan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yilin Yang
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, China
| | - Beichen Zhang
- Department of Rehabilitation, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Kai Chen
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, China
| | - Ming Li
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, China
| | - Mingyuan Yang
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, China,Correspondence: Kai Chen Mingyuan Yang
| | - Kai Chen
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, China,Correspondence: Kai Chen Mingyuan Yang
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Marturello DM, James JC, Perry KL, Déjardin LM. Accuracy of anatomic 3-dimensionally printed canine humeral models. Vet Surg 2023; 52:116-126. [PMID: 36134757 DOI: 10.1111/vsu.13899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/19/2022] [Accepted: 09/05/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the accuracy of various three-dimensional print (3DP) technologies using morphometric measurements. STUDY DESIGN Experimental. SAMPLE POPULATION Cadaveric canine humeri and size-matched 3DP models. METHODS Fiduciary radiopaque markers were affixed to canine humeri of three different sizes (4, 13, 29 kg) at predetermined anatomical landmarks. 3DP models were created using one of three printers; desktop printers Form 3L and Ultimaker 5S, and industrial printer Objet Connex (n = 5/group/printer). Marker based morphometric dimensions between cadavers and 3DP models were statistically compared using 2-factor repeated measures ANOVA followed by Tukey's post-hoc test (p < .05). RESULTS Bone size and printer type both significantly affected 3DP accuracy, with size having the larger effect (p < .0001 and p < .02, respectively). Regardless of printing technology, model size was smaller than native bone in most cases. At the humeral condylar level, the best accuracy was seen in the medium-sized humerus with the Ultimaker printer ([0.09 mm], p < .03). Accuracy was reduced in the proximal humerus in all groups. CONCLUSION Desktop printers were overall more accurate than the industrial printer. Although significant differences were identified between models of different sizes, the submillimetric magnitude of these differences is unlikely to be clinically relevant. CLINICAL SIGNIFICANCE While preoperative planning using 3DP models is becoming mainstream, accurate representation of the actual bone is critical. This study demonstrates that common desktop printers are suitable for this purpose.
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Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Jordan C James
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Karen L Perry
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
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Properties and Implementation of 3-Dimensionally Printed Models in Spine Surgery: A Mixed-Methods Review With Meta-Analysis. World Neurosurg 2023; 169:57-72. [PMID: 36309334 DOI: 10.1016/j.wneu.2022.10.083] [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: 09/09/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spine surgery addresses a wide range of spinal pathologies. Potential applications of 3-dimensional (3D) printed in spine surgery are broad, encompassing education, planning, and simulation. The objective of this study was to explore how 3D-printed spine models are implemented in spine surgery and their clinical applications. METHODS Methods were combined to create a scoping review with meta-analyses. PubMed, EMBASE, the Cochrane Library, and Scopus databases were searched from 2011 to 7 September 2021. Results were screened independently by 2 reviewers. Studies utilizing 3D-printed spine models in spine surgery were included. Articles describing drill guides, implants, or nonoriginal research were excluded. Data were extracted according to reporting guidelines in relation to study information, use of model, 3D printer and printing material, design features of the model, and clinical use/patient-related outcomes. Meta-analyses were performed using random-effects models. RESULTS Forty articles were included in the review, 3 of which were included in the meta-analysis. Primary use of the spine models included preoperative planning, education, and simulation. Six printing technologies were utilized. A range of substrates were used to recreate the spine and regional pathology. Models used for preoperative and intraoperative planning showed reductions in key surgical performance indicators. Generally, feedback for the tactility, utility, and education use of models was favorable. CONCLUSIONS Replicating realistic spine models for operative planning, education, and training is invaluable in a subspeciality where mistakes can have devastating repercussions. Future study should evaluate the cost-effectiveness and the impact spine models have of spine surgery outcomes.
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OKADA R, SAKAI T, NISHISHO T, NITTA A, TAKAHARA S, OBA K, SAIRYO K. Preoperative Planning Using Three-dimensional Printing for Full-endoscopic Spine Surgery: A Technical Note. NMC Case Rep J 2022; 9:249-253. [PMID: 36128054 PMCID: PMC9458159 DOI: 10.2176/jns-nmc.2022-0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Transforaminal full-endoscopic spine surgery (TF-FESS) is a novel minimally invasive spine surgery that requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. To perform TF-FESS safely and efficiently, preoperative planning is quite important as the intervention requires anatomical understanding and high technical skills. Recently, three-dimensional (3D) printing has become a useful tool in various surgeries, and several studies have addressed its efficacy; however, there are no reports on the application of 3D printing to FESS. In this study, we present two cases of severe lumbar deformities for which preoperative 3D printing was useful. The 3D printing enabled the surgeons to visualize and plan the drilling of the superior articular process for a successful foraminoplasty at a low cost. The manufacturing equipment cost about USD 900 and is able to produce an actual-size model at a cost of less than USD 10 per patient. In conclusion, preoperative planning using 3D printing should be adopted to safely perform FESS.
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Affiliation(s)
- Ryo OKADA
- Tokushima Prefectural Miyoshi Hospital
| | - Toshinori SAKAI
- Department of Orthopedics, Tokushima University Graduate School
| | | | | | | | | | - Koichi SAIRYO
- Department of Orthopedics, Tokushima University Graduate School
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Caruso JP, Kafka BR, Traylor JI, Wilson RA, El Ahmadieh T, Nassif RB, Caldwell C, Palmisciano P, Al Tamimi M, Olson DM, Dahdaleh NS, Bagley CA, Aoun SG. Applying 3-Dimensional Printing and Modeling for Preoperative Reconstruction and Instrumentation Placement Planning in Complex Deformity Surgery. Oper Neurosurg (Hagerstown) 2022; 23:514-522. [DOI: 10.1227/ons.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
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21
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Patient-specific 3D printing to replace components of a rib-to pelvis “Eiffel Tower” vertebral expanding prosthetic titanium rib system in an infant: a case report. EUROPEAN SPINE JOURNAL 2022:10.1007/s00586-022-07460-z. [DOI: 10.1007/s00586-022-07460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/18/2022] [Accepted: 11/07/2022] [Indexed: 11/28/2022]
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Application of Image-Fusion 3D Printing Model in Total En Bloc Spondylectomy for Spinal Malignant Tumors. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7907191. [PMID: 36090453 PMCID: PMC9453004 DOI: 10.1155/2022/7907191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
Purpose To examine the effects of 3D printing model in total en bloc spondylectomy (TES). Methods We performed a retrospective chart review of 41 cases of spinal tumors at our institution between 2017 and 2020, in which TES was applied. There were 19 cases with 3D printing model and 22 cases without 3D printing model. Operation time, intraoperative blood loss, excision range, complications, VAS, and ASIA grades were recorded. Statistical methods were used to analyze the data. KaplanMeier survival curve was made to evaluate the survival. Result There were significant differences in intraoperative blood loss between the two groups. The rate of R0 resection and tumor envelope preservation were higher in 3D group than that in non-3D group. In 3D group, the complications included surgical site infection (5.2%) and cerebrospinal fluid leak (15.7%). In non-3D group, the complications included cerebrospinal fluid leak (27.3%) and nerve root injury (13.6%). The pain and neurological dysfunction were significantly relieved before and after surgery in 3D group. However, the neurological relief in non-3D group patients was not complete. The VAS scores of non-3D group at 6 months after surgery were much higher than that of 3D group. Conclusion The application of 3D printing model not only helps surgeons observe the morphology, invasion range, and anatomic relationship of the tumor preoperatively, but also assists surgeons to judge, locate, and separate the tumor intraoperatively. For spinal malignancies, the 3D printing model is worth promoting.
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Park CK. 3D-Printed Disease Models for Neurosurgical Planning, Simulation, and Training. J Korean Neurosurg Soc 2022; 65:489-498. [PMID: 35762226 PMCID: PMC9271812 DOI: 10.3340/jkns.2021.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022] Open
Abstract
Spatial insight into intracranial pathology and structure is important for neurosurgeons to perform safe and successful surgeries. Three-dimensional (3D) printing technology in the medical field has made it possible to produce intuitive models that can help with spatial perception. Recent advances in 3D-printed disease models have removed barriers to entering the clinical field and medical market, such as precision and texture reality, speed of production, and cost. The 3D-printed disease model is now ready to be actively applied to daily clinical practice in neurosurgical planning, simulation, and training. In this review, the development of 3D-printed neurosurgical disease models and their application are summarized and discussed.
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Affiliation(s)
- Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:234-241. [PMID: 35875617 PMCID: PMC9263733 DOI: 10.21037/jss-22-28] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
Background Three-dimensional (3D) printed guides are finding increasing applications in the field of orthopaedic surgery and more recently spine surgery. This retrospective cohort study compares benefits and costs of 3D printed guides in surgical treatment of adolescent idiopathic scoliosis (AIS) compared to freehand techniques. Methods Intraoperative screw placement was conducted either with 3D printed guides (3D cohort) or traditional freehand technique (freehand cohort) for AIS patients undergoing spinal fusion at a single institution. Patient and perioperative data include: screw placement time, length of surgery, blood loss, hospital stay, spinal curvature correction, total implant costs and training level of surgical assist. Multivariate analysis assessed for confounding and effect modification. P-values <0.05 were considered significant. Results There were 29 patients included in analyses, 18 in the 3D and 11 in the freehand (FH) cohort, for a total of 263 3D and 307 freehand screws. Between cohorts, there were no significant differences in patient age (P=0.93), gender (P=0.15), height (P=0.18) or weight (P=0.40). The 3D cohort (mean $26,215, SD =$6,374) had significantly higher implant costs than FH (mean $18,660, SD =$5,587, P=0.003) with significantly reduced intraoperative blood loss (mean 559 mL, SD =273 FH; vs. mean 357 mL, SD =123 3D; P=0.01). On multivariate analysis, surgical residents had significantly faster screw placement times when using 3D guides (P<0.001) than when placing screws freehand. There were no significant differences between cohorts in length of postoperative hospitalization, spinal levels fused, or coronal or sagittal curve correction. Conclusions At significant cost, 3D printed guides reduce intraoperative blood loss compared to freehand pedicle screw placement and reduce screw placement time for surgical residents.
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Affiliation(s)
- William M. McLaughlin
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Claire A. Donnelley
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Kristin Yu
- Yale School of Medicine, New Haven, CT, USA
| | | | - Dominick A. Tuason
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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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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Guran O, Oflaz H, Gunal İ. NO SIGNIFICANT EFFECT OF 3D MODELLING ON SURGICAL PLANNING IN SPINAL DEFORMITIES. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e248982. [PMID: 35864829 PMCID: PMC9270047 DOI: 10.1590/1413-785220223001e248982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/13/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To evaluate the effect of 3d printed models on surgical pre-operative planning of complex spinal deformities. Methods: In our study, five orthopedic surgeons made surgical planning of 5 patients with severe spinal deformity in three conditions: X-ray with computer tomography (X-ray-CT), 3D-computed tomography (3dCT), and 3d printed spine models. Operation plans were examined according to the level and number of instrumentations, osteotomy level, and time required for decision-making. Results: X-ray-CT, 3dCT, and 3d modeling methods were compared, and no statistically significant difference was observed in the number of screws and osteotomy score to be used in operation. The time required for decision ranking is 3d Model, 3d CT, and Xray-CT. Conclusions: 3d printed models do not influence the operative plan significantly; however, it reduces surgical planning time at pre-op duration, and those models gave some opportunities to practice with implants on a patient’s 3d spine model. Level of Evidence III; Diagnostic Studies - Investigating a Diagnostic Test .
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Affiliation(s)
- Ortac Guran
- Sancaktepe Training and Research Hospital, Turkey
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Musser CG, Windsor RC, Wininger F. Corpectomy and spinal stabilization using a 3D-printed spine model and custom jigs to address severe spinal deformities from T9-11 and L2-4 in a 6-month-old German shepherd puppy. Clin Case Rep 2021; 9:e05229. [PMID: 34963810 PMCID: PMC8710705 DOI: 10.1002/ccr3.5229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/22/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022] Open
Abstract
This report describes surgical decompression and stabilization of 2 hemivertebrae in a German shepherd dog. Long-term clinical and imaging outcomes are documented. Spinal cord decompression via corpectomy improved neurological function and intrinsic spinal cord changes on MRI. The dog improved to have minimal paraparesis and an active lifestyle.
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Affiliation(s)
| | | | - Fred Wininger
- Charlotte Animal Referral and EmergencyCharlotteNorth CarolinaUSA
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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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Lopez CD, Boddapati V, Lee NJ, Dyrszka MD, Sardar ZM, Lehman RA, Lenke LG. Three-Dimensional Printing for Preoperative Planning and Pedicle Screw Placement in Adult Spinal Deformity: A Systematic Review. Global Spine J 2021; 11:936-949. [PMID: 32762378 PMCID: PMC8258819 DOI: 10.1177/2192568220944170] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES This current systematic review seeks to identify current applications and surgical outcomes for 3-dimensional printing (3DP) in the treatment of adult spinal deformity. METHODS A comprehensive search of publications was conducted through literature databases using relevant keywords. Inclusion criteria consisted of original studies, studies with patients with adult spinal deformities, and studies focusing on the feasibility and/or utility of 3DP technologies in the planning or treatment of scoliosis and other spinal deformities. Exclusion criteria included studies with patients without adult spinal deformity, animal subjects, pediatric patients, reviews, and editorials. RESULTS Studies evaluating the effect of 3DP drill guide templates found higher screw placement accuracy in the 3DP cohort (96.9%), compared with non-3DP cohorts (81.5%, P < .001). Operative duration was significant decreased in 3DP cases (378 patients, 258 minutes) relative to non-3DP cases (301 patients,272 minutes, P < .05). The average deformity correction rate was 72.5% in 3DP cases (245 patients). There was no significant difference in perioperative blood loss between 3DP (924.6 mL, 252 patients) and non-3DP cases (935.6 mL, 177 patients, P = .058). CONCLUSIONS Three-dimensional printing is currently used for presurgical planning, patient and trainee communication and education, pre- and intraoperative guides, and screw drill guides in the treatment of scoliosis and other adult spinal deformities. In adult spinal deformity, the usage of 3DP guides is associated with increased screw accuracy and favorable deformity correction outcomes; however, average costs and production lead time are highly variable between studies.
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Affiliation(s)
- Cesar D. Lopez
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Venkat Boddapati
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA,Venkat Boddapati, The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA.
| | - Nathan J. Lee
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Marc D. Dyrszka
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Zeeshan M. Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Ronald A. Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Lawrence G. Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
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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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Wang B, Feng C, Pan J, Zhou S, Sun Z, Shao Y, Qu Y, Bao S, Li Y, Yang T. The Effect of 3D Printing Metal Materials on Osteoporosis Treatment. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9972867. [PMID: 34239938 PMCID: PMC8233068 DOI: 10.1155/2021/9972867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/09/2021] [Indexed: 12/27/2022]
Abstract
3D printing has been in use for a long time and has continued to contribute to breakthroughs in the fields of clinical, physical, and rehabilitation medicine. In order to evaluate the role of 3D printing technology in treating spinal disorders, this paper presents a systematic review of the relevant literature. 3D printing is described in terms of its adjunctive function in various stages of spinal surgery and assistance in osteoporosis treatment. A review of metal 3D printed materials and applications of the technology is also provided.
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Affiliation(s)
- Bing Wang
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
| | - Chuwen Feng
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin 8615-0040, China
| | - Jianyu Pan
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
| | - Shuoyan Zhou
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
| | - Zhongren Sun
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
| | - Yuming Shao
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
| | - Yuanyuan Qu
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
| | - Shengyong Bao
- Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Department of Rehabilitation Medicine, Shenzhen 518120, China
| | - Yang Li
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin 8615-0040, China
| | - Tiansong Yang
- Heilongjiang University of Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin 8615-0040, China
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin 8615-0040, China
- Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Department of Rehabilitation Medicine, Shenzhen 518120, China
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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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Liang W, Han B, Hai JJ, Hai Y, Chen L, Kang N, Yin P. 3D-printed drill guide template, a promising tool to improve pedicle screw placement accuracy in spinal deformity surgery: A systematic review and meta-analysis. 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; 30:1173-1183. [PMID: 33558972 DOI: 10.1007/s00586-021-06739-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/22/2020] [Accepted: 01/17/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to compare the pedicle screw placement accuracy and surgical outcomes between 3D-printed (3DP) drill guide template technique and freehand technique in spinal deformity surgery. METHODS A comprehensive systematic literature search of databases (PubMed, Embase, Cochrane Library, and Web of Science) was conducted. The meta-analysis compared the pedicle screw placement accuracy and other important surgical outcomes between the two techniques. RESULTS A total of seven studies were included in the meta-analysis, comprising 87 patients with 1384 pedicle screws placed by 3DP drill guide templates and 88 patients with 1392 pedicle screws placed by freehand technique. The meta-analysis results revealed that the 3DP template technique was significantly more accurate than the freehand technique to place pedicle screws and had a higher rate of excellently placed screws (OR 2.22, P < 0.001) and qualifiedly placed screws (OR 3.66, P < 0.001), and a lower rate of poorly placed screws (OR 0.23, P < 0.001). The mean placement time per screw (WMD-1.99, P < 0.05), total screw placement time (WMD-27.86, P < 0.001), and blood loss (WMD-104.58, P < 0.05) were significantly reduced in the 3DP template group compared with the freehand group. Moreover, there was no significant statistical difference between the two techniques in terms of the operation time and correction rate of main bend curve. CONCLUSIONS This study demonstrated that the 3DP drill guide template was a promising tool for assisting the pedicle screw placement in spinal deformity surgery and deserved further promotion.
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Affiliation(s)
- Weishi Liang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Bo Han
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Junrui Jonathan Hai
- Junior High School, The High School Affiliated to Renmin University of China, Beijing, 100080, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Long Chen
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Nan Kang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Peng Yin
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
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Kaya I, Cingöz ID, Şahin MC, Bozoğlan E. Investigation of the Effects of Three-Dimensional Modeling Techniques on Degenerative Rotoscoliosis Surgery. Cureus 2021; 13:e13075. [PMID: 33643748 PMCID: PMC7885741 DOI: 10.7759/cureus.13075] [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] [Accepted: 02/02/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives The present study aimed to compare patients in whom an operation plan was prepared before surgery using the three-dimensional (3D) modeling technology with the application of freehand screws using magnetic resonance imaging (MRI) and computed tomography (CT) scan images. Methods The printings and modelings were established in the Training and Research Center. Of 40 patients, 20 underwent surgery with 3D printing (Group 1) and 20 with the freehand technique (Group 2). The surgeries were performed by the same surgeons. Moreover, 5-mm pedicle screws were located in 122 vertebrae in 20 patients in whom 3D modeling was used and in 124 vertebrae in 20 patients in whom this modeling technique was not used. Results The mean time of screw insertion was 2.9 ± 1.2 minutes in the experimental group and 4.7 ± 2.3 minutes in the control group. While the mean amount of bleeding was 7.4 ± 4.1 ml in the experimental group, it was found to be 39.6 ± 14.2 ml in the control group. When the locations of the screws in the experimental group were evaluated, it was seen that 106 (86.9%) screws were 'excellent' and 16 (13.1%) screws were 'good.' When the placement of 124 pedicle screws in the control group was evaluated, it was found that 100 (80.6%) screws were 'excellent,' 20 (17.8%) screws were 'good,' and two (1.6%) screws were 'poor.' Conclusion The use of the improved 3D technology in the neurosurgery field is advantageous for surgeons, as it decreases the preoperative preparation phase, length of operation, and risk of complications.
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Affiliation(s)
- Ismail Kaya
- Neurosurgery, Kutahya Health Sciences University, Kutahya, TUR
| | | | | | - Emirhan Bozoğlan
- Bioengineering, Kutahya Health Sciences University, Kutahya, TUR
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Francoisse CA, Sescleifer AM, King WT, Lin AY. Three-dimensional printing in medicine: a systematic review of pediatric applications. Pediatr Res 2021; 89:415-425. [PMID: 32503028 DOI: 10.1038/s41390-020-0991-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Three-dimensional printing (3DP) addresses distinct clinical challenges in pediatric care including: congenital variants, compact anatomy, high procedural risk, and growth over time. We hypothesized that patient-specific applications of 3DP in pediatrics could be categorized into concise, discrete categories of use. METHODS Terms related to "three-dimensional printing" and "pediatrics" were searched on PubMed, Scopus, Ovid MEDLINE, Cochrane CENTRAL, and Web of Science. Initial search yielded 2122 unique articles; 139 articles characterizing 508 patients met full inclusion criteria. RESULTS Four categories of patient-specific 3DP applications were identified: Teaching of families and medical staff (9.3%); Developing intervention strategies (33.9%); Procedural applications, including subtypes: contour models, guides, splints, and implants (43.0%); and Material manufacturing of shaping devices or prosthetics (14.0%). Procedural comparative studies found 3DP devices to be equivalent or better than conventional methods, with less operating time and fewer complications. CONCLUSION Patient-specific applications of Three-Dimensional Printing in Medicine can be elegantly classified into four major categories: Teaching, Developing, Procedures, and Materials, sharing the same TDPM acronym. Understanding this schema is important because it promotes further innovation and increased implementation of these devices to improve pediatric care. IMPACT This article classifies the pediatric applications of patient-specific three-dimensional printing. This is a first comprehensive review of patient-specific three-dimensional printing in both pediatric medical and surgical disciplines, incorporating previously described classification schema to create one unifying paradigm. Understanding these applications is important since three-dimensional printing addresses challenges that are uniquely pediatric including compact anatomy, unique congenital variants, greater procedural risk, and growth over time. We identified four classifications of patient-specific use: teaching, developing, procedural, and material uses. By classifying these applications, this review promotes understanding and incorporation of this expanding technology to improve the pediatric care.
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Affiliation(s)
- Caitlin A Francoisse
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Anne M Sescleifer
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Wilson T King
- Division of Pediatric Cardiology, Saint Louis University School of Medicine, St. Louis, MO, USA.,SSM Health Cardinal Glennon Children's Hospital at SLU, St. Louis, MO, USA
| | - Alexander Y Lin
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA. .,SSM Health Cardinal Glennon Children's Hospital at SLU, St. Louis, MO, USA.
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Chaudhary B, Anand U, Kumari V, Agrawal P, Kumar P, Priyadarshi R. Feasibility and adaptation of three-dimensional model for surgical planning and training: A pilot study. NATIONAL JOURNAL OF CLINICAL ANATOMY 2021. [DOI: 10.4103/2277-4025.329493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Xu HT, Zheng S, Dong RP, Yu T, Zhao JW. Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion: A case report. Medicine (Baltimore) 2020; 99:e21838. [PMID: 33120726 PMCID: PMC7581057 DOI: 10.1097/md.0000000000021838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE The misplaced cervical screw can cause catastrophic surgical complications, such as nerve root damage, vertebral artery compromise, spinal cord injury, and even paraplegia. Thus, the present study aims to describe a novel technique of 3-dimensional printing model (3DPM) combined with 3-dimensional fluoroscopic navigation (3DFN) to facilitate C2 pedicle screw insertion. PATIENT CONCERNS A 56-year-old male patient presented hypoesthesia of the trunk and extremities, accompanied by a walking disorder. DIAGNOSES Congenital atlantoaxial malformation with atlantoaxial dislocation. INTERVENTIONS He underwent an occipital cervical fusion. We used 3DPM and 3DFN technology to guide C2 pedicle screws insertion. OUTCOMES We inserted 2 pedicle screws and 4 lateral mass screws using the combined 3DPM and 3DFN technology. All screws were classified as excellent position postoperatively. The surgical duration, total fluoroscopic time, and the bleeding volume were 258 minutes, 3.9 minutes, and 237 mL, respectively. No surgical complications, such as neurological compromise, nonunion, dysphagia, infection, polypnea, fixation failure, pseudarthrosis formation, or revision surgery, were observed. The follow-up duration lasted 30 months. LESSONS The combination of 3DPM and 3DFN to promote C2 pedicle screws implantation is a safe, accurate, reliable, and useful technology, which can achieve an excellent therapeutic effect and avoid surgical complications. However, using the 3DPM and 3DFN technology may increase the financial burden of patients.
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Senkoylu A, Cetinkaya M, Daldal I, Necefov E, Eren A, Samartzis D. Personalized Three-Dimensional Printing Pedicle Screw Guide Innovation for the Surgical Management of Patients with Adolescent Idiopathic Scoliosis. World Neurosurg 2020; 144:e513-e522. [PMID: 32891830 DOI: 10.1016/j.wneu.2020.08.212] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/29/2020] [Accepted: 08/29/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of patient-specific three-dimensional (3D) rapid-prototype printing technology for pedicle screw insertion in patients with adolescent idiopathic scoliosis (AIS). METHODS The 3D pedicle screw guides were produced after selecting the fixation points for all individual levels to be used intraoperatively. Preoperative computed tomography images recreated 3D bone models of each vertebra specific to each patient. Safe pedicle trajectories were determined in all 3 planes on these models. 3D printed guides were modeled according to these trajectories and manufactured with a biocompatible material. Postoperatively, all screws were evaluated and scored with computed tomography as class 1 (accurate), class 2 (inaccurate), or class 3 (deviated). The mean angle between the inserted pedicle screw and the intended trajectory, and the mean distance between the central longitudinal axis of a screw and pedicle were also measured. RESULTS A total of 134 screws were inserted. On the concave and convex sides, the mean medial malposition was 0.5 ± 0.8 and 0.4 ± 0.6 mm, the mean lateral malposition was 1.4 ± 2.3 and 0.8 ± 1.3 mm, angle between the inserted pedicle screw and the intended trajectory was 4.2 ± 4.6 and 4.3° ± 6.0°, and distance between the central longitudinal axis of a screw and pedicle was 1.5 ± 2.1 and 0.9 ± 1.2 mm, respectively. A total of 117 screws were regarded as class 1, 14 as class 2, and 3 as class 3. Of all screws inserted, 92.5% achieved positional accuracy. There were no screw-related complications. CONCLUSIONS This is one of the initial reports to note the novel design and implementation of patient-specific 3D pedicle screw guides for adolescent idiopathic scoliosis surgery. Our pilot study shows that the use of these low-cost personalized 3D guides is completely safe and effective in both convex and concave sides of the curves.
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Affiliation(s)
- Alpaslan Senkoylu
- Gazi University School of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey.
| | - Mehmet Cetinkaya
- Stellenbosch University Faculty of Medicine and Health Sciences, Department of Orthopaedics, Spinal Unit, Western Cape, South Africa
| | - Ismail Daldal
- Lokman Hekim University, Akay Hospital, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Elsan Necefov
- Nakhchivan Government Hospital, Department of Orthopaedics and Traumatology, Nakhchivan, Azerbaijan
| | - Ali Eren
- Gumushane Kelkit Government Hospital, Department of Orthopaedics and Traumatology, Gumushane, Turkey
| | - Dino Samartzis
- Rush University Department of Orthopaedic Surgery, Department of Orthopaedic Surgery, Chicago, Illinois, USA
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Ballard DH, Mills P, Duszak R, Weisman JA, Rybicki FJ, Woodard PK. Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides. Acad Radiol 2020; 27:1103-1113. [PMID: 31542197 DOI: 10.1016/j.acra.2019.08.011] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVE Three-dimensional (3D) printed anatomic models and surgical guides have been shown to reduce operative time. The purpose of this study was to generate an economic analysis of the cost-saving potential of 3D printed anatomic models and surgical guides in orthopedic and maxillofacial surgical applications. MATERIALS AND METHODS A targeted literature search identified operating room cost-per-minute and studies that quantified time saved using 3D printed constructs. Studies that reported operative time differences due to 3D printed anatomic models or surgical guides were reviewed and cataloged. A mean of $62 per operating room minute (range of $22-$133 per minute) was used as the reference standard for operating room time cost. Different financial scenarios were modeled with the provided cost-per-minute of operating room time (using high, mean, and low values) and mean time saved using 3D printed constructs. RESULTS Seven studies using 3D printed anatomic models in surgical care demonstrated a mean 62 minutes ($3720/case saved from reduced time) of time saved, and 25 studies of 3D printed surgical guides demonstrated a mean 23 minutes time saved ($1488/case saved from reduced time). An estimated 63 models or guides per year (or 1.2/week) were predicted to be the minimum number to breakeven and account for annual fixed costs. CONCLUSION Based on the literature-based financial analyses, medical 3D printing appears to reduce operating room costs secondary to shortening procedure times. While resource-intensive, 3D printed constructs used in patients' operative care provides considerable downstream value to health systems.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffery A Weisman
- University of Illinois at Chicago Occupational Medicine, Chicago, Illinois
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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Campana V, Cardona V, Vismara V, Monteleone AS, Piazza P, Messinese P, Mocini F, Sircana G, Maccauro G, Saccomanno MF. 3D printing in shoulder surgery. Orthop Rev (Pavia) 2020; 12:8681. [PMID: 32913609 PMCID: PMC7459384 DOI: 10.4081/or.2020.8681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 10/25/2022] Open
Abstract
Three-dimensional (3D) printing is a novel modality with the potential to make a huge impact in the surgical field. The aim of this paper is to provide an overview on the current use of 3D printing in shoulder surgery. We have reviewed the use of this new method in 3 fields of shoulder surgery: shoulder arthroplasty, recurrent shoulder instability and orthopedic shoulder traumatology. In shoulder arthroplasty, several authors have shown that the use of the 3D printer improves the positioning of the glenoid component, even if longer clinical follow-up is needed to determine whether the cost of this system rationalizes the potential improved functional outcomes and decreases glenoid revision rates. In the treatment of anterior shoulder instability, the literature agrees on the fact that the use of the 3D printing can: enhance the dept and size of bony lesions, allowing a patient tailored surgical planning and potentially reducing operative times; allow the production of personalized implants to restore substantial bone loss; restore glenohumeral morphology and instability. In orthopedic trauma, the use of 3D printing can be helpful to increase the understanding of fracture patterns, facilitating a more personalized planning, and can be used for resident training and education. We can conclude the current literature regarding the use of 3D printed models in orthopedic surgery agrees finding objective improvements to preoperative planning and to the surgical procedure itself, by shortening the intraoperative time and by the possibility to develop custom-made, patient-specific surgical instruments, and it suggests that there are tangible benefits for its implementation.
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Affiliation(s)
- Vincenzo Campana
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Valentina Cardona
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Valeria Vismara
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | | | - Piero Piazza
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Piermarco Messinese
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Fabrizio Mocini
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giuseppe Sircana
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giulio Maccauro
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
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Li H, Fan W, Zhu X. Three‐dimensional printing: The potential technology widely used in medical fields. J Biomed Mater Res A 2020; 108:2217-2229. [DOI: 10.1002/jbm.a.36979] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hongjian Li
- Southern Marine Science and Engineering Guangdong Laboratory ZhanjiangMarine Medical Research Institute of Guangdong Zhanjiang (GDZJMMRI), Guangdong Medical University Zhanjiang China
| | - Wenguo Fan
- Department of Anesthesiology, Guanghua School of StomatologyHospital of Stomatology, Sun Yat‐sen University Guangzhou China
| | - Xiao Zhu
- Southern Marine Science and Engineering Guangdong Laboratory ZhanjiangMarine Medical Research Institute of Guangdong Zhanjiang (GDZJMMRI), Guangdong Medical University Zhanjiang China
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Overview of Minimally Invasive Spine Surgery. World Neurosurg 2020; 142:43-56. [PMID: 32544619 DOI: 10.1016/j.wneu.2020.06.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/21/2022]
Abstract
Minimally invasive spine surgery (MISS) has continued to evolve over the past few decades, with significant advancements in technology and technical skills. From endonasal cervical approaches to extreme lateral lumbar interbody fusions, MISS has showcased its usefulness across all practice areas of the spine, with unique points of access to avoid pertinent neurovascular structures. Adult spine deformity has also recognized the importance of minimally invasive techniques in its ability to limit complications and to provide adequate sagittal alignment correction and improvements in patients' functional status. Although MISS has continued to make significant progress clinically, consideration must also be given to its economic impact and the learning curve surgeons experience in adding these procedures to their armamentarium. This review examines current innovations in MISS, as well as the economic impact and future directions of the field.
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Serrano C, Fontenay S, van den Brink H, Pineau J, Prognon P, Martelli N. Evaluation of 3D printing costs in surgery: a systematic review. Int J Technol Assess Health Care 2020; 36:1-7. [PMID: 32489157 DOI: 10.1017/s0266462320000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The use of three-dimensional (3D) printing in surgery is expanding and there is a focus on comprehensively evaluating the clinical impact of this technology. However, although additional costs are one of the main limitations to its use, little is known about its economic impact. The purpose of this systematic review is to identify the costs associated with its use and highlight the first quantitative data available. METHODS A systematic literature review was conducted in the PubMed and Embase databases and in the National Health Service Economic Evaluation Database (NHS EED) at the University of York. Studies that reported an assessment of the costs associated with the use of 3D printing for surgical application and published between 2009 and 2019, in English or French, were included. RESULTS Nine studies were included in our review. Nine types of costs were identified, the three main ones being printing material costs (n = 6), staff costs (n = 3), and operating room costs (n = 3). The printing cost ranged from less than U.S. dollars (USD) 1 to USD 146 (in USD 2019 values) depending on the criteria used to calculate this cost. Three studies evaluated the potential savings generated by the use of 3D printing technology in surgery, based on operating time reduction. CONCLUSION This literature review highlights the lack of reliable economic data on 3D printing technology. Nevertheless, this review makes it possible to identify expenditures or items that should be considered in order to carry out more robust studies.
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Affiliation(s)
- Carole Serrano
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
| | - Sarah Fontenay
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Hélène van den Brink
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
| | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Nicolas Martelli
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
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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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The Accuracy of 3D Printing Assistance in the Spinal Deformity Surgery. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7196528. [PMID: 31828123 PMCID: PMC6885147 DOI: 10.1155/2019/7196528] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/21/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
Background The pedicle screw is one of the main tools used in spinal deformity correction surgery. Robotic and navigated surgeries are usually used, and they provide superior accuracy in pedicle screw placement than free-hand and fluoroscopy-guided techniques. However, their high cost and space limitation are problematic. We provide a new solution using 3D printing technology to facilitate spinal deformity surgery. Methods A workflow was developed to assist spinal deformity surgery using 3D printing technology. The trajectory and profile of pedicle screws were determined on the image system by the surgical team. The engineering team designed drill templates based on the bony surface anatomy and the trajectory of pedicle screws. Their effectiveness and safety were evaluated during a preoperative simulation surgery. The surgery consisted in making a pilot hole through the drill template on a computed tomography- (CT-) based, full-scale 3D spine model for every planned segment. Somatosensory evoke potential (SSEP) and motor evoke potential (MEP) were used for intraoperative neurophysiological monitoring. Postoperative CT was obtained 6 months after the correction surgery to confirm the screw accuracy. Results From July 2015 to November 2016, we performed 10 spinal deformity surgeries with 3D printing technology assistance. In total, 173 pedicle screws were implanted using drill templates. No notable change in SSEP and MEP or neurologic deficit was noted. Based on postoperative CT scans, the acceptable rate was 97.1% (168/173). We recorded twelve pedicle screws with medial breach, six with lateral breach, and five with inferior breach. Medial breach (12/23) was the main type of penetration. Lateral breach occurred mostly in the concave side (5/6). Most penetrations occurred above the T8 level (69.6%, 16/23). Conclusion 3D printing technology provides an effective alternative for spinal deformity surgery when expensive medical equipment, such as intraoperative navigation and robotic systems, is unavailable.
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Jiang M, Chen G, Coles‐Black J, Chuen J, Hardidge A. Three‐dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review. ANZ J Surg 2019; 90:243-250. [DOI: 10.1111/ans.15549] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Michael Jiang
- 3DMedLab, Austin HealthThe University of Melbourne Melbourne Victoria Australia
- Department of Orthopaedic SurgeryAustin Health Melbourne Victoria Australia
| | - Gordon Chen
- 3DMedLab, Austin HealthThe University of Melbourne Melbourne Victoria Australia
| | - Jasamine Coles‐Black
- 3DMedLab, Austin HealthThe University of Melbourne Melbourne Victoria Australia
- Department of SurgeryThe University of Melbourne Melbourne Victoria Australia
- Department of Vascular SurgeryAustin Health Melbourne Victoria Australia
| | - Jason Chuen
- 3DMedLab, Austin HealthThe University of Melbourne Melbourne Victoria Australia
- Department of SurgeryThe University of Melbourne Melbourne Victoria Australia
- Department of Vascular SurgeryAustin Health Melbourne Victoria Australia
| | - Andrew Hardidge
- Department of Orthopaedic SurgeryAustin Health Melbourne Victoria Australia
- Department of SurgeryThe University of Melbourne Melbourne Victoria 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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CORR Insights®: Does Three-dimensional Printing Plus Pedicle Guider Technology in Severe Congenital Scoliosis Facilitate Accurate and Efficient Pedicle Screw Placement? Clin Orthop Relat Res 2019; 477:1913-1914. [PMID: 31169623 PMCID: PMC7000006 DOI: 10.1097/corr.0000000000000835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Development of a Patient-specific Guide for High Cervical Spine Fixation. Rev Bras Ortop 2019; 54:20-25. [PMID: 31363238 PMCID: PMC6424808 DOI: 10.1016/j.rbo.2017.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022] Open
Abstract
Objective High cervical spine fixation represents a challenge for spine surgeons due to the complex anatomy and the risks of vascular and medullar injury. The recent advances in 3-D printing have unfolded a whole new range of options for these surgeons. Methods In the present study, a guide for the placement of the lateral mass screw in the C1 vertebra was developed using 3-D printing. Eight real-size models of the high cervical spine and their respective screw guides were built using computed tomography (CT) scan images. The guidewires were inserted with the help of the printed guides and then the models were analyzed with the help of CT scan images. Results All of the guidewires in the present study obtained a safe placement in the models, avoiding the superior and inferior articular surfaces, the vertebral foramen, and the vertebral artery. Conclusion The present study demonstrated the efficiency of the guide, a reliable tool for aiding the insertion of guidewires for screws in lateral masses of the C1.
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Does Three-dimensional Printing Plus Pedicle Guider Technology in Severe Congenital Scoliosis Facilitate Accurate and Efficient Pedicle Screw Placement? Clin Orthop Relat Res 2019; 477:1904-1912. [PMID: 31107327 PMCID: PMC6999999 DOI: 10.1097/corr.0000000000000739] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Three-dimensional (3-D) printing offers the opportunity to create patient-specific guides for pedicle screw placement based on CT-generated models. This technology might allow for more-accurate placement of pedicle screws in patients with severe congenital scoliosis who have rotated vertebrae and small pedicles, but to our knowledge, this premise has not been tested. QUESTIONS/PURPOSES (1) Is the use of 3-D printing and pedicle guider technology as or more accurate than the use of the freehand technique for pedicle-screw placement in patients with severe congenital scoliosis? (2) Does surgical time differ with the use of these guiders? (3) Are complications less common in patients treated with this new approach to pedicle-screw placement? METHODS A prospective controlled study was conducted of patients with severe congenital scoliosis (major curve ≥ 90°) from June 2016 to June 2018. During this period, we treated 93 patients with congenital scoliosis; 32 had severe scoliosis with a major curve ≥ 90°. The patients were divided into a pedicle guider group (n = 15) and a control group (n = 17) based on their willingness to use pedicle guider technology, which was considered a research technology. With the numbers available, there were no between-group differences in terms of age, sex, BMI, or parameters related to curve severity or flexibility, and all patients in both groups had severe curves. Preoperative and postoperative low-dose CT scans were performed in the two groups. In the pedicle guider group, custom software was used to design the pedicle guider, and a 3-D printer was used to print a physical spinal model and pedicle guiders. The pedicle guiders were tested on the surface of the physical spinal model before surgery to ensure proper fit, and then used to assist pedicle screw placement during surgery. A total of 244 screws were implanted with the help of 127 pedicle guiders (254 guiding tunnels) during surgery in the PG group. Five predesigned pedicle guiders were abandoned due to an unstable match, and the success rate of assisted screw placement using a pedicle guider was 96% (244 of 254). The freehand technique was used in the control group, which relied on anatomic localization to place pedicle screws. The accuracy of pedicle screw placement was evaluated with CT scans, which revealed whether screws had broken through the pedicle cortex. We compared the groups in terms of accuracy (defined as unanticipated breaches less than 2 mm), surgical time, time to place pedicle screws, and screw-related complications. RESULTS A higher proportion of the screws placed using pedicle guider technology were positioned accurately than were in the control group (93% [227 of 244] versus 78% [228 of 291]; odds ratio, 3.69 [95% CI, 2.09-6.50]; p<0.001). With pedicle guider use, operative time (296 ± 56 versus 360 ± 74; 95% CI, -111 to -17; p = 0.010), time to place all screws (92 ± 17 versus 118 ± 21; 95% CI, -39 to -12; p = 0.001), and mean time to place one screw (6 ± 1 versus 7 ± 1; 95% CI, -2 to 0; p = 0.011) decreased. One patient in the pedicle guider group and four in the control group experienced screw-related complications; the sample sizes and small number of complications precluded statistical comparisons. CONCLUSIONS In this small, preliminary study, we showed that the accuracy of the surgical technique using spinal 3-D printing combined with pedicle guider technology in patients with severe congenital scoliosis was higher than the accuracy of the freehand technique. In addition, the technique using pedicle guider technology appeared to shorten operative time. If these findings are confirmed in a larger study, pedicle guider technology may be helpful for situations in which intraoperative CT or O-arm navigation is not available. LEVEL OF EVIDENCE Level II, therapeutic study.
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