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Lewandrowski KU, Vira S, Elfar JC, Lorio MP. Advancements in Custom 3D-Printed Titanium Interbody Spinal Fusion Cages and Their Relevance in Personalized Spine Care. J Pers Med 2024; 14:809. [PMID: 39202002 PMCID: PMC11355268 DOI: 10.3390/jpm14080809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024] Open
Abstract
3D-printing technology has revolutionized spinal implant manufacturing, particularly in developing personalized and custom-fit titanium interbody fusion cages. These cages are pivotal in supporting inter-vertebral stability, promoting bone growth, and restoring spinal alignment. This article reviews the latest advancements in 3D-printed titanium interbody fusion cages, emphasizing their relevance in modern personalized surgical spine care protocols applied to common clinical scenarios. Furthermore, the authors review the various printing and post-printing processing technologies and discuss how engineering and design are deployed to tailor each type of implant to its patient-specific clinical application, highlighting how anatomical and biomechanical considerations impact their development and manufacturing processes to achieve optimum osteoinductive and osteoconductive properties. The article further examines the benefits of 3D printing, such as customizable geometry and porosity, that enhance osteointegration and mechanical compatibility, offering a leap forward in patient-specific solutions. The comparative analysis provided by the authors underscores the unique challenges and solutions in designing cervical, and lumbar spine implants, including load-bearing requirements and bioactivity with surrounding bony tissue to promote cell attachment. Additionally, the authors discuss the clinical outcomes associated with these implants, including the implications of improvements in surgical precision on patient outcomes. Lastly, they address strategies to overcome implementation challenges in healthcare facilities, which often resist new technology acquisitions due to perceived cost overruns and preconceived notions that hinder potential savings by providing customized surgical implants with the potential for lower complication and revision rates. This comprehensive review aims to provide insights into how modern 3D-printed titanium interbody fusion cages are made, explain quality standards, and how they may impact personalized surgical spine care.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, Division Personalized Pain Research and Education, Tucson, AZ 85712, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas Bogotá, Bogotá 111321, Colombia
| | - Shaleen Vira
- Orthopedic and Sports Medicine Institute, Banner-University Tucson Campus, 755 East McDowell Road, Floor 2, Phoenix, AZ 85006, USA;
| | - John C. Elfar
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ 85721, USA
| | - Morgan P. Lorio
- Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA;
- Orlando College of Osteopathic Medicine, Orlando, FL 34787, USA
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Nișcoveanu C, Refi D, Obada B, Dragosloveanu S, Scheau C, Baz RO. Beyond the Bony Fragment: A Review of Limbus Vertebra. Cureus 2024; 16:e60065. [PMID: 38746486 PMCID: PMC11093693 DOI: 10.7759/cureus.60065] [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] [Accepted: 05/09/2024] [Indexed: 05/16/2024] Open
Abstract
Vertebral limbus is a condition characterized by the intraspongious herniation of a portion of the nucleus pulposus. It is often asymptomatic, but it can sometimes cause nonspecific symptoms such as local pain and muscle spasm, or, in rare cases, radiculopathies, which is why it can be confused with vertebral fractures, spondyloarthropathies, infectious or tumoral processes. Early recognition of this pathology is preferable for a correct diagnosis and adequate treatment, the latter ranging from conservative approaches (such as personalized exercise programs and physical therapy) to surgical interventions reserved for severe cases with nerve compression.
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Affiliation(s)
- Cosmin Nișcoveanu
- Department of Radiology, Sf. Apostol Andrei County Hospital, Constanta, ROU
- Department of Radiology and Medical Imaging, Faculty of Medicine, Ovidius University, Constanta, ROU
| | - Deria Refi
- Department of Radiology, Sf. Apostol Andrei County Hospital, Constanta, ROU
| | - Bogdan Obada
- Department of Orthopaedics and Traumatology, Sf. Apostol Andrei County Hospital, Constanta, ROU
| | - Serban Dragosloveanu
- Department of Orthopaedics, Foisor Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, Bucharest, ROU
- Department of Orthopaedics and Traumatology, The Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Cristian Scheau
- Department of Radiology and Medical Imaging, Foisor Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, Bucharest, ROU
- Department of Physiology, The Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Radu Octavian Baz
- Department of Radiology, Sf. Apostol Andrei County Hospital, Constanta, ROU
- Department of Radiology and Medical Imaging, Faculty of Medicine, Ovidius University, Constanta, ROU
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Ermawan R, Corrigan H, Wiyono N. Current update and trend of 3D printing in spinal surgery: A bibliometric analysis and review of literature. J Orthop 2024; 50:22-28. [PMID: 38162258 PMCID: PMC10755500 DOI: 10.1016/j.jor.2023.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024] Open
Abstract
Incorporation of three-dimensional (3D) printing technology into the field of spinal surgery is on the rise. A bibliometric analysis of the current topic was carried out to elaborate the trend and to navigate future research. A Scopus database search was conducted with keywords related to 3D printing, spine, and surgery. The final 792 articles were extracted and further analyzed with VOSviewer 1.6.19 and Biblioshiny. The first published article was in 2002. A notable increase in articles in 2014 might be attributable to the availability of cheaper 3D printers which rose significantly on a global scale in 2011. China leads in terms of published research on 3D printing in spinal surgery, followed by the US, Australia, and India. The author's keyword co-occurrence analysis reveals 8 theme clusters, including preoperative and intraoperative measures, biomodelling, spinal neoplasms, biomechanics of 3D-printed materials, degenerative spinal diseases, minimally invasive surgery, and bioprinting. The top 15 of the most recently cited keywords are listed to provide future researchers to produce impactful articles. Two strategic diagrams of 2 periods (2002-2018 and 2018-2023) show the theme's evolution. We found 6 consistent themes in keyword co-occurrence analysis and the strategic diagram analysis, that are promising subjects for future research. Overall, this bibliographic study indicates the expanding importance of 3D printing in spinal surgery and suggests several critical themes and impactful keywords for future researchers.
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Affiliation(s)
- Rieva Ermawan
- Department of Orthopaedic and Traumatology Dr. Moewardi General Province Hospital, Surakarta, Indonesia
- Department of Orthopaedic, Faculty of Medicine Sebelas Maret University Surakarta, Central Java, Indonesia
| | - Hubertus Corrigan
- Department of Orthopaedic and Traumatology Dr. Moewardi General Province Hospital, Surakarta, Indonesia
- Department of Orthopaedic, Faculty of Medicine Sebelas Maret University Surakarta, Central Java, Indonesia
- Department of Anatomy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Nanang Wiyono
- Department of Anatomy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
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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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Martínez Quiñones JV, Orduna Martínez J, Pinilla Arias D, Bernal Lecina M, Consolini Rossi F, Arregui Calvo R. Systematic review of the utility and limits of 3D printing in spine surgery. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:30-40. [PMID: 37473871 DOI: 10.1016/j.neucie.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/18/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The main objective of this study has been to demonstrate why additive printing allows to make complex surgical pathological processes that affect the spine more visible and understandable, increasing precision, safety and reliability of the surgical procedure. METHODS A systematic review of the articles published in the last 10 years on 3D printing-assisted spinal surgery was carried out, in accordance with PRISMA 2020 declaration. Keywords "3D printing" and "spine surgery" were searched in Pubmed, Embase, Cochrane Database of Systematic Reviews, Google Scholar and Opengrey databases, which was completed with a manual search through the list of bibliographic references of the articles that were selected following the defined inclusion and exclusion criteria. RESULTS From the analysis of the 38 selected studies, it results that 3D printing is useful in surgical planning, medical teaching, doctor-patient relationship, design of navigation templates and spinal implants, and research, optimizing the surgical process by focusing on the patient, offering magnificent support during the surgical procedure. CONCLUSIONS The use of three-dimensional printing biomodels allows: making complex surgical pathological processes that affect the spine more visible and understandable; increase the accuracy, precision and safety of the surgical procedure, and open up the possibility of implementing personalized treatments, mainly in tumor surgery.
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Lin M, Paul R, Liao X, Doulgeris J, Menzer EL, Dhar UK, Tsai CT, Vrionis FD. A New Method to Evaluate Pressure Distribution Using a 3D-Printed C2-C3 Cervical Spine Model with an Embedded Sensor Array. SENSORS (BASEL, SWITZERLAND) 2023; 23:9547. [PMID: 38067922 PMCID: PMC10708625 DOI: 10.3390/s23239547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
Cervical degenerative disc diseases such as myelopathy and radiculopathy often require conventional treatments like artificial cervical disc replacement or anterior cervical discectomy and fusion (ACDF). When designing a medical device, like the stand-alone cage, there are many design inputs to consider. However, the precise biomechanics of the force between the vertebrae and implanted devices under certain conditions require further investigation. In this study, a new method was developed to evaluate the pressure between the vertebrae and implanted devices by embedding a sensor array into a 3D-printed C2-C3 cervical spine. The 3D-printed cervical spine model was subjected to a range of axial loads while under flexion, extension, bending and compression conditions. Cables were used for the application of a preload and a robotic arm was used to recreate the natural spine motions (flexion, extension, and bending). To verify and predict the total pressure between the vertebrae and the implanted devices, a 3D finite element (FE) numerical mathematical model was developed. A preload was represented by applying 22 N of force on each of the anterior tubercles for the C2 vertebra. The results of this study suggest that the sensor is useful in identifying static pressure. The pressure with the robot arm was verified from the FE results under all conditions. This study indicates that the sensor array has promising potential to reduce the trial and error with implants for various surgical procedures, including multi-level artificial cervical disk replacement and ACDF, which may help clinicians to reduce pain, suffering, and costly follow-up procedures.
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Affiliation(s)
- Maohua Lin
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (R.P.); (U.K.D.); (C.-T.T.)
| | - Rudy Paul
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (R.P.); (U.K.D.); (C.-T.T.)
| | - Xinqin Liao
- Department of Electronic Science, Xiamen University, Xiamen 361005, China;
| | - James Doulgeris
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (R.P.); (U.K.D.); (C.-T.T.)
| | - Emma Lilly Menzer
- Department of Biological Sciences, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Utpal Kanti Dhar
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (R.P.); (U.K.D.); (C.-T.T.)
| | - Chi-Tay Tsai
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (R.P.); (U.K.D.); (C.-T.T.)
| | - Frank D. Vrionis
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL 33486, 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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Kabra DA, Garg DB. Current applications of 3-dimensional printing in spine surgery. J Orthop 2023; 41:28-32. [PMID: 37287587 PMCID: PMC10241647 DOI: 10.1016/j.jor.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
Background Three-dimensional printing (3D Printing) has emerged as a new technology in the early part of the 21st century, with promising applications in various industries, including the medical field. Spine care is a complex sub-specialty that has shown rapid inculcation of 3D printing. This technology is being used in pre-operative planning, patient education, and simulations, as well as intra-operatively for assistance in the form of patient specific jigs for pedicle screw placement and as implantable material in the form of vertebral body substitutes and patient-specific interbody cages. Applications 3DP in spine care has broadened the scope of minimally invasive and spine deformity surgeries. It has also enabled the production of patient-specific implants for complex spinal malignancies and infections. The technology has been embraced by various government organizations, including the US-FDA, which has drafted guidelines for the medical use of 3DP. Drawbacks Despite these promising advances and results, there still exist some significant drawbacks to the universal application of 3D printing technology. One of the main limitations is the dearth of long-term data describing the advantages and drawbacks in its clinical use. The widespread adoption of 3D models in small-scale healthcare setups is impeded by significant factors such as the high cost associated with their production, the requirement for specialized human resources, and specific instrumentation. Conclusion As technological understanding increases, newer applications and innovations in spine care are expected to unravel in the near future. With the expected surge in 3DP applications in spine care, it is imperative for all spine surgeons to possess a rudimentary understanding of this technology. Although there are still limitations to its universal use, 3DP in spine care has shown promising results and has the potential to revolutionize the field of spine surgery.
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Affiliation(s)
- Dr Apoorva Kabra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Dr Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Fukushi R, Teramoto A, Yoshimoto M, Miyakoshi N, Kudo D, Emori M, Shimada Y, Yamashita T. How Much Experience is Required to Acquire the Skills to Independently Perform Spine Surgery? What Milestones are Needed for Successful Surgery? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:657-667. [PMID: 37404867 PMCID: PMC10315144 DOI: 10.2147/amep.s411047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
Purpose To assess the number of surgeries needed to acquire the necessary skills to perform spine surgery independently. Patients and Methods A questionnaire on 12 different spinal procedures was sent to orthopedic surgeons affiliated with the spine teams of orthopedic departments at either the Akita University or Sapporo Medical University. Participants were asked to identify whether they (A) could independently perform each procedure, (B) could perform each procedure with the assistance of a senior doctor, or (C) were unable to perform each procedure. Those whose response was (A) were asked how many surgeries were required to acquire the necessary skills. Those who responded to (B) or (C) were asked how many surgeries they believed were required to acquire the skills necessary to operate independently. Participants also responded to 10 questions on surgical training techniques and rated the usefulness of each method. Results A total of 55 spine surgeons responded to the questionnaire. Group A required significantly fewer surgeries in the following categories to become independent than required Group C: upper cervical spine surgery (7.3/19.3), anterior cervical decompression/fusion (6.7/28.8), posterior cervical decompression/fusion (9.5/27.3), lumbar discectomy (12.6/26.7), endoscopic lumbar discectomy (10.2/24.2), spinal tumor resection (6.5/37.2), and spinal kyphosis surgery (10.3/32.3). Over 80% of participants responded that the following were effective methods: "surgeries where a senior doctor is the main surgeon, and the respondent is the assistant and observer"; "surgeries where the respondent is the main surgeon, and a senior doctor is an assistant"; "self-study using surgery manuals, articles, and textbooks"; and "training through video surgery sessions". Conclusion Surgeons who do not perform specific procedures independently require more surgical experience than those who operate independently. Our results may help develop more efficient training methods for spine surgeons.
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Affiliation(s)
- Ryunosuke Fukushi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naohisa Miyakoshi
- Department of Orthopaedic Surgery, Akita University School, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopaedic Surgery, Akita University School, Akita, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoichi Shimada
- Department of Orthopaedic Surgery, Akita University School, Akita, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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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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Kabra A, Mehta N, Garg B. 3D printing in spine care: A review of current applications. J Clin Orthop Trauma 2022; 35:102044. [PMID: 36340962 PMCID: PMC9633990 DOI: 10.1016/j.jcot.2022.102044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/10/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022] Open
Abstract
3D printing (3DP) has been brought to medical use since the early part of this century- but it has been widely researched on and publicized only in the last few years. Amongst patients with spinal disorders, 3DP has been utilized in various facets of patient care. These include pre-operative aspects - such as patient education, resident training, pre-operative planning and simulations, intra-operative assistance in the form of customized jigs for pedicle screw insertion, patient specific interbody cages and vertebral body substitutes in complex malignancies and spinal infections. It has also been utilized in deformity surgeries and has opened new avenues in minimally invasive spine care. Guidelines have now been drafted by various organizations including the FDA with a prime focus on quality control measures applicable to this new technology. There has been a recent surge in publications supporting the use of 3DP in spinal disorders, reporting an improvement in various aspects of patient care. As the technology spreads out its wings further, more innovations and applications are expected to unfold in the coming years. Considering the rapid advances that 3DP has made, having a basic understanding of this technology is imperative for all spine surgeons. Despite promising preliminary results, there still exist a few pitfalls of the technology which have hindered the universal application of 3DP. Most importantly, there is a dearth of data related to long term outcomes supporting its clinical use. The prohibitive cost of 3D models, the specialized manpower it necessitates and the need for specific instrumentation are major deterrents to widespread use of this technology, particularly in small-scale healthcare setups. With further advancements in technology, the goal must be to make it more accurate and affordable to hospitals and patients so that the benefits of the technology can reach a wider patient population.
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Affiliation(s)
- Apoorva Kabra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Fitzgerald K, Bindra R, Canning S, Tansley G, Lloyd DG, Zheng M, Quinn A, Maharaj J, Perevoshchikova N, Saxby DJ. A human-centred design approach to hybrid manufacturing of a scapholunate interosseous ligament medical practice rig. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Cornejo J, Cornejo-Aguilar JA, Vargas M, Helguero CG, Milanezi de Andrade R, Torres-Montoya S, Asensio-Salazar J, Rivero Calle A, Martínez Santos J, Damon A, Quiñones-Hinojosa A, Quintero-Consuegra MD, Umaña JP, Gallo-Bernal S, Briceño M, Tripodi P, Sebastian R, Perales-Villarroel P, De la Cruz-Ku G, Mckenzie T, Arruarana VS, Ji J, Zuluaga L, Haehn DA, Paoli A, Villa JC, Martinez R, Gonzalez C, Grossmann RJ, Escalona G, Cinelli I, Russomano T. Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6797745. [PMID: 35372574 PMCID: PMC8970887 DOI: 10.1155/2022/6797745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.
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Affiliation(s)
- José Cornejo
- Facultad de Ingeniería, Universidad San Ignacio de Loyola, La Molina, Lima 15024, Peru
- Department of Medicine and Biology & Department of Physics and Engineering, Bioastronautics and Space Mechatronics Research Group, Lima 15024, Peru
| | | | | | | | - Rafhael Milanezi de Andrade
- Robotics and Biomechanics Laboratory, Department of Mechanical Engineering, Universidade Federal do Espírito Santo, Brazil
| | | | | | - Alvaro Rivero Calle
- Department of Oral and Maxillofacial Surgery, Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Martínez Santos
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Damon
- Department of Neurosurgery, Mayo Clinic, FL, USA
| | | | | | - Juan Pablo Umaña
- Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotá DC, Colombia
| | | | - Manolo Briceño
- Villamedic Group, Lima, Peru
- Clínica Internacional, Lima, Peru
| | | | - Raul Sebastian
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | | | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Peru
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jiakai Ji
- Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY, USA
| | - Laura Zuluaga
- Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | | | - Albit Paoli
- Howard University Hospital, Washington, DC, USA
| | | | | | - Cristians Gonzalez
- Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut of Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France
| | | | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ilaria Cinelli
- Aerospace Human Factors Association, Aerospace Medical Association, VA, USA
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Jackson TJ, Freedman BA, Morris JM, Currier BL, Nassr A. Cervical myelopathy in a patient with Klippel-Feil syndrome treated with a patient-specific custom cervical spine locking plate. Spinal Cord Ser Cases 2022; 8:6. [PMID: 35031606 PMCID: PMC8760332 DOI: 10.1038/s41394-022-00478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Klippel-Feil Syndrome is the congenital fusion of at least two cervical vertebrae. Often asymptomatic, though in rare cases it may lead to severe cervical spine deformity and neurologic injury. CASE PRESENTATION We report a case of a 48-year-old woman with a history of Klippel-Feil Syndrome and congenital scoliosis who developed progressive cervical myelopathy. She was surgically treated with anterior C5 corpectomy and arthrodesis. Pre-operative evaluation was facilitated by 3D printed models. The surgical decompression and spinal reconstruction was completed with the use of a patient-specific, custom-made cervical spine locking plate. DISCUSSION Pre-operative evaluation with 3D printing technology was useful in understanding the patient's complex curve pattern and in designing a patient specific implant. Custom designed implant is a reasonable option to treat cervical myelopathy associated with complex cervical deformity.
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Affiliation(s)
- Taylor J. Jackson
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Brett A. Freedman
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Jonathan M. Morris
- grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, Rochester, MN USA
| | - Bradford L. Currier
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Ahmad Nassr
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
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Shi H, Shan Y, Yu G, Lu Y, Kong H, Jiang X, Shen Z, Sun F. Application of three-dimensional reconstruction technology combined with three-dimensional printing in the treatment of pectus excavatum. Ann Thorac Med 2022; 17:173-179. [PMID: 35968400 PMCID: PMC9374120 DOI: 10.4103/atm.atm_506_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 11/04/2022] Open
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Lin M, Abd MA, Taing A, Tsai CT, Vrionis FD, Engeberg ED. Robotic Replica of a Human Spine Uses Soft Magnetic Sensor Array to Forecast Intervertebral Loads and Posture after Surgery. SENSORS (BASEL, SWITZERLAND) 2021; 22:s22010212. [PMID: 35009754 PMCID: PMC8749580 DOI: 10.3390/s22010212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 05/07/2023]
Abstract
Cervical disc implants are conventional surgical treatments for patients with degenerative disc disease, such as cervical myelopathy and radiculopathy. However, the surgeon still must determine the candidacy of cervical disc implants mainly from the findings of diagnostic imaging studies, which can sometimes lead to complications and implant failure. To help address these problems, a new approach was developed to enable surgeons to preview the post-operative effects of an artificial disc implant in a patient-specific fashion prior to surgery. To that end, a robotic replica of a person's spine was 3D printed, modified to include an artificial disc implant, and outfitted with a soft magnetic sensor array. The aims of this study are threefold: first, to evaluate the potential of a soft magnetic sensor array to detect the location and amplitude of applied loads; second, to use the soft magnetic sensor array in a 3D printed human spine replica to distinguish between five different robotically actuated postures; and third, to compare the efficacy of four different machine learning algorithms to classify the loads, amplitudes, and postures obtained from the first and second aims. Benchtop experiments showed that the soft magnetic sensor array was capable of precisely detecting the location and amplitude of forces, which were successfully classified by four different machine learning algorithms that were compared for their capabilities: Support Vector Machine (SVM), K-Nearest Neighbor (KNN), Random Forest (RF), and Artificial Neural Network (ANN). In particular, the RF and ANN algorithms were able to classify locations of loads applied 3.25 mm apart with 98.39% ± 1.50% and 98.05% ± 1.56% accuracies, respectively. Furthermore, the ANN had an accuracy of 94.46% ± 2.84% to classify the location that a 10 g load was applied. The artificial disc-implanted spine replica was subjected to flexion and extension by a robotic arm. Five different postures of the spine were successfully classified with 100% ± 0.0% accuracy with the ANN using the soft magnetic sensor array. All results indicated that the magnetic sensor array has promising potential to generate data prior to invasive surgeries that could be utilized to preoperatively assess the suitability of a particular intervention for specific patients and to potentially assist the postoperative care of people with cervical disc implants.
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Affiliation(s)
- Maohua Lin
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (M.A.A.); (C.-T.T.)
| | - Moaed A. Abd
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (M.A.A.); (C.-T.T.)
| | - Alex Taing
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22904, USA;
| | - Chi-Tay Tsai
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (M.A.A.); (C.-T.T.)
| | - Frank D. Vrionis
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL 33486, USA
- Correspondence: (F.D.V.); (E.D.E.)
| | - Erik D. Engeberg
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (M.A.A.); (C.-T.T.)
- Center for Complex Systems and Brain Sciences, Florida Atlantic University, Boca Raton, FL 33431, USA
- Correspondence: (F.D.V.); (E.D.E.)
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18
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Yang J, Ni P, Zhang L, Lu Z, Liu D, Mo F, Liu T. Clinical Application of a 3D-Printed Positioning Module and Navigation Template for Percutaneous Vertebroplasty. Surg Innov 2021; 29:760-768. [PMID: 34961370 DOI: 10.1177/15533506211062404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to evaluate a personalized 3D-printed percutaneous vertebroplasty positioning module and navigation template based on preoperative CT scan data that was designed to treat patients with vertebral compression fractures caused by osteoporosis. METHODS A total of 22 patients with vertebral compression fractures admitted to our hospital were included in the study. Positioning was performed with the new 3D-printed positioning module, and the navigation template was used for patients in the experimental group, and the traditional perspective method was used for patients in the control group. The experimental group consisted of 11 patients, 2 males and 9 females, with a mean age of 67.27 ± 11.86 years (range: 48 to 80 years), and the control group consisted of 11 patients, 3 males and 8 females, with a mean age of 74.27 ± 7.24 years (range: 63 to 89 years). The puncture positioning duration, number of intraoperative fluoroscopy sessions, and preoperative and postoperative visual analog scale (VAS) scores were statistically analyzed in both groups. RESULTS The experimental group had shorter puncture positioning durations and fewer intraoperative fluoroscopy sessions than the control group, and the differences were statistically significant (P < .05). There were no significant differences in age or preoperative or postoperative VAS scores between the two groups (P > .05). CONCLUSIONS The new 3D-printed vertebroplasty positioning module and navigation template shortened the operation time and reduced the number of intraoperative fluoroscopy sessions. It also reduced the difficulty in performing percutaneous vertebroplasty and influenced the learning curve of senior doctors learning this operation to a certain degree.
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Affiliation(s)
- Jing Yang
- Department of Orthopedics, 571957The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopedics, The Fifth Affiliated Hospital, 74790Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Penghui Ni
- Department of Orthopedics, The First People's Hospital of Jingmen City, Jingmen, Hubei, China
| | - Lina Zhang
- Department of Psychiatry, 571957The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhanxin Lu
- Department of Orthopedics, The Fifth Affiliated Hospital, 74790Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Dapeng Liu
- Department of Orthopedics, The Fifth Affiliated Hospital, 74790Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Fuhao Mo
- 528787College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan, China
| | - Tang Liu
- Department of Orthopedics, 571957The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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19
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Naghieh S, Lindberg G, Tamaddon M, Liu C. Biofabrication Strategies for Musculoskeletal Disorders: Evolution towards Clinical Applications. Bioengineering (Basel) 2021; 8:123. [PMID: 34562945 PMCID: PMC8466376 DOI: 10.3390/bioengineering8090123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Biofabrication has emerged as an attractive strategy to personalise medical care and provide new treatments for common organ damage or diseases. While it has made impactful headway in e.g., skin grafting, drug testing and cancer research purposes, its application to treat musculoskeletal tissue disorders in a clinical setting remains scarce. Albeit with several in vitro breakthroughs over the past decade, standard musculoskeletal treatments are still limited to palliative care or surgical interventions with limited long-term effects and biological functionality. To better understand this lack of translation, it is important to study connections between basic science challenges and developments with translational hurdles and evolving frameworks for this fully disruptive technology that is biofabrication. This review paper thus looks closely at the processing stage of biofabrication, specifically at the bioinks suitable for musculoskeletal tissue fabrication and their trends of usage. This includes underlying composite bioink strategies to address the shortfalls of sole biomaterials. We also review recent advances made to overcome long-standing challenges in the field of biofabrication, namely bioprinting of low-viscosity bioinks, controlled delivery of growth factors, and the fabrication of spatially graded biological and structural scaffolds to help biofabricate more clinically relevant constructs. We further explore the clinical application of biofabricated musculoskeletal structures, regulatory pathways, and challenges for clinical translation, while identifying the opportunities that currently lie closest to clinical translation. In this article, we consider the next era of biofabrication and the overarching challenges that need to be addressed to reach clinical relevance.
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Affiliation(s)
- Saman Naghieh
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada
| | - Gabriella Lindberg
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopaedic Surgery, University of Otago Christchurch, Christchurch 8011, New Zealand
- Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA
| | - Maryam Tamaddon
- Institute of Orthopaedic & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore HA7 4LP, UK
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore HA7 4LP, UK
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20
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Chytas D, Salmas M, Noussios G, Demesticha T, Skandalakis GP, Paraskevas G. Letter: Immersive 3-Dimensional Virtual Reality Modeling for Case-Specific Presurgical Discussions in Cerebrovascular Neurosurgery. Oper Neurosurg (Hagerstown) 2021; 20:E458-E459. [PMID: 33733658 DOI: 10.1093/ons/opab075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/24/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dimitrios Chytas
- Department of Anatomy National School of Public Health University of West Attica Athens, Greece
| | - Marios Salmas
- Department of Anatomy School of Medicine National and Kapodistrian University of Athens Athens, Greece
| | - George Noussios
- School of Physical Education and Sports Sciences of Serres Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Theano Demesticha
- Department of Anatomy School of Medicine National and Kapodistrian University of Athens Athens, Greece
| | - Georgios P Skandalakis
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York, USA
| | - Georgios Paraskevas
- Department of Anatomy and Surgical Anatomy Faculty of Medicine Aristotle University of Thessaloniki Thessaloniki, Greece
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21
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Amin T, Parr WC, Mobbs RJ. Opinion Piece: Patient-Specific Implants May Be the Next Big Thing in Spinal Surgery. J Pers Med 2021; 11:jpm11060498. [PMID: 34199467 PMCID: PMC8228233 DOI: 10.3390/jpm11060498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/08/2021] [Accepted: 05/30/2021] [Indexed: 12/13/2022] Open
Abstract
The emergence of 3D-Printing technologies and subsequent medical applications have allowed for the development of Patient-specific implants (PSIs). There have been increasing reports of PSI application to spinal surgery over the last 5 years, including throughout the spine and to a range of pathologies, though largely for complex cases. Through a number of potential benefits, including improvements to the implant–bone interface and surgical workflow, PSIs aim to improve patient and surgical outcomes, as well as potentially provide new avenues for combating challenges routinely faced by spinal surgeons. However, obstacles to widespread acceptance and routine application include the lack of quality long-term data, research challenges and the practicalities of production and navigating the regulatory environment. While recognition of the significant potential of Spinal PSIs is evident in the literature, it is clear a number of key questions must be answered to inform future clinical and research practices. The spinal surgical community must selectively and ethically continue to offer PSIs to patients, simultaneously allowing for the necessary larger, comparative studies to be conducted, as well as continuing to provide optimal patient care, thereby ultimately determining the exact role of this technology and potentially improving outcomes.
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Affiliation(s)
- Tajrian Amin
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney 2000, Australia
| | - William C.H. Parr
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick 2031, Australia
- 3DMorphic Pty Ltd., Matraville 2036, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney 2000, Australia; (T.A.); (W.C.H.P.)
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney 2000, Australia
- Correspondence: ; Tel.: +61-(02)-9650-4766
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22
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Faraj M, Arkawazi B, Al-Attar Z. Three-dimensional printing applications in the neurosurgery: A pilot study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Three-dimensional (3D) printing is an evolving technology that has been used recently in a wide spectrum of applications.
AIM: The objective is to evaluate the application of 3D printing in various neurosurgical practice.
PATIENTS AND METHODS: This pilot study was conducted in the neurosurgical hospital in Baghdad/Iraq between July 2018 and July 2019. An X, Y, and Z printer was used. The working team included neurosurgeons, biomedical engineers, and bio-technicians. The procedure starts with obtaining Magnetic resonance imaging (MRI) or computed tomography (CT) scan in particular protocols. The MRI, and CT or angiography images were imported into a 3D programmer for DICOM images called 3D slice where these files converted into a 3D pictures. Next, the neurosurgeon determines the cut section he needs to print. The final required object is exported to the X, Y, Z printing software where the technician starts to print it out. The final prototype delivered to the neurosurgeon. He uses it intraoperatively to have an apparent actual size 3D representation of the actual lesion with nearby healthy tissues to have a good idea about the case they manages.
RESULTS: This pilot study was applied in three major projects: brain tumors (ten cases), cerebral aneurysms (nine cases), and spine surgery (14 cases).
CONCLUSION: Three-dimensional printing has excellent advantages in neurosurgical practice. It can replace many other recent modalities. It enables the neurosurgeon works with more precision, less time-consuming, less cost, and less radiation exposure.
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23
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De Salvatore S, Vadalà G, Oggiano L, Russo F, Ambrosio L, Costici PF. Virtual Reality in Preoperative Planning of Adolescent Idiopathic Scoliosis Surgery Using Google Cardboard. Neurospine 2021; 18:199-205. [PMID: 33819947 PMCID: PMC8021821 DOI: 10.14245/ns.2040574.287] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Preoperative planning in spine surgery is a fundamental step of the surgical workup and is often assisted by direct visualization of anatomical 2-dimensional images. This process is time-consuming and may excessively approximate the 3-dimensional (3D) nature of spinal anatomy. Virtual reality (VR) is an emerging technology capable of reconstructing an interactive 3D anatomical model that can be freely explored and manipulated. METHODS Sixty patients with adolescent idiopathic scoliosis underwent correction of the scoliotic curve by posterior arthrodesis after preoperative planning using traditional on-screen visualization of computed tomography scans (control group, n = 30) or exploration of a 3D anatomical model in VR using Google Cardboard (Google Inc.) (VR group, n = 30). Mean operative time, blood loss, length of hospital stay, and surgeon's satisfaction were assessed after surgery. RESULTS The use of VR led to a significant decrease in operative time and bleeding while increasing the surgeon's satisfaction compared to the control group. CONCLUSION Preoperative planning with VR turned out to be effective in terms of operative time and blood loss reduction. Moreover, such technology proved to be reproducible, costeffective, and more satisfactory compared to conventional planning.
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Affiliation(s)
- Sergio De Salvatore
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Leonardo Oggiano
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Parthasarathy J, Sribnick EA, Ho ML, Beebe A. Customised hybrid CT-MRI 3D-printed model for grade V spondylolisthesis in an adolescent. BMJ Case Rep 2021; 14:e239192. [PMID: 33649040 PMCID: PMC7929802 DOI: 10.1136/bcr-2020-239192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 11/03/2022] Open
Abstract
3D-printed patient-specific models provide added value for initial clinical diagnosis, preoperative surgical and implant planning and patient and trainee education. 3D spine models are usually designed using CT data, due to the ability to rapidly image osseous structures with high spatial resolution. Combining CT and MRI to derive a composite model of bony and neurological anatomy can potentially provide even more useful information for complex cases. We describe such a case involving an adolescent with a grade V spondylolisthesis in which a composite model was manufactured for preoperative and intraoperative evaluation and guidance. We provide a detailed workflow for creating such models and outline their potential benefit in guiding a multidisciplinary team approach.
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Affiliation(s)
| | - Eric A Sribnick
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Neurosurgery, The Ohio State University, Columbus, Ohio, USA
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Allan Beebe
- Department of Orthopaedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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Park SY, An JH, Kwon H, Choi SY, Lim KY, Kwak HH, Hussein KH, Woo HM, Park KM. Custom-made artificial eyes using 3D printing for dogs: A preliminary study. PLoS One 2020; 15:e0242274. [PMID: 33216792 PMCID: PMC7678976 DOI: 10.1371/journal.pone.0242274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/29/2020] [Indexed: 01/02/2023] Open
Abstract
Various incurable eye diseases in companion animals often result in phthisis bulbi and eye removal surgery. Currently, the evisceration method using silicone balls is useful in animals; however, it is not available to those with impaired cornea or severe ocular atrophy. Moreover, ocular implant and prostheses are not widely used because of the diversity in animal size and eye shape, and high manufacturing cost. Here, we produced low-cost and customized artificial eyes, including implant and prosthesis, using computer-aided design and three-dimensional (3D) printing technique. For 3D modeling, the size of the artificial eyes was optimized using B-mode ultrasonography. The design was exported to STL files, and then printed using polycaprolactone (PCL) for prosthesis and mixture of PCL and hydroxyapatite (HA) for ocular implant. The 3D printed artificial eyes could be produced in less than one and half hour. The prosthesis was painted using oil colors and biocompatible resin. Two types of eye removal surgery, including evisceration and enucleation, were performed using two beagle dogs, as a preliminary study. After the surgery, the dogs were clinically evaluated for 6 months and then histopathological evaluation of the implant was done. Ocular implant was biocompatible and host tissue ingrowth was induced after in vivo application. The custom-made prosthesis was cosmetically excellent. Although long-term clinical follow-up might be required, the use of 3D printed-customized artificial eyes may be beneficial for animals that need personalized artificial eye surgery.
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Affiliation(s)
- So-Young Park
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Jeong-Hee An
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyun Kwon
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Seo-Young Choi
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Ka-Young Lim
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Ho-Hyun Kwak
- Department of Surgery, College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - Kamal Hany Hussein
- Department of Surgery, College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
- Department of Animal Surgery, College of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Heung-Myong Woo
- Department of Surgery, College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - Kyung-Mee Park
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
- * E-mail:
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3D Printed Personalized Guide Plate in the Femoral Head Core Decompression. BIOMED RESEARCH INTERNATIONAL 2020. [DOI: 10.1155/2020/7250528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To investigate the feasibility of using 3D printed personalized guide plates in core decompression procedures for the treatment of osteonecrosis of the femoral head (ONFH). Methods. The clinical data of 8 patients undergoing femoral head core decompression from January to December 2019 were analyzed retrospectively. Three-dimensional (3D) images of the patients were reconstructed from the CT scan data taken preoperatively. From the data obtained, puncture position, drill hole, and depth were evaluated, and individualized 3D puncture guide plates were designed using Mimics 21.0 software. During the operation, the needle went through the hole of the guide plate, the depth of the drill was controlled, and the obtained bone tissues were sent for pathological evaluation. Intraoperative X-ray and postoperative pathological results were used to evaluate the success of the puncture. Results. The individualized guide plates used for core compression on the 8 patients were well fitted with the anatomic structure of the puncture site, and the direction and depth of the needle insertion were consistent with the preoperative design. The operation time was about 15-22 mins. The position of the decompression tunnel was the same as the designed plate. The postoperative pathology showed necrotic bone tissue. There were no postoperative complications such as infection, bleeding, and fracture. Conclusion. The 3D printed individualized guide plate can simplify core decompression and would make this procedure more accurate, safe, and quick, in addition to obtaining necrotic tissues for pathological examination.
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Parr WCH, Burnard JL, Singh T, McEvoy A, Walsh WR, Mobbs RJ. C3-C5 Chordoma Resection and Reconstruction with a Three-Dimensional Printed Titanium Patient-Specific Implant. World Neurosurg 2019; 136:226-233. [PMID: 31811966 DOI: 10.1016/j.wneu.2019.11.167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND With this case report, we aim to add to the clinical literature on the use of three-dimensional printed patient-specific implants in spinal surgery, show the current state of the art in patient-specific implant device design, present thorough clinical and radiographic outcomes, and discuss the suitability of titanium alloy as an implant material for patients with cancer. CASE DESCRIPTION A 45-year-old man presented with neck and left arm pain combined with shoulder weakness. Imaging revealed significant destruction of the C3-C5 vertebrae, and chordoma diagnosis was confirmed by biopsy. Gross total tumor resection including multilevel corpectomy was performed in combination with reconstruction using a three-dimensional printed titanium custom implant. Custom-designed features aimed to reduce reconstruction time and result in good clinical and radiographic outcomes. Clinical scores improved postoperatively and remained improved at 17-month postoperative follow-up: visual analog scale score 10/10 preoperatively improved to 2-6/10 at 17 months; Neck Disability Index 46% preoperatively improved to 32% at 17 months. Neither dysphagia nor dysphonia remained after surgical soft tissue swelling subsided. The patient was successfully treated with proton beam therapy after surgery, with no tumor recurrence at 17-month follow-up. Radiographic assessment showed incomplete fusion at 3 months, with clinically insignificant implant subsidence (2.7 mm) and no implant migration or failure at 14 months. CONCLUSIONS Computer-aided preoperative planning with three-dimensional printed biomodels and custom implant resulted in relatively quick and simple reconstruction after tumor resection, with good clinical and radiographic outcomes at 17 and 14 months, respectively. For patients with primary tumors who may require follow-up radiotherapy or postoperative magnetic resonance imaging, metals used in the devices cause significant imaging artifact.
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Affiliation(s)
- William C H Parr
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia; 3DMorphic Pty Ltd., Sydney, Australia.
| | - Joshua L Burnard
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia
| | - Telvinderjit Singh
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia
| | - Aidan McEvoy
- Matrix Medical Innovations Pty Ltd., Sydney, Australia
| | - William R Walsh
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Ralph J Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia; Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
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