Design of mulitlevel OLF approach (“V”-shaped decompressive laminoplasty) based on 3D printing technology
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To introduce a new surgical approach to the multilevel ossification of the ligamentum flavum (OLF) aided by three-dimensional (3D) printing technology.
A multilevel OLF patient (male, 66 years) was scanned using computed tomography (CT). His saved DICOM format data were inputted to the Mimics14.0 3D reconstruction software (Materialise, Belgium). The resulting 3D model was used to observe the anatomical features of the multilevel OLF area and to design the surgical approach. At the base of the spinous process, two channels were created using an osteotomy bilaterally to create a “V” shape to remove the bone ligamentous complex (BLC). The decompressive laminoplasty using mini-plate fixation was simulated with the computer. The physical model was manufactured using 3D printing technology. The patient was subsequently treated using the designed surgery.
The operation was completed successfully without any complications. The operative time was 90 min, and blood loss was 200 ml. One month after the operation, neurologic function was recovered well, and the JOA score was improved from 6 preoperatively to 10. Postoperative CT scanning showed that the OLF was totally removed, and the replanted BLC had not subsided.
3D printing technology is an effective, reliable, and minimally invasive method to design operations. The technique can be an option for multilevel OLF surgical treatment. This can provide sufficient decompression with minimum damage to the spine and other intact anatomical structures.
Keywords3D printing Ossification of the ligamentum flavum Decompressive laminoplasty
We would like to thank Mr Liao for the computer software support (Guangzhou You Dao Computer Technology Co., Ltd) and all the operating room staff. This work was supported by the Science and Technology Project of Guangdong Province (2014B090901055, 2015B010125005, and 2016B090917001), the south wisdom valley innovation team plan (2015CXTD05), and the National Natural Science Foundation of China (61427807).
Compliance with ethical standards
Conflict of interest statement
None of the authors has any potential conflict of interest.
The Science and Technology Project of Guangdong Province (2014B090901055, 2015B010125005, and 2016B090917001). South wisdom valley innovation team plan (2015CXTD05). National Natural Science Foundation of China (61427807).
- 16.Putzier M, Strube P, Cecchinato R, Lamartina C, Hoff E (2014) A new navigational tool for pedicle screw placement in patients with severe scoliosis: a pilot study to prove feasibility, accuracy, and identify operative challenges. J Spinal Disord TechGoogle Scholar
- 18.Hunt J (2010) Truss implant. USGoogle Scholar
- 19.Beer ND, Merwe AVD (2013) Patient-specific intervertebral disc implants using rapid manufacturing technology. Rapid Prototyp J 19(2):8Google Scholar
- 20.Figueroa O, Rodríguez C, Siller H, Martínez-Romero O, Flores-Villalba E, Díaz-Elizondo J, Ramírez R (2013) Lumbar cage design concepts based on additive manufacturing, vol 102Google Scholar
- 21.Domanski J, Skalski K, Grygoruk R, Mróz A (2015) Rapid prototyping in the intervertebral implant design process. Rapid Prototyp J 21(6)Google Scholar
- 22.Knutsen AR, Borkowski SL, Ebramzadeh E, Flanagan CL, Hollister SJ, Sangiorgio SN (2015) Static and dynamic fatigue behavior of topology designed and conventional 3D printed bioresorbable PCL cervical interbody fusion devices. J Mech Behav Biomed Mater 49:332–342CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Ben HK, Jemel H, Haouet S, Khaldi M (2003) Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases. J Neurosurg 99(2 Suppl):157–161Google Scholar
- 40.Miyashita T, Ataka H, Tanno T (2013) Spontaneous reduction of a floated ossification of the ligamentum flavum after posterior thoracic decompression (floating method); report of a case (abridged translation of a primary publication). Spine J: Off J North Am Spine Soc 13(8):e7–e9. doi: 10.1016/j.spinee.2013.02.013 CrossRefGoogle Scholar