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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

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Abstract

Purpose

To address the anatomical challenges facing complex and revision spinal surgery, patient-specific 3D-printed models (3D-PMs) have received growing attention worldwide, primarily in adults. We report the use of a 3D-PM in the treatment of a case of wound breakdown over a component of a VEPTR (Vertical Expandable Prosthetic Titanium Rib; DePuy-Synthes) system, requiring replacement of Dunn-McCarthy hook and sleeve with components contoured to a patient-specific 3D-PM of the spine.

Method

A two-year-old born with myelomeningocele (MMC), repaired at birth, developed progressive MMC-associated kyphoscoliosis. Elective insertion of a rib-to-pelvis ‘Eiffel Tower’ bilateral VEPTR growing rods construct was performed without initial complication. Prominence of the right VEPTR sleeve and Dunn-McCarthy hook side-to-side connector resulted in breakdown of overlying poor-quality soft tissues, necessitating washout, partial implant removal, intravenous antibiotic therapy and delayed primary wound closure. A patient-specific 3D-PM, utilising pre-operative CT spine and pelvis 3D-reconstructions, allowed pre-operative formation of a contoured implant, which was inserted without need for further revision.

Results

The patient underwent further VEPTR lengthening without recurrent infection, wound breakdown or implant failure at 24-month follow-up. Satisfactory control of the deformity has been achieved with continued improvement in sitting height and radiographic indices.

Conclusion

This case illustrates the possibility, in certain cases, of using 3D-PM to develop complex components of spinal implant systems pre-operatively, removing the time and difficulty of intra-operative contouring. Consequently, custom-contoured implants may be produced, sterilised and implanted. This technique may be an option, in infants, including MMC-associated kyphoscoliosis, where midline fixation is not possible.

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Authors and Affiliations

  1. Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK

    Martin Li, Bashar Alhani, Matthew Newton-Ede, David Marks & Morgan Jones

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  1. Martin Li
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  2. Bashar Alhani
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  3. Matthew Newton-Ede
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  4. David Marks
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  5. Morgan Jones
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Correspondence to Martin Li.

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Li, M., Alhani, B., Newton-Ede, M. et al. 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. Eur Spine J 32, 2607–2614 (2023). https://doi.org/10.1007/s00586-022-07460-z

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  • DOI: https://doi.org/10.1007/s00586-022-07460-z

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