To investigate the stability and cost-effectiveness of the three-dimensional-printed (3DP) off-the-shelf (OTS) prosthesis in the reconstruction of the anterior column of the thoracic/lumbar spine after tumor resection.
Thirty-five patients (26 with primary malignant tumors and nine with metastatic malignant tumors) who underwent tumor resection and anterior column reconstruction between January 2014 and January 2019 were included in a single institute. Patients were divided into the 3DP OTS prosthesis (3DP) group (n = 14) and the titanium mesh cage (TMC) group (n = 21) by the type of implant. The operation time, intraoperative blood loss, hospital stay, history of radiotherapy, surgical level and total cost were collected and compared between the two groups. Mechanical complications and radiological parameters including mean vertebral height, subsidence, fixation failure(nonunion, migration, screw loosening, rod breakage) rate were recorded at preoperation, 1 week, 3 months, 6 months, 12 months after surgery then at 1 year interval or stop until the end of survival. The follow-up patients were also sent with short form-36 to assess their health-related quality of life (HRQoL) and questions about the current condition of their disease.
The mean overall follow-up was 24.6 months. Of the 35 patients involved, six patients died and six were lost to follow-up. The differences between the two groups in operative time, intraoperative blood loss, and hospital stay were not statistically significant (p > 0.05). The differences in fixation failure and the subsidence rate between the two groups were not statistical significant (p > 0.05). The difference of subsidence rate between the cases with and without osteoporosis, cases with and without radiotherapy was statistically significant within each group (p < 0.05). However, the difference of subsidence rate between the surgical level above or below T10 was not statistically significant (p > 0.05). The response rate of the questionnaire among the survived patients was 100% (23/23 patients). The results of the Short Form- (SF-)36 between the two groups were similar (p > 0.05). The total cost was higher in the 3DP group (p < 0.05) with its higher graft cost (p < 0.05), but the differences in internal fixation cost and other cost were not statistically significant between groups (p > 0.05).
Compared to TMC, the 3DP OTS prosthesis achieved similar clinical and radiological results in spinal anterior spinal column reconstruction of thoracic/lumbar spinal tumor resection. However, the 3DP OTS prosthesis was more expansive than TMC.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Garofalo F, di Summa PG, Christoforidis D, Pracht M, Laudato P, Cherix S, Bouchaab H, Raffoul W, Demartines N, Matter M (2015) Multidisciplinary approach of lumbo-sacral chordoma: from oncological treatment to reconstructive surgery. J Surg Oncol 112(5):544–554
Greco C, Pares O, Pimentel N et al (2015) Spinal metastases: from conventional fractionated radiotherapy to single-dose SBRT. Reports Pract Oncol Radiotherapy J Greatpoland Cancer Center in Poznan Polish Soc Radiat Oncol 20(6):454–463
Joaquim AF, Ann P, Ilya L et al (2015) An update in the management of spinal metastases. Arq Neuropsiquiatr 73(9):795
Elder BD, Ishida W, Goodwin CR et al (2017) Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis. Neurosurg Focus 42(1):E16
Yanamadala V, Rozman PA, Kumar JI, Schwab JH, Lee SG, Hornicek FJ, Curry WT Jr (2017) Vascularized fibular strut autografts in spinal reconstruction after resection of vertebral chordoma or chondrosarcoma: a retrospective series. Neurosurgery 81(1):156–164
Lewandrowski KU, Hecht AC, Delaney TF et al (2004) Anterior spinal arthrodesis with structural cortical allografts and instrumentation for spine tumor surgery. Spine 29(10):1150
Bridwell KH, Lenke LG , Mcenery KW et al (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?. Spine 20(12):1410.
Dvorak MF, Kwon BK, Fisher CG, Eiserloh HL 3rd, Boyd M, Wing PC (2003) Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection. Spine (Phila Pa 1976) 28(9):902–908.
Boriani S, Biagini R, Bandiera S et al (2002) Reconstruction of the anterior column of the thoracic and lumbar spine with a carbon fiber Stackable Cage System. Orthopedics 25(1):37–42
Viswanathan A, Abd-El-Barr MM, Doppenberg E et al (2012) Initial experience with the use of an expandable titanium cage as a vertebral body replacement in patients with tumors of the spinal column: a report of 95 patients. Eur Spine J 21(1):84–92
Glennie RA, Rampersaud YR, Boriani S, Reynolds JJ, Williams R, Gokaslan ZL, Schmidt MH, Varga PP, Fisher CG (2016) A systematic review with consensus expert opinion of best reconstructive techniques after osseous en bloc spinal column tumor resection. Spine (Phila Pa 1976) 41(Suppl 20):S205–S211.
Wallace N, Schaffer NE, Aleem IS, Patel R (2020) 3D-printed patient-specific spine implants: a systematic review. Clin Spine Surg 33(10):400–407
Burnard JL, Parr WCH, Choy WJ, Walsh WR, Mobbs RJ (2020) 3D-printed spine surgery implants: a systematic review of the efficacy and clinical safety profile of patient-specific and off-the-shelf devices. Eur Spine J 29(6):1248–1260
Kato S, Murakami H, Demura S et al (2014) Patient-reported outcome and quality of life after total en bloc spondylectomy for a primary spinal tumour. Bone Joint J 96-B(12):1693–1698.
Salame K, Regev G, Keynan O et al (2015) Total en bloc spondylectomy for vertebral tumors. Israel Med Assoc J IMAJ 17(1):37–41
Calori GM, Colombo M, Mazza EL et al (2014) Incidence of donor site morbidity following harvesting from iliac crest or RIA graft. Injury-Int J Care Injured 45(Suppl 6):S116–S120
Harel R, Chao S, Krishnaney A et al (2010) Spine instrumentation failure after spine tumor resection and radiation: comparing conventional radiotherapy with stereotactic radiosurgery outcomes. World Neurosurg 74(4–5):517–522
Salem KM, Fisher CG (2016) Anterior column reconstruction with PMMA: an effective long-term alternative in spinal oncologic surgery. Eur Spine J 25(12):3916–3922
Yoshioka K, Murakami H, Demura S et al (2013) Clinical outcome of spinal reconstruction after total en bloc spondylectomy at 3 or more levels. Spine 38(24):1511–1516
Ventola CL (2014) Medical applications for 3D printing: current and projected uses. P T 39(10):704–711
Gross BC, Erkal JL, Lockwood SY et al (2014) Evaluation of 3D printing and its potential impact on biotechnology and the chemical sciences. Anal Chem 86(7):3240–3253
Zema L, Melocchi A, Maroni A, Gazzaniga A (2017) Three-dimensional printing of medicinal products and the challenge of personalized therapy. J Pharm Sci 106(7):1697–1705
Martelli N, Serrano C, Hélène VDB et al (2016) Advantages and disadvantages of 3-dimensional printing in surgery: asystematic review. Surgery, pp 1485–1500.
Tack P, Victor J, Gemmel P et al (2016) 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 15(1):115
Girard N (2016) Evidence appraisal of Malik HH, Darwood ARJ, Shaunak S, Kulatilake P, El-Hilly AA, Mulki O, Baskaradas A. Three-dimensional printing in surgery: a review of current surgical applications.: J Surg Res. 2015;199(2):512–522. AORN J 104(6):601–606
Wilcox B, Mobbs RJ, Wu AM et al (2017) Systematic review of 3D printing in spinal surgery: the current state of play. J Spine Surg 3(3):433–443
Girolami M, Boriani S, Bandiera S, Barbanti-Bródano G, Ghermandi R, Terzi S, Tedesco G, Evangelisti G, Pipola V, Gasbarrini A (2018) Biomimetic 3D-printed custom-made prosthesis for anterior column reconstruction in the thoracolumbar spine: a tailored option following en bloc resection for spinal tumors: Preliminary results on a case-series of 13 patients. Eur Spine J 27(12):3073–3083
Mobbs RJ, Wen JC, Wilson P et al (2018) L5 En-bloc vertebrectomy with customized reconstructive implant: comparison of patient-specific versus off-the-shelf implant. World Neurosurg 112:94–100
Tan X P, Tan YJ, Chow CSL et al (2017) Metallic powder-bed based 3D printing of cellular scaffolds for orthopaedic implants: A state-of-the-art review on manufacturing, topological design, mechanical properties and biocompatibility. Mater Sci Eng C 76(Jul):1328.
Sidambe A (2014) Biocompatibility of advanced manufactured titanium implants—a review. Materials (Basel, Switzerland) 7(12):8168
Palmquist A, Snis A, Emanuelsson L et al (2013) Long-term biocompatibility and osseointegration of electron beam melted, free-form-fabricated solid and porous titanium alloy: experimental studies in sheep. J Biomater Appl 27(8):1003–1016
Wu X, Chen H, Huang C et al (2017) Curcumin attenuates surgery-induced cognitive dysfunction in aged mice. Metab Brain Dis 32(3):1–10
Chong E, Pelletier MH, Mobbs RJ, Walsh WR (2015) The design evolution of interbody cages in anterior cervical discectomy and fusion: a systematic review. BMC Musculoskelet Disord 16:99
Rao PJ, Pelletier MH, Walsh WR, Mobbs RJ (2014) Spine interbody implants: material selection and modification, functionalization and bioactivation of surfaces to improve osseointegration. Orthop Surg 6(2):81–89
Hasegawa K, Abe M, Washio T et al (2001) An experimental study on the interface strength between titanium mesh cage and vertebra in reference to vertebral bone mineral density. Spine 26(8):957
Chen Y, Chen D, Guo Y et al (2008) Subsidence of titanium mesh cage: a study based on 300 cases. J Spinal Disord Tech 21(7):489–492
Ahmed M, Michael T, Damiano P (2018) Cervical fusion cage computationally optimized with porous architected Titanium for minimized subsidence. J Mech Behav Biomed Mater 85:134–151
Salchow-Gille M, Rieger B, Reinshagen C, Molcanyi M, Lemke J, Brautferger U, Sitoci-Ficici KH, Polanski W, Pinzer T, Schackert G (2021) Prospective surgical solutions in degenerative spine: spinal simulation for optimal choice of implant and targeted device development. Innov Surg Sci 6(1):11–24
Park SJ, Lee CS, Chang BS, Kim YH, Kim H, Kim SI, Chang SY, Korean Spine Tumor Study Group (2019) Rod fracture and related factors after total en bloc spondylectomy. Spine J 19(10):1613–1619
Alsaadi G, Quirynen M, Komárek A, van Steenberghe D (2008) Impact of local and systemic factors on the incidence of late oral implant loss. Clin Oral Implants Res 19(7):670–676
Hansson T, Roos B, Nachemson A (1980) The bone mineral content and ultimate compressive strength of lumbar vertebrae. Spine 5(1):46
Mcbroom R (1985) Prediction of vertebral body compressive fracture using quantitative computed tomography. J Bone Joint Surg-Am 67(8):1206–1214
Hansson T, Keller T, Spengler D. Mechanical behavior of the human lumbar spine. II. Fatigue strength during dynamic compressive loading. Journal of Orthopaedic Research Official Publication of the Orthopaedic Research Society, 2010, 5(4):479.
Cho JH, Hwang CJ, Kim H, Joo YS, Lee DH, Lee CS (2018) Effect of osteoporosis on the clinical and radiological outcomes following one-level posterior lumbar interbody fusion. J Orthop Sci 23(6):870–877
Hoshijima K (1997) Strength and stability of posterior lumbar interbody fusion. Comparison of titanium fiber mesh implant and tricortical bone graft. Spine 22(11):1181.
Wang Z, Liu Y, Rong Z, Wang C, Liu X, Zhang F, Zhang Z, Xu J, Dai F (2019) Clinical evaluation of a bone cement-injectable cannulated pedicle screw augmented with polymethylmethacrylate: 128 osteoporotic patients with 42 months of follow-up. Clinics (Sao Paulo) 74:e346
Liu YY, Xiao J, Yin X, Liu MY, Zhao JH, Liu P, Dai F (2020) Clinical efficacy of bone cement-injectable cannulated pedicle screw short segment fixation for lumbar spondylolisthesis with osteoporosise. Sci Rep 10(1):3929
Yoshioka K, Murakami H, Demura S et al (2017) Risk factors of instrumentation failure after multilevel total en bloc spondylectomy. Spine Surg Relat Res 1(1):31–39
Disch AC, Schaser KD, Melcher I et al (2011) Oncosurgical results of multilevel thoracolumbar en-bloc spondylectomy and reconstruction with a carbon composite vertebral body replacement system. Spine 36(10):647–655
Liljenqvist U, Lerner T, Halm H et al (2008) En bloc spondylectomy in malignant tumors of the spine. Eur Spine J 17(4):600–609
Matsumoto M, Watanabe K, Tsuji T et al (2011) Late instrumentation failure after total en bloc spondylectomy. J Neurosurg Spine 15(3):320–327
Zhu Z, Xing W, Lizarondo L et al (2020) Psychometric properties of self-reported financial toxicity measures in cancer survivors: a systematic review protocol using COSMIN methodology. BMJ Open 10(5):e036365
Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH (2018) Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer. Am J Med 131(10):1187–1199.e5
Wei R, Guo W, Ji T, Zhang Y, Liang H (2017) One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J 26(7):1902–1909
Lador R, Regev G, Salame K, Khashan M, Lidar Z (2020) Use of 3-dimensional printing technology in complex spine surgeries. World Neurosurg 133:e327–e341
Conflict of interest
There are no competing interests in this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Chen, Z., Lü, G., Wang, X. et al. Is 3D-printed prosthesis stable and economic enough for anterior spinal column reconstruction after spinal tumor resection? A retrospective comparative study between 3D-printed off-the-shelf prosthesis and titanium mesh cage. Eur Spine J 32, 261–270 (2023). https://doi.org/10.1007/s00586-022-07480-9
- Thoracic/lumbar spine tumor
- Spinal reconstruction
- 3D printing prosthesis
- Titanium mesh cage