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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

European Spine Journal volume 32, pages 261–270 (2023)Cite this article

Abstract

Object

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.

Methods

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.

Results

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).

Conclusion

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.

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References

  1. 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

    Article  Google Scholar 

  2. 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

    Google Scholar 

  3. Joaquim AF, Ann P, Ilya L et al (2015) An update in the management of spinal metastases. Arq Neuropsiquiatr 73(9):795

    Article  Google Scholar 

  4. 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

    Article  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. 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

    Article  Google Scholar 

  7. 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.

  8. 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.

  9. 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

    Article  CAS  Google Scholar 

  10. 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

    Article  Google Scholar 

  11. 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.

  12. 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

    Article  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. 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.

  15. 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

    Google Scholar 

  16. 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

    Article  Google Scholar 

  17. 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

    Article  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. 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

    Article  Google Scholar 

  20. Ventola CL (2014) Medical applications for 3D printing: current and projected uses. P T 39(10):704–711

    Google Scholar 

  21. 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

    Article  CAS  Google Scholar 

  22. 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

    Article  CAS  Google Scholar 

  23. Martelli N, Serrano C, Hélène VDB et al (2016) Advantages and disadvantages of 3-dimensional printing in surgery: asystematic review. Surgery, pp 1485–1500.

  24. 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

    Article  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. 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

    Article  Google Scholar 

  27. 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

    Article  Google Scholar 

  28. 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

    Article  Google Scholar 

  29. 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.

  30. Sidambe A (2014) Biocompatibility of advanced manufactured titanium implants—a review. Materials (Basel, Switzerland) 7(12):8168

    Article  Google Scholar 

  31. 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

    Article  CAS  Google Scholar 

  32. 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

    Article  CAS  Google Scholar 

  33. 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

    Article  Google Scholar 

  34. 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

    Article  Google Scholar 

  35. 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

    Article  CAS  Google Scholar 

  36. 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

    Article  Google Scholar 

  37. 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

    Article  Google Scholar 

  38. 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

    Google Scholar 

  39. 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

    Article  Google Scholar 

  40. 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

    Google Scholar 

  41. Hansson T, Roos B, Nachemson A (1980) The bone mineral content and ultimate compressive strength of lumbar vertebrae. Spine 5(1):46

    Article  CAS  Google Scholar 

  42. Mcbroom R (1985) Prediction of vertebral body compressive fracture using quantitative computed tomography. J Bone Joint Surg-Am 67(8):1206–1214

    Article  CAS  Google Scholar 

  43. 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.

  44. 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

    Article  Google Scholar 

  45. 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.

  46. 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

    Article  Google Scholar 

  47. 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

    Article  CAS  Google Scholar 

  48. 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

    Article  Google Scholar 

  49. 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

    Article  Google Scholar 

  50. 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

    Article  Google Scholar 

  51. Matsumoto M, Watanabe K, Tsuji T et al (2011) Late instrumentation failure after total en bloc spondylectomy. J Neurosurg Spine 15(3):320–327

    Article  Google Scholar 

  52. 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

    Article  Google Scholar 

  53. 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

    Article  Google Scholar 

  54. 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

    Article  Google Scholar 

  55. 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

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China

    Zejun Chen, Guohua Lü, Xiaoxiao Wang, Haoyu He, Hui Yuan, Changyu Pan & Lei Kuang

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  1. Zejun Chen
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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

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  • DOI: https://doi.org/10.1007/s00586-022-07480-9

Keywords

  • Thoracic/lumbar spine tumor
  • Spinal reconstruction
  • 3D printing prosthesis
  • Titanium mesh cage
  • Subsidence
  • Cost-effectiveness