Skip to main content

Advertisement

SpringerLink
Log in

Designing patient-specific solutions using biomodelling and 3D-printing for revision lumbar spine surgery

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Despite the variety of “off-the-shelf” implants and instrumentation, outcomes following revision lumbosacral surgery are inconstant. Revision fusion surgery presents a unique set of patient-specific challenges that may not be adequately addressed using universal kits. This study aims to describe how patient-specific factors, surgeon requirements, and healthcare efficiencies were integrated to design and manufacture anatomically matched surgical tools and implants to complement a minimally invasive posterior approach for revision lumbar fusion surgery.

Methods

A 72-year-old woman presented with sciatica and a complex L5–S1 pseudoarthrosis 12 months after L2–S1 fixation surgery for symptomatic degenerative scoliosis. Patient computed tomography data were used to develop 1:1 scale biomodels of the bony lumbosacral spine for pre-operative planning, patient education, and intraoperative reference. The surgeon collaborated with engineers and developed a patient-specific 3D-printed titanium lumbosacral fixation implant secured by L2–L5, S2, and iliac screws. Sizes and trajectories for the S2 and iliac screws were simulated using biomodelling to develop a stereotactic 3D-printed drill guide. Self-docking 3D-printed nylon tubular retractors specific to patient tissue depth and bony anatomy at L5–S1 were developed for a minimally invasive transforaminal approach. The pre-selected screws were separately sourced, bundled with the patient-specific devices, and supplied as a kit to the hospital before surgery.

Results

At 6-month follow-up, the patient reported resolution of symptoms. No evidence of implant dysfunction was observed on radiography.

Conclusion

Pre-operative planning combined with biomodelling and 3D printing is a viable process that enables surgical techniques, equipment, and implants to meet patient and surgeon-specific requirements for revision lumbar fusion surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Kaiser MG, Eck JC, Groff MW, Watters WC 3rd, Dailey AT, Resnick DK, Choudhri TF, Sharan A, Wang JC, Mummaneni PV, Dhall SS, Ghogawala Z (2014) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology. J Neurosurg Spine 21:2–6. https://doi.org/10.3171/2014.4.SPINE14257

    Article  PubMed  Google Scholar 

  2. Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 28:S26–S35. https://doi.org/10.1097/01.BRS.0000076895.52418.5E

    Article  PubMed  Google Scholar 

  3. Rajaee SS, Bae HW, Kanim LE, Delamarter RB (2012) Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine 37:67–76. https://doi.org/10.1097/BRS.0b013e31820cccfb

    Article  PubMed  Google Scholar 

  4. Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA (2007) Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine 32:2119–2126. https://doi.org/10.1097/BRS.0b013e318145a56a

    Article  PubMed  Google Scholar 

  5. D’Urso PS, Askin G, Earwaker JS, Merry GS, Thompson RG, Barker TM, Effeney DJ (1999) Spinal biomodeling. Spine 24:1247–1251

    Article  PubMed  Google Scholar 

  6. Mobbs RJ, Coughlan M, Thompson R, Sutterlin CE 3rd, Phan K (2017) The utility of 3D printing for surgical planning and patient-specific implant design for complex spinal pathologies: case report. J Neurosurg Spine 26:513–518. https://doi.org/10.3171/2016.9.SPINE16371

    Article  Google Scholar 

  7. Mobbs RJ, Phan K, Thayaparan GK, Rao PJ (2016) Anterior lumbar interbody fusion as a salvage technique for pseudarthrosis following posterior lumbar fusion surgery. Glob Spine J 6:14–20. https://doi.org/10.1055/s-0035-1555656

    Article  Google Scholar 

  8. Adogwa O, Parker SL, Shau D, Mendelhall SK, Aaronson O, Cheng J, Devin CJ, McGirt MJ (2015) Cost per quality-adjusted life year gained of revision fusion for lumbar pseudoarthrosis: defining the value of surgery. J Spinal Disord Tech 28:101–105. https://doi.org/10.1097/BSD.0b013e318269cc4a

    Article  PubMed  Google Scholar 

  9. Vertuani S, Nilsson J, Borgman B, Buseghin G, Leonard C, Assietti R, Quraishi NA (2015) A cost-effectiveness analysis of minimally invasive versus open surgery techniques for lumbar spinal fusion in Italy and the United Kingdom. Value Health 18:810–816. https://doi.org/10.1016/j.jval.2015.05.002

    Article  PubMed  Google Scholar 

  10. Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR (2016) Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review. J Neurosurg Spine 24:416–427. https://doi.org/10.3171/2015.2.SPINE14973

    Article  PubMed  Google Scholar 

  11. Goldstein CL, Phillips FM, Rampersaud YR (2016) Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar interbody fusion: a systematic review. Spine 41(Suppl 8):S74–S89. https://doi.org/10.1097/BRS.0000000000001462

    Article  PubMed  Google Scholar 

  12. Lindsey C, Deviren V, Xu Z, Yeh RF, Puttlitz CM (2006) The effects of rod contouring on spinal construct fatigue strength. Spine 31:1680–1687. https://doi.org/10.1097/01.brs.0000224177.97846.00

    Article  PubMed  Google Scholar 

  13. Kleck CJ, Illing D, Lindley EM, Noshchenko A, Patel VV, Barton C, Baldini T, Cain CM, Burger EL (2017) Strain in posterior instrumentation resulted by different combinations of posterior and anterior devices for long spine fusion constructs. Spine Deform 5:27–36. https://doi.org/10.1016/j.jspd.2016.09.045

    Article  PubMed  Google Scholar 

  14. Palumbo MA, Shah KN, Eberson CP, Hart RA, Daniels AH (2015) Outrigger rod technique for supplemental support of posterior spinal arthrodesis. Spine J 15:1409–1414. https://doi.org/10.1016/j.spinee.2015.03.004

    Article  PubMed  Google Scholar 

  15. D’Urso PS, Williamson OD, Thompson RG (2005) Biomodeling as an aid to spinal instrumentation. Spine 30:2841–2845

    Article  PubMed  Google Scholar 

  16. Zheng F, Cammisa FP Jr, Sandhu HS, Girardi FP, Khan SN (2002) Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine 27:818–824

    Article  PubMed  Google Scholar 

  17. Seng C, Siddiqui MA, Wong KP, Zhang K, Yeo W, Tan SB, Yue WM (2013) Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine 38:2049–2055. https://doi.org/10.1097/BRS.0b013e3182a8212d

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr Philip M. Lewis for providing academic support.

Author information

Authors and Affiliations

  1. Department of Neurosciences Epworth Healthcare, Richmond, Victoria, Australia

    Ganesha K. Thayaparan & Paul S. D’Urso

  2. The Epworth Centre, Suite 7, Level 8, 32 Erin Street, Richmond, Victoria, 3121, Australia

    Ganesha K. Thayaparan

  3. Anatomics Pty Ltd, St Kilda, Victoria, Australia

    Mark G. Owbridge, Robert G. Thompson & Paul S. D’Urso

Authors
  1. Ganesha K. Thayaparan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark G. Owbridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert G. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul S. D’Urso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ganesha K. Thayaparan.

Ethics declarations

Conflict of interest

Mark Owbridge is an employee at Anatomics Pty Ltd. Robert Thompson is an employee at Anatomics Pty Ltd. Paul D’Urso is a director and shareholder at Anatomics Pty Ltd and has received funding from Stryker Corporation, Epworth Healthcare, and Anatomics Pty Ltd.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval for this study was obtained from Epworth Healthcare Human Research Ethics and Research Governance Committees (HREC2017-254).

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent for surgery was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thayaparan, G.K., Owbridge, M.G., Thompson, R.G. et al. Designing patient-specific solutions using biomodelling and 3D-printing for revision lumbar spine surgery. Eur Spine J 28 (Suppl 2), 18–24 (2019). https://doi.org/10.1007/s00586-018-5684-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5684-z

Keywords

Search

Navigation