L5 Enbloc Vertebrectomy with Customised Reconstructive Implant: Comparison of Patient Specific versus Off-The-Shelf Implant.

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L5 Enbloc Vertebrectomy with Customised Reconstructive Implant: Comparison of Patient Specific versus Off-The-Shelf Implant.

World Neurosurg. 2018 Jan 20;:

Authors: Mobbs RJ, JieChoy W, Wilson P, McEvoy A, Phan K, Parr WCH

Abstract
BACKGROUND: Spine surgery has the potential to benefit from Additive Manufacturing / 3-Dimensional (3D) printing (3DP) technology with complex anatomical pathologies requiring reconstruction, with the potential to customise surgery to reduce operative times, reduce blood loss, provide immediate stability and potentially improve fusion rates. We report a unique case of intraoperative trial placement of a custom Patient Specific Implant (PSI) versus final implantation of a customisable Off-The-Shelf (OTS) implant. Data collected for comparison include time to implant, ease of implantation, firmness of press-fit, and fixation options following implantation.
CASE DESCRIPTION: A 64-year-old male presented with low back pain. CT and MRI revealed a solitary lesion in the L5 vertebral body, confirmed by PET scan. Removal of the L5 vertebral body was performed and reconstruction was achieved with an expandable cage. The time of implant insertion was minimal with the PSI (90 seconds) versus the OTS (>40 minutes). Immediate press-fit and 'firmness' of implantation was clearly superior with the PSI, although this was an intraoperative subjective assessment. Other benefits include integral fixation that is predetermined with the PSI, reduced time and blood loss and ease of bone grafting with a PSI.
CONCLUSIONS: Use of 3DP has been able to reduce operative time significantly. Surgeons can train prior to performing complex procedures, which enhances their pre-surgical planning, with the goal to maximise patient outcomes. When considering implants and prostheses, the use of 3DP allows a superior anatomical fit for the patient, with the potential to improve restoration of anatomy.

PMID: 29366999 [PubMed - as supplied by publisher]

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