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3D Navigated Spine Surgery

What is 3D Printing for Complex Spine Disorders?

Complex spinal deformity, trauma, infection, or tumors result in notable bony distortion, and hence a standard implant off the shelf is not normally adequate to fill this void. 3D printing technology allows a truly perfect and patient-specific implant to be developed to the individual’s own anatomy and circumstance.

Three-dimensional printing (3DP), also known as “Additive Manufacturing,” is a fast-growing technology, specifically in the area of spinal surgery. Given the complex anatomy of the spine and the delicate nature of surrounding structures, 3D printing has the potential to assist with surgical planning and procedural precision. 3D printing refers to a process where a 3D object is developed from a digital design through successive layering of material under computer control until a full prototype of a custom-specific 3D model is created.

Custom 3D printing of implants for complex spine disorders has the potential to improve patient outcomes and results from spine surgery. 3D-printed implants have a special design and can be custom printed to match each patient’s individual needs. Each implant is 3D-printed in multiple sizes and shapes which are matched to the patient at the time of surgery. This enables the implant to be custom fit to the patient’s individual anatomy. The surgical instruments used to perform the spinal procedure can also be printed to match the patient’s body needs. The technology has the potential for enhanced implant properties, as well as reduced surgical time and better patient outcomes. At present, 3D printing technology is being utilized for surgical planning, custom prostheses, intra-operative surgical guides, as well as “off-the-shelf” implants.

Indications for 3D Printing for Complex Spine Disorders

Your surgeon may recommend spine surgery in conjunction with a 3D printed spinal implant for complex spine disorders, such as a traumatic spine fracture requiring spinal fusion. Spinal fusion is a procedure in which two or more bones (vertebrae) of the spine are joined together with the use of a spinal implant and bone graft to eliminate the movement between them. This will help fuse your spine to minimize motion and provide stability. 3D printing technology can be specifically helpful in complex or severe cases that require multiple levels of fusion or higher fusion rates.

Spinal fusion surgery in conjunction with a 3D printed spinal implant is recommended in certain conditions that cause persistent back or leg pain even after conservative treatment. The surgery is indicated in the following conditions:

  • Injury or fracture of the vertebra
  • Instability of the spine caused by infections or tumors
  • Spondylolisthesis (slipped vertebrae)
  • Abnormal spinal curvature (kyphosis)
  • Degenerative disc disease
  • Spinal stenosis (combined with foraminotomy or laminotomy)

Preparation for 3D Printing for Complex Spine Disorders

Preoperative preparation for 3D printing for complex spine disorders may involve the following steps:

  • A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to create patient-specific 3D-printed spinal implants.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking or any conditions you have such as heart or lung disease.
  • You may be asked to avoid medications such as blood thinners, aspirin, or anti-inflammatories for a specific period.
  • You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
  • You should refrain from alcohol or tobacco at least a few days prior to surgery and several weeks after as it can hinder the healing process.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You are advised to arrange for someone to drive you home after surgery.
  • A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for 3D Printing for Complex Spine Disorders

Advanced 3D printing technology can be utilized for complex spine disorders requiring a spinal fusion surgery. The procedure may involve the following steps:

  • You will lie face down on the operating table under the influence of general anesthesia.
  • A surgical cut is made over the affected vertebrae (cervical, thoracic or lumbar area).
  • Muscles surrounding the affected vertebrae are retracted to gain access to the damaged vertebrae.
  • The damaged vertebral bone or intervertebral disc is removed from the affected area of the spinal column.
  • Your surgeon then performs spinal fusion. Spinal fusion can be performed through different angles depending upon the specific advantages of each and the choice of your surgeon. The spine may be approached and the graft can be placed either from a posterior approach (back), anterior approach (front), or a combination of both (anterior and posterior). It may involve an interbody fusion where a bone graft is placed in the space present between the two vertebrae or a posterolateral fusion where bone grafts are placed between the transverse processes present in the back of the spine. Other techniques may also be employed for spinal fusion that involves the entire removal of the disc between the affected vertebrae. A patient-specific 3D printed spine implant is then placed between the vertebrae. This special implant helps your surgeon to restore natural spine alignment and height of the disc, as well as assist fusion.
  • The fusion process is followed by spinal instrumentation, which involves fitting titanium screws, rods, cages, or plates to stabilize the vertebrae and further accelerate bone fusion.
  • Following this, care is taken to reposition the soft tissues carefully and the incision is closed.

Postoperative Care and Recovery

Postoperative care instructions and recovery involved with 3D printing for complex spine disorders may involve the following:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover. 
  • You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed to address these.
  • The application of cold and warm compresses to the treatment area is also recommended to reduce inflammation and pain.
  • Antibiotics are also prescribed as needed to address the risk of surgery-related infection.
  • You are encouraged to walk and move around in bed with support as frequently as possible to prevent the risk of blood clots.
  • Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
  • Avoid lifting, bending, or twisting your back for the first 6 weeks. Do not lift anything heavier than 5 pounds for the first 2 weeks. Refrain from any strenuous activities such as housework, yard work, or sex for at least a month.
  • A corset or brace is recommended to limit bending and assist with the healing of the fused region.
  • A physical therapy protocol is recommended to help strengthen the spine muscles and optimize their function. Walking is good exercise and is strongly recommended to improve your endurance.
  • Refrain from driving until you are fully fit and receive your doctor’s consent.
  • You should be able to resume your normal activities in a couple of weeks but may have certain activity restrictions.
  • Complete recovery and return to work vary from patient to patient as it is related to a patient’s overall health status and the type of work one does.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

3D printing for complex spine disorders is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

  • Infection
  • Bleeding
  • Blood clots
  • Allergic/anesthetic reactions
  • Hardware failure
  • Bone graft migration
  • Persistent pain
  • Failure of vertebral fusion
  • Injury to adjacent organs, nerves, or blood vessels