The mechanisms of skull impact loading may change following surgical interventions such as the removal of bone lesions, but little is known about the consequences in the event of subsequent head trauma. We, therefore, prepared acrylonitrile butadiene styrene human skull models based on clinical computed tomography skull data using a three-dimensional printer. Six replicate physical skull models were tested, three with bone excisions and three without. A drop tower was used to simulate the impact sustained by falling backwards onto the occipital lobe region. The impacts were recorded with a high-speed camera, and the occipital strain response was determined by digital image correlation. Although the hole affected neither the magnitude nor the sequence of the fracture pattern, the digital image correlation analysis highlighted an increase in strain around the excised area (0.45%–16.4% of the principal strain). Our approach provides a novel method that could improve the quality of life for patients on many fronts, including protection against trauma, surgical advice, post-operative care, advice in litigation cases, as well as facilitating general biomechanical research in the area of trauma injuries.

Most commercial spine analogues are not intended for biomechanical testing, and those developed for this purpose are expensive and yet still fail to replicate the mechanical performance of biological specimens. Patient-specific analogues that address these limitations and avoid the ethical restrictions surrounding the use of human cadavers are therefore required. We present a method for the production and characterisation of biofidelic, patientspecific, spine motion segment (SMS = 2 vertebrae and the disk in between) analogues that allow for the biological variability encountered when dealing with real patients. Porcine spine segments (L1-L4) were scanned by computed tomography, and 3D models were printed in acrylonitrile butadiene styrene (ABS). Four biological specimens and four ABS motion segments were tested, three of which were further segmented into two vertebral bodies (VBs) with their intervertebral disc (IVD). All segments were loaded axially at 0.6 mm/min (strainrate range 6-10×10 -4 s -1 ). The artificial VBs behaved like biological segments within the elastic region, but the best two-part artificial IVD were ~15% less stiff than the biological IVDs. High-speed images recorded during compressive loading allowed full-field strains to be produced. During compression of the spine motion segments, IVDs experienced higher strains than VBs as expected. Our method allows the rapid, inexpensive and reliable production of patient-specific 3D-printed analogues, which morphologically resemble the real ones, and whose mechanical behaviour is comparable to real biological spine motion segments and this is their biggest asset.

Patient-specific computational models are powerful tools which may assist in predicting the outcome of invasive surgery on the musculoskeletal system, and consequently help to improve therapeutic decision-making and post-operative care. Unfortunately, at present the use of personalized models that predict the effect of biopsies and full excisions is so specialized that tends to be restricted to prominent individuals, such as high-profile athletes. We have developed a finite element analysis model to determine the influence of the location of an ellipsoidal excision (14.2 mm × 11.8 mm) on the structural integrity of a human skull when exposed to impact loading, representing a free fall of an adult male from standing height. The finite element analysis model was compared to empirical data based on the drop-tower testing of three-dimensional-printed physical skull models where deformations were recorded by digital image correlation. In this bespoke example, we found that the excision site did not have a major effect on the calculated stress and strain magnitudes unless the excision was in the temporal region, where the reduction in stiffness around the excision caused failure within the neighboring area. The finite element analysis model allowed meaningful conclusions to be drawn for the implications of using such a technique based on what we know about such conditions indicating that the approach could be both clinically beneficial and also cost-effective for wider use.

Most commercially available spine analogues are not intended for biomechanical testing, and the few that are suitable for using in conjunction with implants and devices to allow a hands on practice on operative procedures are very expensive and still none of these offers patient-specific analogues that are can be accessed within reasonable time and price range. Man-made spine analogues would also avoid the ethical restrictions surrounding the use of biological specimens and complications arising from their inherent biological variability. Here we sought to improve the biofidelity and accuracy of a patient-specific motion segment analogue that we presented recently [13]. These models were made by acrylonitrile butadiene styrene (ABS) in 3D printing of porcine spine segments (T12-L5) from microCT scan data, and were tested in axial loading at 0.6 mm/min (strain rate range 6-10×10 -4 s -1 ). In this paper we have sought to improve the biofidelity of these analogue models by concentrating in improving the two most critical aspects of the mechanical behaviour: the material used for the intervertebral disc and the influence of the facet joints. The deformations were followed by use of DIC (Digital Image Correlation) and consequently different scanning resolutions and data acquisition techniques were also explored and compared to determine their effect. We found that the selection of an appropriate intervertebral disc simulant (PT Flex 85) achieved a realistic force/displacement response and also that the facet joints have a key role to play to achieve a biofidelic behaviour for the entire motion segment. We have therefore overall confirmed the feasibility of producing, by rapid and inexpensive 3D-printing methods, high-quality patient-specific spine analogue models suitable for biomechanical testing and practice.