Current status of 3D printing in spine surgery

Abstract

Three-dimensional printing (3DP) is one of the latest tools in the armamentarium of the modern spine surgeon. The yearning to be more precise and reliable whilst operating on the spine has led to an interest in this technology which has claimed to achieve these goals. 3D printing has been used pre-operatively for surgical planning and for resident or patient education. It has also found its way to the operation theatre where it is used to fabricate customized surgical tools or patient-specific implants. Several authors have highlighted significant benefits when 3D printing is used for specific indications in spine surgery. Novel applications of this technology in spine surgery have also been described and though still in a nascent stage, these are important for this technology to sustain itself in the future. However, major limitations have also come to light with this technology in use. This article seeks to review the current status and applications of 3D printing in spinal surgery and its major drawbacks while briefly describing the essentials of the technology. It is imperative that the modern spine surgeon knows about this important innovation and when and how it can be applied to improve surgical outcomes.

Clinical significance of three-dimensional printed biomaterials and biomedical devices

“…FDM is a commonly used process for quickfabrication of models, but for more advanced applications, the standard machines are of the SLA and SLS type, for creating fine microscale features and details. 45,46 Other techniques are also employed depending on the need to add functionality such as color and controlled porosity, including poly-jet or multi-jet additive techniques that are currently used in different hospitals. 47 A prime example of this functionality is in the field of maxillofacial surgery, where doctors have historically been challenged to find ways to practice performing surgeries.…”

“…Such tools enable doctors to optimize their surgical procedure and decrease the amount of time required for the surgery. 45 With 3DP, these guides can conform to the anatomy of the patient, enabling a much safer and stabilized drilling procedure. While specialized for each patient, 3DP does showcasing osteoid tissue and blue/green showcasing mineralized bone.…”

“…39 add additional time to the surgery preparation due to sizing and print time, therefore, its use must play an integral role in the overall surgery to make it economic for surgeons and practitioners. 45…”

Three-dimensional Printing in Spine Surgery: Protocol of a Systematic Review and Meta-analysis

“…Due to the diversity of printer manufacturers and material manufacturers, the quality of the biological materials used to make 3D printing tools or implants is still questionable. Since 3D printed implants have only been used in the past ten years or so, data on their long-term safety are missing, which is also a problem in the application of 3DP technology [19].…”

Three-Dimensional Printing for Preoperative Planning and Pedicle Screw Placement in Adult Spinal Deformity: A Systematic Review

“…1,2 Three-dimensional printing technology involves using computed tomography (CT) or magnetic resonance imaging (MRI) to create a digital 3D model that is then sliced into 2D sections, which are physically produced in layers by a 3D printer and eventually fused into a final model. 3 Different materials are used in the printing process-stereolithography (SLA) most commonly involves the use of polystyrene or resin, whereas selective laser sintering (SLS) employs a focused energy source on various materials such as nylon, titanium, or stainless steel to sculpt a final model. 3 Another 3DP type, fused deposition modeling (FDM), creates layers using a heat-softened polymer.…”