Reconstruction after resection of C2 vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh

Abstract

BackgroundSurgical resection of C2 vertebral tumors is challenging owing to the complex anatomy of C2 vertebrae and the challenges to surgical exposure. Various surgical approaches are available, but some are associated with excessively high risks of complications. An additional challenge is reconstruction of the upper cervical spine following surgery. In the last decade, additive-manufacturing personalized artificial vertebral bodies (AVBs) have been introduced for the repair of large, irregular bony defects; however, their use and efficacy in upper cervical surgery have not been well addressed. Therefore, in this study, we compared instrumented fixation status between patients who underwent conventional titanium mesh reconstruction and those who underwent the same resection but with personalized AVBs.MethodsWe performed a retrospective comparative study and recruited a single-institution cohort of patients with C2 vertebral tumors. Clinical data and imaging findings were reviewed. Through data processing and comparative analysis, we described and discussed the feasibility and safety of surgical resection and the outcomes of hardware implants. The primary outcome of this study was instrumented fixation status.ResultsThe 31 recruited patients were divided into two groups. There were 13 patients in group A who underwent conventional titanium mesh reconstruction and 18 group B patients who underwent personalized AVBs. All patients underwent staged posterior and anterior surgical procedures. In the cohort, 9.7% achieved total en bloc resection of the tumor, while gross total resection was achieved in the remaining 90.3%. The perioperative complication and mortality rates were 45.2% and 6.5%, respectively. The occurrence of perioperative complications was related to the choice of anterior approach (p < 0.05). Group A had a higher complication rate than group B (p < 0.05). Four patients (4/13, 30.8%) developed hardware problems during the follow-up period; however, this rate was marginally higher than that of group B (1/18, 5.6%).ConclusionsTotal resection of C2 vertebral tumors was associated with a high risk of perioperative complications. The staged posterior and retropharyngeal approaches are better surgical strategies for C2 tumors. Personalized AVBs can provide a reliable reconstruction outcome, yet minor pitfalls remain that call for further modification.

Comparison of clinical efficacy of 3D-printed artificial vertebral body and conventional titanium mesh cage in spinal reconstruction after total en bloc spondylectomy for spinal tumors: a systematic review and meta-analysis

“…No sources of heterogeneity were identified after the sensitivity and meta-regression analyses ( Tables 2 , 3 ). Therefore, a qualitative descriptive analysis was performed, and the results showed that five studies ( 12 , 13 , 16 – 18 ) reported significantly less intraoperative blood loss in the 3D-printed AVB group than in the conventional TMC group, whereas the remaining three studies ( 14 , 15 , 19 ) reported no significant difference between the two groups.…”

“…Early complications mainly included cerebrospinal fluid leakage, pleural effusion or lung infection due to pleural rupture, poor healing of infected wounds, and neurological complications. The occurrence of early complications between 3D-printed AVB (n = 150) and conventional TMC (n = 167) groups was compared in seven studies (12,13,(15)(16)(17)(18)(19). The OR in early complications between two groups was 0.52, significantly inclined toward the conventional TMC group (95% CI: 0.29 to 0.90, P = 0.02; I² = 40%, fixed-effects model; Figure 8).…”

Using additive manufacturing for craniocervical reconstruction in traditionally challenging cases

“…In our preliminary report of the rst 3D printed C2 vertebral body replacement in 2016, we described this new implant design, which was suitable for the patient's anatomical structure to increase the contact area between adjacent vertebrae, with the additional feature of zero-pro le xation, and improved conduciveness to bone-ingrowth due to their trabecular pores [13]. In 2022, Hu et al of our center conducted a comparative study of conventional titanium mesh and 3D printed AVB for reconstruction after resection of C2 tumor, which showed that personalized AVB can provide reliable reconstruction [21]. Laratta et al proposed that the advantage of 3D printed AVB for postoperative fusion is its dense reticular structure, which can increase the interaction with surrounding bone and promote bone growth inward without bone grafting [22].…”

Novelties for increased safety in cranio-vertebral surgery: a review

“…In 2014, Ji et al proposed a tailored titanium clivus plate to reconstruct the craniovertebral junction in combination with posterior fixation in order to augment upper cervical stabilization [ 37 ]. In 2022, Hu et al proved that 3D printed vertebral bodies provided reliable reconstruction support comparable with titanium mesh after en bloc resection of C2 tumors [ 32 ]. Indeed, 3D technology has facilitated the process of tailoring such implants to a given patient and has also been reported to be helpful for surgical planning and teaching [ 8 , 51 ].…”