Retracted Article: Application of 3D printing technology in orthopedic medical implant - Spinal surgery as an example
Additive manufacturing has been used in complex spinal surgical planning since the 1990s and is now increasingly utilized to produce surgical guides, templates, and more recently customized implants. Surgeons report beneficial impacts using additively manufactured biomodels as pre-operative planning aids as it generally provides a better representation of the patient’s anatomy than on-screen viewing of computed tomography (CT) or magnetic resonance imaging (MRI). Furthermore, it has proven to be very beneficial in surgical training and in explaining complex deformity and surgical plans to patients/ parents. This paper reviews the historical perspective, current use, and future directions in using additive manufacturing in complex spinal surgery cases. This review reflects the authors’ opinion of where the field is moving in light of the current literature. Despite the reported benefits of additive manufacturing for surgical planning in recent years, it remains a high niche market. This review raises the question as to why the use of this technology has not progressed more rapidly despite the reported advantages – decreased operating time, decreased radiation exposure to patients intraoperatively, improved overall surgical outcomes, pre-operative implant selection, as well as being an excellent communication aid for all medical and surgical team members. Increasingly, the greatest benefits of additive manufacturing technology in spinal surgery are customdesigned drill guides, templates for pedicle screw placement, and customized patient-specific implants. In view of these applications, additive manufacturing technology could potentially revolutionize health care in the near future.
1.Green N, Glatt V, Tetsworth K, et al., 2016, A Practical Guide to Image Processing in the Creation of 3D Models for Orthopaedics. Tech Orthop, 31(3):153-63. DOI 10.1097/ BTO.0000000000000181.
2. D’Urso P, Askin G, Earwaker J, 1999, Spinal Biomodeling. Spine (Phila Pa 1976), 24:1247-51. DOI 10.1097/00007632-199906150-00013.
3. D’Urso PS, Williamson OD, Thompson RG, 2005, Biomodeling as an Aid to Spinal Instrumentation. Spine (Phila Pa 1976), 30(12):2841-5. DOI 10.1097/01. brs.0000190886.56895.3d.
4. D’Urso PS, 2006, Biomodelling. In: Gibson I, editor. Advanced Manufacturing Technology for Medical Applications: Reverse Engineering, Software Conversion and Rapid Prototyping. Chichester, United Kingdom: John Wiley and Sons Ltd., p31-57. DOI 10.1002/0470033983.ch3.
5. Izatt MT, Thorpe PLP, Thompson RG, et al., 2007, The use of Physical Biomodelling in Complex Spinal Surgery. Eur Spine J, 16(9):1507-18. DOI 10.1007/s00586-006-0289-3.
6. Yamazaki M, Akazawa T, Okawa A, et al., 2007, Usefulness of Three-dimensional Full-scale Modeling of Surgery for a Giant Cell Tumor of the Cervical Spine. Spinal Cord, 45:250-53. DOI 10.1038/sj.sc.3101959.
7. Mizutani J, Matsubara T, Fukuoka M, et al., 2008, Application of Full-scale Three-dimensional Models in Patients with Rheumatoid Cervical Spine. Eur Spine J, 17(5):644-9. DOI 10.1007/s00586-008-0611-3.
8. Mao K, Wang Y, Xiao S, et al., 2010, Clinical Application of Computer-designed Polystyrene Models in Complex Severe Spinal Deformities: APilot Study. Eur Spine J, 19(5):797-802. DOI 10.1007/s00586-010-1359-0.
9. Yang JC, Ma XY, Lin J, et al., 2011, Personalised Modified Osteotomy using Computer-aided Design-rapid Prototyping to Correct Thoracic Deform-ities. Int Orthop, 35(12):1827-32. DOI 10.1007/s00264-010-1155-9.
10. Martelli N, Serrano C, van den Brink H, et al., 2016, Advantages and Disadvantages of 3-dimensional Printing in Surgery: A Systematic Review. Surgery, 159(6):1485-500. DOI 10.1016/j.surg.2015.12.017.
11. Lu S, Xu YQ, Lu WW, et al., 2009, A Novel Patient-specific Navigational Template for Cervical Pedicle Screw Placement. Spine (Phila Pa 1976), 34(26):E959-66. DOI 10.1097/ BRS.0b013e3181c09985.
12. Lu S, Xu YQ, Zhang YZ, et al., 2009, A Novel Computer-assisted Drill Guide Template for Placement of C2 Laminar Screws. Eur Spine J, 18(9):1379-85. DOI 10.1007/s00586-009-1051-4.
13. Fu M, Lin L, Kong X, et al., 2013, Construction and Accuracy Assessment of Patient-specific Biocompatible Drill Template for Cervical Anterior Transpedicular Screw (ATPS) Insertion: An in vitro Study. PLoS One, 8(1):e53580. DOI 0.1371/ journal.pone.0053580.
14. Hu Y, Yuan Z, Spiker WR, et al., 2013, Deviation Analysis of C2 Translaminar Screw Placement Assisted by a Novel Rapid Prototyping Drill Template: A Cadaveric Study. Eur Spine J, 22(12):2770-6. DOI 10.1007/s00586-013-2993-0.
15. Takemoto M, Fujibayashi S, Ota E, et al., 2016, AdditiveManufactured Patient-specific Titanium Templates for Thoracic Pedicle Screw Place-ment: Novel Design with Reduced Contact Area. Eur Spine J, 25:1698-705. DOI 10.1007/s00586-015-3908-z.
16. de Beer N, Scheffer C, 2012, Reducing Subsidence Risk by using Rapid Manufactured Patient-specific Intervertebral Disc Implants. Spine J, 12(11):1060-6. DOI 10.1016/j. spinee.2012.10.003.
17. Berretta S, Evans KE, Ghita OR, 2018, Additive Manufacture of PEEK Cranial Implants: Manufacturing Considerations Versus Accuracy and Mechanical Performance. Mater Des, 139(1):141-52. DOI 10.1016/j.matdes.2017.10.078.
18. Cook HP, 1969, Titanium in Mandibular Replacement. Br J Oral Surg, 7:108-11. DOI 10.1016/S0007-117X(69)80005-3.
19. Sing S, Yenog WY, Wiria FE, 2018, Selective Laser Melting of Titanium Alloy with 50 wt% Tantalum: Effect of Laser Process Parameters on Part Quality. Int J Refract Met Hard Mater, 77:120-7. DOI 10.1016/j.ijrmhm.2018.08.006.
20. Yang J, Cai H, Lv J, et al., 2014, in vivo Study of a Self-Stabilizing Artificial Vertebral Body Fabricated by Electron Beam Melting. Spine (Phila Pa 1976), 39(8):E486-92. DOI 10.1097/BRS.0000000000000211. Zhang, et al. International Journal of Bioprinting (2019)–Volume 5, Issue 2 11
21. Wang X, Xu S, Zhou S, et al., 2016, Topological Design and Additive Manufacturing of Porous Metals for Bone Scaffolds and Orthopaedic Implants: A Review. Biomaterials, 83:127-41. DOI 10.1016/j.biomaterials.2016.01.012.
22. Xillo, 2011, The World’s First 3D Printed Total Jaw Reconstruction. Available from: http://www.xilloc.com/ patients/stories/total-mandibular-implant.
23. Mertens C, Lowenheim H, Hoffmann J, 2013, Image Data Based Reconstruction of the Midface Using a Patientspecific Implant in Combination with a Ascularized Osteomyocutaneous Scapular Flap. J Cranio Maxillofac Surg, 41:219-25. DOI 10.1016/j.jcms.2012.09.003.
24. Jardini AL, Larosa MA, Zavaglia CAC, et al., 2014, Customised Titanium Implant Fabricated in Additive Manufacturing for Craniomaxillofacial Surgery. Virtual Phys
Prototyp, 9:115-25. DOI 10.1080/17452759.2014.900857.