The rapidly growing 3-D printing industry could lead to enhanced spine implants as well as decreased surgical time and improved patient outcomes in spine surgery, according to a systematic literature review in the Journal of Spine Surgery.
The authors searched six electronic databases for original published studies reporting cases or outcomes for 3DP surgical models, guides or implants for spinal surgery. Of the 2,411 articles these searches returned, 54 were included in the review.
Here are eight trends in 3-D printing for spine surgery.
1. Currently, 3-D printing is used for surgical planning, intraoperative surgical guides, customized prostheses as well as "off-the-shelf" implants. Issues such as financial impact, time to design and print, materials selection and bioprinting will continue to evolve.
2. 3-D printing becomes more useful in spine surgery as the complexity of the pathology increases.
3. The technology is most frequently used in the preoperative planning stage. Assessing complex pathologies on a model overcomes many of the challenges associated with traditional 3-D imaging, such as the lack of realistic anatomical representation and the complexity of associated computer-related skills and techniques.
4. 3-D printed surgical guides may offer an alternative to intraoperative imaging as a simple, convenient and low-cost way to improve pedicle screw placement accuracy.
5. All the 3-D printed customized, patient-specific implants in the review were reported to fit well. Implant stability increased while complications such as stress shielding and subsistence were minimized.
6. Spinal prosthetic manufacturers, such as Stryker and 4Web Medical, are starting to use the technology to optimize the properties of the implantable devices. 3-D printing allows for the manufacturing of previously impossible-to-create geometries, including the ability to mimic the interconnected structure of cancellous bone. Osseointegration can be optimized by controlling the porosity and surface roughness of implants.
7. 3-D printing can produce enough implants to be competitive in the marketplace. In the future, 3-D printing is expected to be able to incorporate additional features such as porous matrices where density, pore diameter and mechanical properties can vary in different regions of the implant.
8. Bioprinting is likely the future; 3-D printing will increasingly use cells, growth factors and biomaterial to create living tissue.
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