使用三维打印患者特异性植入物和虚拟手术计划治疗成人腰椎半椎体前路腰椎椎体间融合术(ALIF):一份技术报告

IF 0.1 Q4 SURGERY Surgical Techniques Development Pub Date : 2023-11-08 DOI:10.3390/std12040019
Tajrian Amin, William C. H. Parr, Pragadesh Natarajan, Andrew Lennox, Lianne Koinis, Ralph J. Mobbs
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引用次数: 0

摘要

引言:半椎体是一种常见的椎体形成缺陷,可能导致衰弱的先天性脊柱侧凸,需要高度创伤性的手术。虚拟手术计划(VSP)和3d打印患者特异性植入物(psi)越来越多地应用于复杂的脊柱手术,并提供了一系列潜在的好处。研究问题:我们报告使用3d打印psi和VSP作为两节段前路腰椎椎体间融合(ALIF)的一部分,用于治疗外侧半椎体和先天性脊柱侧凸。材料与方法:一名53岁男性,由于L4半椎体和轻度先天性脊柱侧凸导致的慢性下腰痛,表现为新发腿部疼痛。CT显示L4/5和L5/S1变性和椎间孔狭窄。考虑到复杂的解剖结构和广泛的多层次骨癣,3d打印的psi被设计、制造和植入作为两级ALIF的一部分。结果:术中种植体配合良好,经术后影像学证实。VSP辅助导航具有挑战性的骨骼和血管解剖。术后三个月的影像显示结构稳定,骨融合的早期迹象,植入物放置,脊柱弯曲和椎间盘高度校正与VSP密切匹配。经过9个月的临床随访,患者的疼痛和功能障碍得到了有效的解决。讨论与结论:虚拟手术计划和3d打印psi在半椎体和先天性脊柱侧凸的复杂病例的治疗中是有用的手术辅助工具。该先天性病理病例增加了PSI应用于各种复杂脊柱病理的报道,分析显示术后构建与术前VSP密切匹配。
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Anterior Lumbar Interbody Fusion (ALIF) for Lumbar Hemivertebra in an Adult Using Three-Dimensional-Printed Patient-Specific Implants and Virtual Surgery Planning: A Technical Report
Introduction: Hemivertebrae are a common defect of vertebral formation, potentially resulting in debilitating congenital scoliosis and necessitating highly traumatic surgery. Virtual surgical planning (VSP) and 3D-printed patient-specific implants (PSIs) have increasingly been applied to complex spinal surgery, and offer a range of potential benefits. Research Question: We report the use of 3D-printed PSIs and VSP as part of a two-level anterior lumbar interbody fusion (ALIF) for the management of lateral hemivertebra and congenital scoliosis. Material and Methods: A 53-year-old male with chronic low-back pain, due to L4 hemivertebra and mild congenital scoliosis, presented with new-onset leg pain. CT revealed L4/5 and L5/S1 degeneration and foraminal stenosis. Given the complex anatomy and extensive multi-level osteophytosis, 3D-printed PSIs were designed, manufactured, and implanted as part of a two-level ALIF. Results: Excellent implant fit was achieved intraoperatively, confirmed via postoperative imaging. VSP assisted with navigating challenging bony and vascular anatomy. Three-month postoperative imaging demonstrated construct stability, early signs of bony fusion, with implant placement, spinal curvature, and disc height corrections closely matching the VSP. Clinically, the patient’s pain and functional impairment had effectively resolved by nine-month follow up, as demonstrated through subjective and objective measures. Discussion and Conclusions: Virtual surgical planning and 3D-printed PSIs can be useful surgical aids in the management of the often-complex cases involving hemivertebrae and congenital scoliosis. This case of congenital pathology adds to the growing reports of PSI application to a variety of complex spinal pathologies, with analyses showing a close match of the postoperative construct to the preoperative VSP.
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