Application of the polystyrene model made by 3-D printing rapid prototyping technology for operation planning in revision lumbar discectomy

ObjectiveThe objective was to evaluate the effectiveness of 3-D rapid prototyping technology in revision lumbar discectomy.Summary of background data3-D rapid prototyping technology has not been reported in the treatment of revision lumbar discectomy.MethodsPatients with recurrent lumbar disc herniation who were preparing to undergo revision lumbar discectomy from a single center between January 2011 and 2013 were included in this analysis. Patients were divided into two groups. In group A, 3-D printing technology was used to create subject-specific lumbar vertebral models in the preoperative planning process. Group B underwent lumbar revision as usual. Preoperative and postoperative clinical outcomes were compared between groups included operation time, perioperative blood loss, postoperative complications, Oswestry Disability Index (ODI), Japan Orthopaedics Association (JOA) scores, and visual analogue scale (VAS) scores for back pain and leg pain.ResultsA total of 37 patients were included in this study (Group A = 15, Group B = 22). Group A had a significantly shorter operation time (106.53 ± 11.91 vs. 131.92 ± 10.81 min, P < 0.001) and significantly less blood loss (341.67 ± 49.45 vs. 466.77 ± 71.46 ml, P < 0.001). There was no difference between groups for complication rate. There were also no differences between groups for any clinical metric.ConclusionUsing the 3-D printing technology before revision lumbar discectomy may reduce the operation time and the perioperative blood loss. There does not appear to be a benefit to using the technology with respect to clinical outcomes. Future prospective studies are needed to further elucidate the efficacy of this emerging technology.

[1]  James Neil Weinstein,et al.  Low back pain [5] (multiple letters) , 2001 .

[2]  K. Swartz,et al.  Recurrent lumbar disc herniation. , 2003, Neurosurgical focus.

[3]  C. Hurson,et al.  Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures. , 2007, Injury.

[4]  M. R Results of operative management of ankle fractures , 1975 .

[5]  J. Skinner,et al.  Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. , 2006, JAMA.

[6]  Wei Lei,et al.  Accuracy and Safety Assessment of Pedicle Screw Placement Using the Rapid Prototyping Technique in Severe Congenital Scoliosis , 2011, Journal of spinal disorders & techniques.

[7]  B. Chang,et al.  Recurrence Rate of Lumbar Disc Herniation After Open Discectomy in Active Young Men , 2009, Spine.

[8]  Jonathan J Ross Magnetic resonance imaging of the postoperative spine , 1988, Topics in magnetic resonance imaging : TMRI.

[9]  Yan Wang,et al.  Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot study , 2010, European Spine Journal.

[10]  The clinical significance of rapid prototyping technique in complex spinal deformity surgery—Case sharing and literature review , 2013 .

[11]  Le Xie,et al.  A novel computer‐assisted drill guide template for lumbar pedicle screw placement: a cadaveric and clinical study , 2009, The international journal of medical robotics + computer assisted surgery : MRCAS.

[12]  I. Keskimäki Reoperations After Lumbar Disc Surgery: A Population-Based Study of Regional and Interspecialty Variations , 2000, Spine.

[13]  Richard A. Robb,et al.  Virtual Pelvic Anatomy and Surgery Simulator: An Innovative Tool for Teaching Pelvic Surgical Anatomy , 2009, MMVR.

[14]  S. Moon,et al.  Recurrent Lumbar Disc Herniation: Results of Operative Management , 2001, Spine.

[15]  Francesca De Crescenzio,et al.  CAD/CAM and rapid prototyped scaffold construction for bone regenerative medicine and surgical transfer of virtual planning: A pilot study , 2009, Comput. Medical Imaging Graph..

[16]  Yue Zhou,et al.  Reoperation after lumbar disc surgery in two hundred and seven patients , 2013, International Orthopaedics.

[17]  P. Lewis,et al.  Lumbar diskectomy for recurrent disk herniation. , 1994, Journal of spinal disorders.

[18]  T. Smit,et al.  Polyurethane Real-Size Models Used in Planning Complex Spinal Surgery , 2001, Spine.

[19]  P. Sell,et al.  Incidental durotomy in lumbar spine surgery: incidence and management , 2005, European Spine Journal.

[20]  E. Carragee,et al.  Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Anular Competence , 2003, The Journal of bone and joint surgery. American volume.

[21]  Joseph S. Cheng,et al.  Asymptomatic Same-Site Recurrent Disc Herniation After Lumbar Discectomy: Results of a Prospective Longitudinal Study With 2-Year Serial Imaging , 2011, Spine.

[22]  J. Emans,et al.  The Correlation of Preoperative Three-Dimensional Computed Tomography Reconstructions With Operative Findings in Congenital Scoliosis , 2003, Spine.

[23]  M. Newey,et al.  A comparative study of the outcomes of primary and revision lumbar discectomy surgery. , 2013, The bone & joint journal.

[24]  K Torres,et al.  Application of rapid prototyping techniques for modelling of anatomical structures in medical training and education. , 2011, Folia morphologica.

[25]  J. Guarino,et al.  Rapid Prototyping Technology for Surgeries of the Pediatric Spine and Pelvis: Benefits Analysis , 2007, Journal of pediatric orthopedics.

[26]  R A Deyo,et al.  Low back pain. , 2001, The New England journal of medicine.

[27]  A. Lenkoski,et al.  Repeat surgery after lumbar decompression for herniated disc: the quality implications of hospital and surgeon variation. , 2012, The spine journal : official journal of the North American Spine Society.

[28]  R. Mobbs,et al.  Lumbar discectomy and the diabetic patient: incidence and outcome , 2001, Journal of Clinical Neuroscience.

[29]  C. Morgan-Hough,et al.  Primary and revision lumbar discectomy. A 16-year review from one centre. , 2003, The Journal of bone and joint surgery. British volume.