TY - JOUR
T1 - Rapid Implementation of a 3-Dimensional–Printed Patient-Specific Titanium Sacrum Implant for Severe Neuropathic Spinal Arthropathy and Guide to Compassionate US Regulatory Approval
AU - Ruiz-Cardozo, Miguel A.
AU - Trevino, Gabriel
AU - Pando, Alejandro
AU - Brehm, Samuel
AU - Olufawo, Michael
AU - Barot, Karma
AU - Carey-Ewend, Abigail
AU - Yahanda, Alexander T.
AU - Perdomo-Pantoja, Alexander
AU - Jauregui, Julio J.
AU - Cadieux, Magalie
AU - Costa, Megan
AU - Coenen, Julie
AU - Dorward, Ian
AU - Anolik, Rachel A.
AU - Sacks, Justin M.
AU - Molina, Camilo A.
N1 - Publisher Copyright:
© Congress of Neurological Surgeons 2023. All rights reserved.
PY - 2023/11/16
Y1 - 2023/11/16
N2 - BACKGROUND AND OBJECTIVE: Rapid design and production of patient-specific 3-dimensional–printed implants (3DPIs) present a novel opportunity to restore the biomechanically demanding integrity of the lumbopelvic junction. We present a unique case of a 61-year-old patient with severe neuropathic spinal arthropathy (Charcot spine) who initially underwent a T4-to-sacrum spinal fusion. Massive bone destruction led to dissociation of his upper body from his pelvis and legs. Reconstruction of the spinopelvic continuity was planned with the aid of a personalized lumbosacral 3DPI. METHOD: Using high-resolution computed tomography scans, the custom 3DPI was made using additive titanium manufacturing. The unique 3DPI consisted of (1) a sacral platform with iliac screws, (2) modular corpectomy device with rigid connection to the sacral platform, and (3) anterior plate connection with screws for proximal fixation. The procedures to obtain compassionate use Food and Drug Administration approval were followed. The patient underwent debridement of a chronically open wound before undertaking the 3-stage reconstructive procedure. The custom 3DPI and additional instrumentation were inserted as part of a salvage rebuilding procedure. RESULTS: The chronology of the rapid implementation of the personalized sacral 3DPI from decision, design, manufacturing, Food and Drug Administration approval, and surgical execution lasted 28 days. The prosthesis was positioned in the defect according to the expected anatomic planes and secured using a screw–rod system and a vascularized fibular bone strut graft. The prosthesis provided an ideal repair of the lumbosacral junction and pelvic ring by merging spinal pelvic fixation, posterior pelvic ring fixation, and anterior spinal column fixation. CONCLUSION: To the best of our knowledge, this is the first case of a multilevel lumbar, sacral, and sacropelvic neuropathic (Charcot) spine reconstruction using a 3DPI sacral prosthesis. As the prevalence of severe spine deformities continues to increase, adoption of 3DPIs is becoming more relevant to offer personalized treatment for complex deformities.
AB - BACKGROUND AND OBJECTIVE: Rapid design and production of patient-specific 3-dimensional–printed implants (3DPIs) present a novel opportunity to restore the biomechanically demanding integrity of the lumbopelvic junction. We present a unique case of a 61-year-old patient with severe neuropathic spinal arthropathy (Charcot spine) who initially underwent a T4-to-sacrum spinal fusion. Massive bone destruction led to dissociation of his upper body from his pelvis and legs. Reconstruction of the spinopelvic continuity was planned with the aid of a personalized lumbosacral 3DPI. METHOD: Using high-resolution computed tomography scans, the custom 3DPI was made using additive titanium manufacturing. The unique 3DPI consisted of (1) a sacral platform with iliac screws, (2) modular corpectomy device with rigid connection to the sacral platform, and (3) anterior plate connection with screws for proximal fixation. The procedures to obtain compassionate use Food and Drug Administration approval were followed. The patient underwent debridement of a chronically open wound before undertaking the 3-stage reconstructive procedure. The custom 3DPI and additional instrumentation were inserted as part of a salvage rebuilding procedure. RESULTS: The chronology of the rapid implementation of the personalized sacral 3DPI from decision, design, manufacturing, Food and Drug Administration approval, and surgical execution lasted 28 days. The prosthesis was positioned in the defect according to the expected anatomic planes and secured using a screw–rod system and a vascularized fibular bone strut graft. The prosthesis provided an ideal repair of the lumbosacral junction and pelvic ring by merging spinal pelvic fixation, posterior pelvic ring fixation, and anterior spinal column fixation. CONCLUSION: To the best of our knowledge, this is the first case of a multilevel lumbar, sacral, and sacropelvic neuropathic (Charcot) spine reconstruction using a 3DPI sacral prosthesis. As the prevalence of severe spine deformities continues to increase, adoption of 3DPIs is becoming more relevant to offer personalized treatment for complex deformities.
KW - 3D-printed patient-specific implant
KW - Case report
KW - Charcot spine
KW - Neuropathic spinal arthropathy
KW - Rapid implementation
KW - Spine surgery
UR - http://www.scopus.com/inward/record.url?scp=85174640593&partnerID=8YFLogxK
U2 - 10.1227/ons.0000000000000872
DO - 10.1227/ons.0000000000000872
M3 - Article
C2 - 37584482
AN - SCOPUS:85174640593
SN - 2332-4252
VL - 25
SP - 469
EP - 476
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 5
ER -