Volume 169, January 2023, Pages 57-72Author links open overlay panelObjective

Spine surgery addresses a wide range of spinal pathologies. Potential applications of 3-dimensional (3D) printed in spine surgery are broad, encompassing education, planning, and simulation. The objective of this study was to explore how 3D-printed spine models are implemented in spine surgery and their clinical applications.

Methods

Methods were combined to create a scoping review with meta-analyses. PubMed, EMBASE, the Cochrane Library, and Scopus databases were searched from 2011 to 7 September 2021. Results were screened independently by 2 reviewers. Studies utilizing 3D-printed spine models in spine surgery were included. Articles describing drill guides, implants, or nonoriginal research were excluded. Data were extracted according to reporting guidelines in relation to study information, use of model, 3D printer and printing material, design features of the model, and clinical use/patient-related outcomes. Meta-analyses were performed using random-effects models.

Results

Forty articles were included in the review, 3 of which were included in the meta-analysis. Primary use of the spine models included preoperative planning, education, and simulation. Six printing technologies were utilized. A range of substrates were used to recreate the spine and regional pathology. Models used for preoperative and intraoperative planning showed reductions in key surgical performance indicators. Generally, feedback for the tactility, utility, and education use of models was favorable.

Conclusions

Replicating realistic spine models for operative planning, education, and training is invaluable in a subspeciality where mistakes can have devastating repercussions. Future study should evaluate the cost-effectiveness and the impact spine models have of spine surgery outcomes.

Introduction

Spine surgery represents a broad field that combines both neurosurgery and orthopedic surgery experience and training to treat a wide range of spinal pathologies, from trauma to deformity correction and oncology. The complex nature of spinal surgery is exacerbated by a growing demand to operate on older individuals, those with higher-than-average risk for surgery1 and the demands of intervening in patients with complex structural abnormalities.2

Three-dimensional (3D) printing is utilized across a range of surgical fields.3 Observed benefits of this evolution include the ability to develop patient-specific implants efficiently with high degrees of precision.4 Incorporating 3D-printed models in patient education has increased overall patient satisfaction.5 Better learning outcomes, such as confidence and procedural performance, have been reported following the implementation of 3D printed models for trainee education and surgical simulation.6 Potential applications of 3D printing in spine surgery are broad, encompassing the factors listed previously.

The objective of this mixed methods review was to explore how 3D-printed spine models are implemented in spine surgery. The review investigated the specifics of model design and fabrication, the nature of which anatomical and physiological features are replicated, and the utilization of models in clinical practice. The current and future trends in the literature are discussed, while evaluating the impact 3D printing has on clinical outcomes.

Section snippetsProcedure

Given the scope of this project, a mixed-methods review design was utilized. Scoping review methods were incorporated to understand the breadth, depth, and focus of literature available for 3D-printed models in spine surgery. Systematic review methods and meta-analyses were incorporated to synthesize outcome data arising from studies utilizing 3D-printed spine model interventions. Constituents of the review were conducted in accordance with the Preferred Reporting Items for Systematic reviews

Search Results

Database searches identified 10,009 records. After removing duplicates, 6300 records were screened, with 89 studies sought for full-text review. Based on the eligibility criteria, 41 studies were excluded (Figure 1. Eligibility flow), 8 reports were not retrieved, leaving 40 studies included for qualitative synthesis including 3 studies contributing to meta-analyses.

Study Information

Thirty-five (87.5%) studies were published in the last 5 years, between 2017 and 2021. North America (the United States of

Discussion

This review examined 40 papers published between 2010 and 2021 exploring the literature regarding the use of 3D-printed spine models in surgery. Most of the studies arose from North America. The majority (47%) of 3D models were generated with fused deposition modeling printers and were most commonly used for preoperative surgical planning, surgical simulation, or trainee education. The models generated were typically produced from acrylonitrile butadiene styrene, a rigid thermoplastic, and

Conclusion

Spine surgery is a complex and demanding field. Spine surgeons face the additive challenges of providing adequate learning opportunities for trainees, educating and informing patients, and all while being attuned to the specifics of individual patient anatomy to prevent serious complications. With the ability to produce accurate spine models using various substrates while incorporating artificial physiology, 3D printing in spine surgery offers to improve communication and delivery of care. With

CRediT authorship contribution statement

Patrick Pearce: Conceptualisation, Methodology formal analysis, Investigation, Data curation, Writing – original draft, Writing – review & editing, Visualisation. James Novak: Conceptualisation, Formal analysis, Investigation, Writing – original draft, Writing – review & editing, Visualisation. Akila Wijesekera: Formal analysis, Investigation, Writing – original draft, Writing – review & editing, Visualisation. Thorbjorn Loch-Wilkinson: Conceptualisation, Investigation, Writing – original

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