3D Printing in Spine Surgery
Over the past decade, 3D printing has gone from a distant, futuristic technology to something that is used in professional environments around the world every single day.
3D printing has also recently found its way into the field of healthcare. Physicians all over the world are finding ways to 3D print medical tools, prosthetic limbs, tissues with blood blood vessels, bones and even vital organs. Moreover, within the past two years, spine surgeons have found a way to harness the power of 3D printing to benefit patients in their field. While the technology is certainly still emerging and developing, physicians around the world are starting to use 3D printers to create customized, perfectly-fitted interbody devices.
Spinal interbody devices are commonplace tools within fusion surgeries. These implants are placed between the vertebrae of the spine to stabilize it after an affected disc is removed and help assist in the fusion process. As it stands, the technology for these interbody devices is already very good. The materials used in production and roughened implant surfaces help promote growth at a nano level and allow for more successful fusions and shorter recovery periods.
That said, most spinal implants in the United States are still taken “off-the-shelf”. There are many different shapes and sizes available which, for the most part, do their job and suit many of the issues that spine surgeons face, but they’re not customized for individual patients and their specific spinal conditions. Additionally, neurosurgeons will occasionally face complicated cases like destructive spine tumors, spinal deformities, trauma or severe spinal degeneration that simply cannot be treated with an off-the-shelf device.
Some might argue that the difference between an off-the-shelf and 3D printed devices is only a matter of millimeters, which is true. But, in surgery, those millimeters can be the difference between a successful, stable fusion and the need for more surgery because the implant didn’t take. Spinal implants require cooperation from the body at the nano level and an osteogenic environment that promotes bone growth and fusion. If something isn’t right at the nano level, it can void the entire operation.
3D printing technology presents a solution to that problem.
The biggest benefit of 3D printing is the flexibility it gives surgeons to customize and create an interbody device for the unique spine of every patient that comes through their doors.
According to Caroline Grant, PhD a researcher at Queensland University of Technology, the reported benefits of 3D printing are, “decreased operating time, decreased radiation exposure to patients intraoperatively, improved overall surgical outcomes, preoperative implant selection, as well as being an excellent communication aid for all medical and surgical team members.”
Physicians begin the fusion process by taking CT and MRI scans of a patient’s spine. This gives them a full view of what exactly where the affected disc is located, where they need to make their incision and gives them the exact dimensions they need to design and print a 3D interbody device that is custom-fit to the patient; before they ever reach the operating table.
Surgeons will often print two versions of the implant before undergoing surgery. The first, known as the “dummy model” is designed so that physicians can see, practice with and test the device for as long as they need before going into the operating room. Occasionally, doctors will also 3D print a replica of the patient’s spine to ensure that the printed device was a perfect fit.
Since 3D printing spinal implants is such a new development in the world of medicine, there isn’t much precedence for the material that should be used within the device. However, in recent months, spine surgeons have tested and suggested that titanium is the strongest, most durable element that can be printed.
The emergence of the 3D printing in spine care is an exciting and, potentially, game-changing development. However, surgeons are still somewhat limited by the technology that is available on the market. For example, printing an interbody device, especially with titanium, can take up to three months and for patients who are struggling with a spinal tumor, severe degeneration or intense pain, this can be too long of a wait. Additionally, the process to design a customized interbody device is long, tedious and complicated.
However, this shouldn’t be discouraging. 3D printing in spinal care is uncharted territory and the technology needed to do it quickly and successfully still needs to be developed but, looking back on history, nearly all emerging technologies had similar struggles at one point. When the first computer was invented in the 1930’s, it took up an entire room. Now, they can fit in the palm of your hand. Similarly, when 3D printing first became a possibility in the early 2000’s it took hours for engineers to produce even a small, low-quality object. Now, it only takes 10 minutes.
As 3D printing technology continues to advance, production times and complications will only continue to decrease until, eventually, every doctor can take an MRI and CT scan, print a 3D device and perform a lifesaving surgery within a matter of days. We predict this will be the case within the next decade.
Another roadblock is clearance from the FDA and surgeon acceptance of the technology across the United States. Our federal government has never been known to be quick at adapting new technologies and the Food and Drug Administration is no exception. It can take the committee over 6 months to simply clear or deny a device for sale in the United States, however this doesn’t account for the fact that there is virtually no regulatory framework for approving 3D printing technology is spine care. This being the case, it will likely take much longer to develop a system of oversight and accountability for the technology as well as approving the technology itself. Additionally, once the technology is approved by the government, it still has to be adapted by neurosurgeons and hospitals across the country. This can be more difficult than it may seem.
Medicine is a very specific and slowly changing field. Surgeons get set in a certain way of doing things, become skilled at using certain devices and technology and are often very wary of taking the time and energy to learn a completely new system when they have one that already works; even if the new technology is better. For example, robotic spine surgery is another emerging technology in the field of medicine that has proven to have better and more accurate results for patients than typical, open spine surgery. Nevertheless, the adaptation of the technology has been slow primarily because there is a significant learning curve for surgeons who are interested in the minimally invasive procedure.
But there is still adaptation! In the end, good surgeons want to deliver the best quality of care possible to each of their patients. This being the case, if they see the demand for the technology rising they will take the time and energy to learn it.
3D printing has the power to change the field of medicine forever and greatly increase the success of even the most complicated spinal surgeries. The technology, though still advancing, already exists and is being used in countries around the world; it simply needs to be accepted and adapted in the United States.