Where spine surgeons see 3D printing headed in the future


Eight spine surgeons discuss whether the use of 3D-printed implants in spine surgery will increase.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

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Question: What are your thoughts on the trajectory of 3D-printed implants in spine surgery? Will its use grow?

Mark M. Mikhael, MD. Spine Surgeon at NorthShore University HealthSystem's Orthopaedic Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): I am most excited to see how 3D printing will grow with regard to the different materials used, specifically porous metal and biologically favorable implants so they can grow onto bone, similar to what we see in total joint replacement. When it comes to custom implants for spine surgery, they are mainly used as spacers or cages to hold for fusions. The technology is promising but not necessary for all spinal pathologies; most typical patients fall into pre-set implant sizes and don't need custom printed implants.

As a potential advantage going forward, premade 3D-printed devices can be most useful to determine an appropriate implant size, so the surgical team can prepare the correct implant for surgery, instead of bringing multiple styles and trials into the OR. In this way, 3D-printed implants do provide a cost-savings in our value-based healthcare system and might continue to do so as this technology evolves. Finally, 3D-printed spine models can be useful in deformity surgery when based off preoperative CT scans. This can allow surgeons to better prepare for osteotomies and implant placement prior to the procedures.

Rob D. Dickerman, DO, PhD. Director of Neurosurgery at Presbyterian Hospital of Plano (Texas) and Director of Spine Surgery at Medical Center Frisco (Texas): With hospitals cutting costs repeatedly, I don't see 3D implanting being a financially viable option.

Christian Zimmerman, MD. Spinal Neurosurgeon at Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Sterility, precision and added liability will be the largest of hurdles. Yet, the conventional means of manufacturing and surgical applications have become more mechanized. The use will only increase as the proven method of ease, cost and specificity excels.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: The 3D printing realm is really exciting. I think custom-printed implants will most definitely grow. As the costs come down, you will see its use spread. And I think as surgeons can convince purse-holders that these implants cut down on failure and on operating room time, it will take off.

J. Brian Gill, MD. Spine Surgeon at Nebraska Spine Hospital (Omaha): I am really excited about this new technology and its application to spine surgery. I have just begun using these materials in patients. The potential to achieve better fusion rates and overall better outcomes remains to be seen. I anticipate using a far majority of these implants in the spine surgeries I perform over the next 12 months.

Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): This is a technology in its infancy, but it certainly holds promise in the development of a more individualized approach. There are a number of applications for 3D-printed implants which have not even been thought of yet. I think cost considerations are the current limit to its widespread implementation. As costs decrease, volume will rise leading to further cost reduction.

Issada Thongtrangan, MD. Orthopedic Spine and Neurosurgeon at Minimally Invasive Spine (Phoenix): 3D-printed implants have been a hot topic in the past couple of years in spine industry. In my opinion, it makes a lot of sense in difficult cases such as tumor resections and/or any other bony deficiency... I am still waiting to see the outcomes evidence in common degenerative fusion cases.

Ram Mudiyam, MD, Orthopedic Spine Surgeon at Hoag Orthopedic Institute (Irvine, Calif.): Although the concept of 3D-printed (also known as additive manufacturing) spinal devices is exciting and potentially revolutionary, production and application are still in their infancy. Currently 3D printing is limited to interbody cages where porosity and structure can be designed to mimic cancellous bone. There is no level 1 evidence to prove they provide clinically superior outcomes. The technology certainly has the potential to be a game changer with regard to custom manufacturing of spinal segments in tumor replacement and complex deformity surgery.



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