Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Summary

Herein, we present a three-dimensional printing guide template for percutaneous vertebraplasty. A patient with a T11 vertebral compression fracture was selected as a case study.

Abstract

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The accuracy of PVP mainly depends on the surgeons' experience and multiple fluoroscopes during a traditional procedure. Puncture related complications were reported all over the world. To make the surgical procedure more precise and decrease the rate of puncture-related complications, our team applied a three-dimensional printing guide template to PVP to modify the traditional procedure. This protocol introduces how to model target vertebrae DICOM imaging data into three-dimensions in the software, how to simulate operation in this 3-D model, and how to use all of the surgical data to reconstruct a patient specific template for application. Using this template, surgeons can identify suitable puncture points accurately to improve the accuracy of the operation. The whole protocol includes: 1) diagnosis of the osteoporotic vertebral compression fracture; 2) acquisition of CT imaging of the target vertebra; 3) simulation of the operation in the software; 4) design and fabrication of the 3-D printing guide template; and 5) application of the template into an operation procedure.

Introduction

As the most common type fracture among all kinds of osteoporotic fractures, osteoporotic vertebral compression fracture (OVCF) is a highly concerning clinical problem nowadays. As current guidelines recommend, percutaneous vertebroplasty is one of the most effective minimally invasive methods to clinically treat osteoporotic vertebral compression fractures¹.

Traditionally, surgeons perform percutaneous vertebroplasty guided by a C-arm fluoroscope to treat a vertebral compression fracture to restore the compressed vertebral body and relieve early-stage pain². Even experienced surgeons make mist....

Protocol

The present study was approved by the ethics committee of Beijing Friendship Hospital Capital Medical University.

1. Diagnosis of the osteoporotic vertebral compression fracture (OVCF) by X-ray fluoroscopy, magnetic resonance image (MRI), bone scintigraphy, and symptoms

1. Identify patients who have OVCF by older patients with back pain, tenderness in the spinous process, paraspinal muscles at back, etc.
2. Use posterioanterior X-ray fluoroscopy to check if patient has vertebral compression fracture.
3. Use an MRI to diagnosis whether a patient has a newly onset vertebral compression fracture, and determine the target....

Results

Acquisition of CT images and digital modeling were performed in the hospital, while 3-D printing was performed in a 3-D printing company. Thirty minutes were needed to reconstruct the 3-D model from the CT images for the 3-D printing, and the 3-D printing company needed about 6 hours to print 2 guide templates out and send to the hospital.

The pre-operation images of the target vertebra of the patient were shown in

Discussion

Percutaneous vertebroplasty (PVP) is considered one of the best methods to treat osteoporotic vertebral compression fracture⁹ due to some distinct advantages: it is minimally invasive; there is less bleeding, and recovery is rapid. Traditional PVP is primarily guided by a C-arm fluoroscope that requires repeated fluoroscopy to determine safe and ideal puncture points, puncture angles and orientations, which increases the intraoperative radiation dosage and the operation time¹⁰

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
X-ray machine	Company Philips		machine
Magnetic resonance image machine	Company GE		machine
computer tomography	Company GE		machine
HORI 3D printing machine	Company of Beijing Huitianwei Technology co. ltd.		machine
Geomagic Design X	3D Systems Company		software
Materialise Interactive Medical Image Control System	Materialise Company		software
VertePort needle	Stryker Company		operation appliance
Spineplex	Stryker Company		operation appliance
Percutaneous Cement Delivery System	Stryker Company		operation appliance
Spirit Level Plus	IOS App store		gradientor