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| GUEST EDITORIAL |
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| Year : 2023 | Volume
: 71
| Issue : 2 | Page : 207-208 |
Precision Neurosurgery with 3D Printing
YR Yadav, J Bajaj
Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| Date of Web Publication | 29-Apr-2023 |
Correspondence Address:
Y R Yadav
Director Office, 4th Floor, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.375410
How to cite this article:
Yadav Y R, Bajaj J. Precision Neurosurgery with 3D Printing. Neurol India 2023;71:207-8 |
Neurosurgery is a challenging field that requires precision and accuracy. The cervical and thoracic areas are particularly challenging due to the surrounding critical neurovascular structures making a little margin of error. Pedicle screw breaches either in the spinal canal or in the vertebral artery foramen may lead to significant neurologic deficits. To overcome this problem, many new armamentariums have been developed, including navigation and robotic-based techniques, which have proven to be effective in preventing screw misplacements.[1],[2] However, these techniques come with high costs and increase the operating time considerably.
The use of 3D-printed devices in neurosurgery has increased significantly and is being applied in various areas such as surgeries for craniovertebral junction, subaxial and thoracic spine, aneurysms, cranioplasties, brain tumors, and others.[3],[4],[5] One of the main advantages of 3D printing is the ability to simulate patient-specific anatomy, which can be useful both for the patient and for teaching purposes. The article by Kashyap et al.[6] describes their innovative technique of a 3D-printed trajectory guide based on the patient's lamina and facets. A trajectory guide is a unique option that can help to overcome some of the limitations of existing technologies by locking onto the spinous process, transverse process, and lamina and directing the screws into the intended trajectory. The study found very high success rates of correct placement of screws both in deformed and aligned spines. The study, however, lacked a control arm and had only 23 patients. This technique per se is not unknown, and several authors have described the use of 3D printing before, albeit with some variations.[7],[8] 3D printing has also been found useful in revision spine surgeries.[9] While the emergence of 3D-printed models has undeniably helped to refine accuracy, we must acknowledge that it cannot offer a guarantee of absolute precision, and factors such as inept design, positioning, identification of bony landmarks, and surgeon-related factors can lead to inaccuracies. In addition, the availability of 3D models can be challenging, as they may need to be created outside the facility, which can take 1–2 days and impede emergency workflows.
Cost still remains a significant issue. Although the cost of one vertebral level is low, the total cost for long segments can be high. The cost is, however, expected to decrease with the increasing number of suppliers. The utilization of personalized 3D modeling presents a noteworthy apprehension with regard to environmental impact, given that the model's utility becomes obsolete once the surgery is complete, resulting in the generation of plastic waste. As such, it is imperative that the scientific community seriously contemplates this aspect too.
Comparing the precision of robotic systems to 3D printing is an intriguing prospect, as the former is known to be more accurate. However, it is worth noting that navigation systems are not without their limitations, with a failure rate, even with O-arm integration, of approximately 3%–4%.[1] To shed more light on the matter, future research should focus on exploring the potential clinical significance of using 3D printing techniques versus traditional and navigation-based methods in reducing neurologic deficits. We eagerly await Class I evidence in this field to better inform our understanding.
| » References | |  |
| 1. | Shree Kumar D, Ampar N, Wee Lim L. Accuracy and reliability of spinal navigation: An analysis of over 1000 pedicle screws. J Orthop 2020;18:197-203.  |
| 2. | Li C, Li H, Su J, Wang Z, Li D, Tian Y, et al. Comparison of the accuracy of pedicle screw placement using a fluoroscopy-assisted free-hand technique with robotic-assisted navigation using an O-Arm or 3D C-Arm in scoliosis surgery. Global Spine J 2022:21925682221143076. doi: 10.1177/21925682221143076. |
| 3. | Cai S, He Y, Cui H, Zhou X, Zhou D, Wang F, et al. Effectiveness of three-dimensional printed and virtual reality models in learning the morphology of craniovertebral junction deformities: A multicentre, randomised controlled study. BMJ Open 2020;10:e036853. doi: 10.1136/bmjopen-2020-036853. |
| 4. | Rashim K, Verma Pawan K, Sinha VD. Increasing the safety of surgical treatment for complex Cranio-vertebral anomalies using customized 3D printed models. J Clin Neurosci 2018;48:203-8. |
| 5. | Chaudhary A, Chopra S, Sinha VD. Role of Three-dimensional printing in neurosurgery: An institutional experience. Asian J Neurosurg 2021;16:531-8. [Full text] |
| 6. | Kashyap A, Karim A, Arora S, Singh K, Jha S, Maini L. Accuracy of Patient-Specific, 3D-Printed Laminofacetal Based Trajectory-Guide for Pedicle Screw Placement in Subaxial Cervical and Thoracic Spine. Neurol India 2023;71:260-6. [Full text] |
| 7. | Deng T, Jiang M, Lei Q, Cai L, Chen L. The accuracy and the safety of individualized 3D printing screws insertion templates for cervical screw insertion. Comput Assist Surg (Abingdon) 2016;21:143-9. |
| 8. | Sugawara T, Kaneyama S, Higashiyama N, Tamura S, Endo T, Takabatake M, et al. Prospective multicenter study of a multistep screw insertion technique using patient-specific screw guide templates for the cervical and thoracic spine. Spine (Phila Pa 1976) 2018;43:1685-94. |
| 9. | Faldini C, Barile F, Cerasoli T, Ialuna M, Viroli G, Manzetti M, et al. Accuracy of patient-specific 3D-printed guides for pedicle screw insertion in spine revision surgery: Results of a retrospective study. Surg Technol Int 2022;41:sti41/1642. doi: 10.52198/22.STI.41.NS1642. |
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