This publication was supported by the Beijing Municipal Natural Science Foundation (L192059).

All data come from the clinical patient, whose SDR operation was carried out at BJ Dongzhimen Hospital. The protocol follows the guidelines of and was approved by the Dongzhimen Hospital research ethics committee.
NOTE: The whole map of the model reconstruction protocol is shown in Figure 1. The high-resolution computed tomography (HRCT) data and Dixon data are raw materials for modeling; then, the 3D model creation consists of image registration and fusion. The f...

<ol>
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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improving+access+to+selective+dorsal+rhizotomy+for+children+with+cerebral+palsy.">Improving access to selective dorsal rhizotomy for children with cerebral palsy.</a> Canadian Medical Association Journal. 191 (44), E1205-E1206 (2019).</li><li>Buizer, A. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selective+dorsal+rhizotomy+in+children+with+cerebral+palsy.">Selective dorsal rhizotomy in children with cerebral palsy.</a> The Lancet. Child &amp; Adolescent Health. 3 (7), 438-439 (2019).</li><li>Wong, K. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3D-printed+patient-specific+applications+in+orthopedics.">3D-printed patient-specific applications in orthopedics.</a> Orthopedic Research and Reviews. 8, 57-66 (2016).</li><li>Wong, K. C., Kumta, S. M., Geel, N. V., Demol, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One-step+reconstruction+with+a+3D-printed,+biomechanically+evaluated+custom+implant+after+complex+pelvic+tumor+resection.">One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection.</a> Computer Aided Surgery. 20 (1), 14-23 (2015).</li><li>Zhu, R., Li, X., Zhang, X., Ma, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=MRI+and+CT+medical+image+fusion+based+on+synchronized-anisotropic+diffusion+model.">MRI and CT medical image fusion based on synchronized-anisotropic diffusion model.</a> IEEE Access. 8, 91336-91350 (2020).</li><li>Park, T. S., Gaffney, P. E., Kaufman, B. A., Molleston, M. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selective+lumbosacral+dorsal+rhizotomy+immediately+caudal+to+the+conus+medullaris+for+cerebral+palsy+spasticity.">Selective lumbosacral dorsal rhizotomy immediately caudal to the conus medullaris for cerebral palsy spasticity.</a> Neurosurgery. 33 (5), 929-934 (1993).</li><li>Sindou, M., Georgoulis, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Keyhole+interlaminar+dorsal+rhizotomy+for+spastic+diplegia+in+cerebral+palsy.">Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy.</a> Acta Neurochirurgica. 157 (7), 1187-1196 (2015).</li><li>Peacock, W. J., Staudt, L. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selective+posterior+rhizotomy:+evolution+of+theory+and+practice.">Selective posterior rhizotomy: evolution of theory and practice.</a> Pediatric Neurosurgery. 17 (3), 128-134 (1991).</li><li>Vitrikas, K., Dalton, H., Breish, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+palsy:+an+overview.">Cerebral palsy: an overview.</a> American Family Physician. 101 (4), 213-220 (2020).</li><li>Niikura, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tactile+surgical+navigation+system+for+complex+acetabular+fracture+surgery.">Tactile surgical navigation system for complex acetabular fracture surgery.</a> Orthopedics. 37 (4), 237-242 (2014).</li><li>Lepisto, J., Armand, M., Armiger, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Periacetabular+osteotomy+in+adult+hip+dysplasia-developing+a+computer+aided+real-time+biome-chanical+guiding+system+(BGS).">Periacetabular osteotomy in adult hip dysplasia-developing a computer aided real-time biome-chanical guiding system (BGS).</a> Finnish Journal of Orthopaedics and Traumatology. 31 (2), 186-190 (2008).</li><li>Armiger, R. S., Armand, M., Tallroth, K., Lepisto, J., Mears, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+mechanical+evaluation+of+joint+contact+pressure+in+12+periacetabular+osteotomy+patients+with+10-year+follow-up.">Three-dimensional mechanical evaluation of joint contact pressure in 12 periacetabular osteotomy patients with 10-year follow-up.</a> Acta Orthopaedica. 80 (2), 155-161 (2009).</li><li>Rengier, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3D+printing+based+on+imaging+data:+review+of+medical+applications.">3D printing based on imaging data: review of medical applications.</a> International Journal of Computer Assisted Radiology and Surgery. 5 (4), 335-341 (2010).</li><li>Jiang, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Model-based+compensation+of+moving+tissue+for+state+recognition+in+robotic-assisted+pedicle+drilling.">Model-based compensation of moving tissue for state recognition in robotic-assisted pedicle drilling.</a> IEEE Transactions on Medical Robotics and Bionics. 2 (3), 463-473 (2020).</li><li>Setton, L. 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This study provides a workflow for establishing a preoperative 3D printing model of the lumbar spine in patients with cerebral palsy, with the aim of facilitating preoperative planning for SDR surgery and enhancing anatomical training based on the patient's specific model. The study aims to establish a highly reliable 3D-printed model that accurately demonstrates the patient's lumbar vertebral and nerve structures. By measuring the position of the lamina and spinal nerve in the model before surgery, precise planning of t...

Spastic cerebral palsy affects over half of all children with cerebral palsy1, leading to tendon contractures, abnormal skeletal development, and decreased mobility, greatly impacting the quality of life of affected children2. As the main surgical method for the treatment of spastic cerebral palsy, selective dorsal rhizotomy (SDR) has been fully validated and recommended by many countries3,4. However, the intricate and high-risk nature of SDR surgery, including the precise cutting of the lamina, positioning and dissociation of nerve roots, and severing of nerve fibers, presents a significant challenge for young doctors who are just beginning to engage with SDR in clinical practice; further, the learning curve of SDR is very steep.
In traditional orthopedic surgery, surgeons must mentally integrate all preoperative two-dimensional (2D) images and create a 3D surgical plan5. This approach is particularly difficult for preoperative planning involving complex anatomical structures and surgical manipulations, such as SDR. With advances in medical imaging and computer technology, 2D axial images, such as computed tomography (CT) and magnetic resonance imaging (MRI) can be processed to create 3D virtual models with patient-specific anatomy6. With improved visualization, surgeons can analyze this processed information to make more detailed diagnoses, planning, and surgical interventions tailored to the patient&#39;s condition. In recent years, the application of multimodal image fusion technology in orthopedics has gradually attracted attention7. This technology could fuse CT and MRI images, greatly improving the accuracy of the digital3D analog model. However, the application of this technique in preoperative models of SDR has not been researched yet.
Accurate positioning of the lamina and spinal nerve and precise cutting during SDR surgery are crucial for successful outcomes. Typically, these tasks rely on experts&#39; experience and are confirmed repeatedly by a C-arm during the operation, resulting in a complex and time-consuming surgical process. The 3D digital model serves as the foundation for future SDR surgical navigation and can also be utilized for preoperative planning of laminectomy procedures.&#160;This model fuses the bone structure from CT and the spinal nerve structure from MRI, and assigns different colors to the lumbar vertebra sections marked for cutting according to the surgical plan. Such holographic 3D printing models for SDR not only facilitate preoperative planning and simulation, but also output accurate 3D navigation coordinates to the intraoperative robotic arm for precise cutting.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>J55 Prime 3D-Printer</td>
			<td>Stratasys</td>
			<td>J55 Prime</td>
			<td>Manufacturing the model</td>
		</tr>
		<tr>
			<td>MATLAB</td>
			<td>MathWorks&#160;</td>
			<td>2022B</td>
			<td>Computing and visualization&#160;</td>
		</tr>
		<tr>
			<td>Mimics</td>
			<td>Materialise</td>
			<td>Mimics Research V20</td>
			<td>Model format transformation</td>
		</tr>
		<tr>
			<td>Tools for volum fusion</td>
			<td>Intelligent Entropy</td>
			<td>VolumeFusion V1.0</td>
			<td>Beijing Intelligent Entropy Science &#38; Technology Co Ltd. 
			Modeling for CT/MRI fusion</td>
		</tr>
	</tbody>
</table>

3d printing model of a patient's specific lumbar vertebra

Selective dorsal rhizotomy (SDR) is a difficult, risky, and sophisticated operation, in which a laminectomy should not only expose an adequate surgical field of view but also protect the patient&#39;s spinal nerves from injury. Digital models play an important role in the pre-and intra-operation of SDR, because they can not only make doctors more familiar with the anatomical structure of the surgical site, but also provide precise surgical navigation coordinates for the manipulator. This study aims to create a 3D digital model of a patient-specific lumbar vertebra that can be used for planning, surgical navigation, and training of the SDR operation. The 3D printing model is also manufactured for more effective work during these processes.
Traditional orthopedic digital models rely almost entirely on computed tomography (CT) data, which is less sensitive to soft tissues. Fusion of the bone structure from CT and the neural structure from magnetic resonance imaging (MRI) is the key element for the model reconstruction in this study. The patient&#39;s specific 3D digital model is reconstructed for the real appearance of the surgical area and shows the accurate measurement of inter-structural distances and regional segmentation, which can effectively help in the preoperative planning and training of SDR. The transparent bone structure material of the 3D-printed model allows surgeons to clearly distinguish the relative relationship between the spinal nerve and the vertebral plate of the operated segment, enhancing their anatomical understanding and spatial sense of the structure. The advantages of the individualized 3D digital model and its accurate relationship between spinal nerve and bone structures make this method a good choice for preoperative planning of SDR surgery.

Based on lumbar CT/MRI image fusion data in children with cerebal palsy, we created a representative model of the lumbar spine combined with spinal nerves. High-pass filtering was used to extract the high signal in the CT value range of 190-1,656 from HRCT, so as to achieve the reconstruction of the bone structure of the lumbar spine in the operation area. Spinal nerve structures were reconstructed by the high-pass filtering of Dixon-w sequences in MRI. The digital model and point cloud data coordinates of the lumbar ver...

Watch this Scientific Journal Video about 3D Printing Model of a Patient's Specific Lumbar Vertebra at JoVE.com

3D Printing Model of a Patient&#039;s Specific Lumbar Vertebra

This study aims to create a 3D-printed model of a patient-specific lumbar vertebra, which contains both the vertebra and spinal nerve models fused from high-resolution computed tomography (HRCT) and MRI-Dixon data.

3D Printing Model of a Patient's Specific Lumbar Vertebra

Selective dorsal rhizotomy (SDR) is a difficult, risky, and sophisticated operation, in which a laminectomy should not only expose an adequate surgical ...

The protocol has fills the complex CT and MRI images of human anatomical structures, leveraging the respectively advantage of both type of imaging. This is a significant innovation in the field of medical imaging. In the fused model, doctors can view both bone structure from CT and softer tissue structures from MRI.Additionally, the 3D model can be used for precise 3D navigation of surgical robots. This technology is applicable to almost all seniors that require multimodal fusion, such as ultrasonic image fusion. The 3D fusion model is also of great significance for pre-arbitral planning and the post-arbitral evaluation.When using this technology, you will have insight from multimodal imaging simultaneously. Different dimension perspective will unfold synchronously, and the diagnostic and therapeutic process will evolve. To begin, set the data resources from the CT machine station.Open the single CT 2012 B software to receive data from the scanning protocol SpineRoutine_1. Use a slice thickness of one millimeter with a matrix size of 512 pixels by 512 pixels, in which the pixel spacing is 0.3320 millimeters. The actual size of the 3D volume achieved is 512 by 512 by 204 voxels.Call the Dicom2Mat subprocess in the MATLAB workplace to obtain the 3D volume from the DICOM files stored in the HRCT data folder. View each slice within the 3D volume through the graphical user interface or GUI. Then visualize the intensity distribution of the vertebrae HRCT data by the heist function.Call the noise clean subprocess to delete signal noise formed by the device under the HRCT data file parts. And use the vertebrae function subprocess under the same path, to gain the vertebrae model which is also a 3D volume, but only with the bone structure. Use the high-pass filter parameters and the intensity range from 190 to 1, 656.Use the Dicom2Mat subprocess in both parts of the Dixon-In and Dixon_W sequences, and get their 3D volume. Visualize each individual slice that constitutes a 3D volume and access this visualization once the Dicom2Mat subprocess has been completed. Use the spinal nerve function to reconstruct the spinal nerve model with high-pass filter parameters and the intensity range from 180 to 643.Filter out points with low intensity to extract the spinal nerve 3D volume as the nerve signals in the Dixon_W sequence are very high. Once the spinal nerve subprocess is finished check the model generated in the GUI. Copy the three 3D volumes to the file path of the project.The models from HRCT and DIXON-In include the same vertebrae structure. And the models from DIXON-In and Dixon_W have the same coordinates. Put the three models file names into the vertebrae fusion subprocess as an input to generate the fusion model.If fine tuning is necessary from the doctor's perspective, add coordinate parameters in all directions to the same function to correct the fusion model. If slight errors are observed in fusion from a clinical perspective, use the vertebra fusion function to fine tune the fusion coordinates. This process involves parameter adjustments to the six dimensions of coordinate direction.Make a separate folder in the project directory for outputting the result of the fusion model. Export the fusion models to be used for 3D printing in the DICOM format sequences under the file path of the fusion directory. Utilize the mat2dicom algorithm to execute the export operation.by inputting the fusion model. Open the DICOM file sequence exported previously using Materialise Mimics version 20 to perform the export operation. Navigate to the export menu under the file tab and select the VRML format.The file path for the export can be freely customized according to the user's requirements. As transparent colorful 3D printing is a professional service, compress and pack the VRML files and send them to the service provider. The multimodal fusion model of CT and MRI is used for preoperative planning and training in Selective Dorsal Rhizotomy or SDR.The GUI of slices in the volume from the HRCT data is shown in this figure. Through this GUI, surgeons can view the spine structure contained in all the CT data. The graphical image shown here represents the intensity distribution of vertebrae HRCT data.This quantitative information helps to determine the filtering range of vertebrae structure. The 3D printing model for Selective Dorsal Rhizotomy or SDR planning and training is shown in this image. Different colored dyes are used to disdain and distinguish the structures, such as bones and nerves.The spinal nerve structure is dyed yellow and the lamina of L4 and L5 segments in the corresponding operation area, are distinguished by red and blue staining. The bone structure is printed using a transparent resin material, which allows the doctors to observe the nerve structure under the lamina through the bone structure. Equivalent, insensitive, or multimodal fusion technology is bound to bring various new applications as doctors can obtain information from different dimensions in one model.Medical imaging based diagnostic treatment and the surgical navigation are the main battlegrounds for multimodal fusion technology in the field of medical imaging.

3d-printing-model-of-a-patient-s-specific-lumbar-vertebra

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JoVE Journal

Medicine

1.6K Views.  Beijing University of Chinese Medicine. The protocol has fills the complex CT and MRI images of human anatomical structures, leveraging the respectively advantage of both type of imaging. This is a significant innovation in the field of medical imaging. In the fused model, doctors can view both bone structure from CT and softer tissue structures from MRI.Additionally, the 3D model can be used for precise 3D navigation of surgical robots. This technology is applicable to almost all seniors that require multimodal fusion, such...

Video: 3D Printing Model of a Patient's Specific Lumbar Vertebra

This study aims to create a 3D-printed model of a patient-specific lumbar vertebra, which contains both the vertebra and spinal nerve models fused from high-resolution computed tomography (HRCT) and MRI-Dixon...

3d planning and printing of patient specific implants for reconstruction of bony defects

3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects

This protocol describes the use of 3D planning and printing for reconstruction of bony defects. We use segmentation tools to create 3D models followed by 3D design software to create patient specific implants for reconstruction purposes concomitant to ablative surgery or as a second...

treatment of facial deformities using 3d planning and printing of patient-specific implants

Treatment of Facial Deformities using 3D Planning and Printing of Patient-Specific Implants

As technology develops and becomes more user-friendly, planning of operations and patient-specific surgical guides and fixation plates should be performed by the surgeon. We present a protocol for 3D planning of orthognathic skeletal movements and 3D planning and printing of patient-specific fixation plates and surgical...

combining augmented reality and 3d printing to display patient models on a smartphone

Combining Augmented Reality and 3D Printing to Display Patient Models on a Smartphone

Presented here is a method to design an augmented reality smartphone application for the visualization of anatomical three-dimensional models of patients using a 3D-printed reference...

3d printing - evaluating particle emissions of a 3d printing pen

3D Printing - Evaluating Particle Emissions of a 3D Printing Pen

This protocol presents a method to analyze the emission of 3D printing pens. Particle concentration and particle size distribution of the released particle is measured. Released particles are further analyzed with transmission electron microscopy (TEM). Metal content in filaments is quantified by inductively coupled plasma mass spectrometry...

mouse lumbar vertebra uniaxial compression testing with embedding of the loading surface

Author Spotlight: Enhancing Small Animal Bone Compression Testing for Research

In this protocol, two approaches are described to make uniaxial compression testing of mouse lumbar vertebrae more attainable. First, the conversion of a three-point bending machine to a compression testing machine is described. Second, an embedding method for preparing the loading surface that uses bone cement is adapted for mouse lumbar...

Mouse Lumbar Vertebra Uniaxial Compression Testing with Embedding of the Loading Surface

interactive molecular model assembly with 3d printing

Interactive Molecular Model Assembly with 3D Printing

Physical modeling of microscopic systems helps obtain insights that are difficult to gain by other means. To facilitate the construction of physical molecular models, we demonstrate how 3D printing can be used to assemble functional macroscopic models that capture qualities of molecular systems in a tactile...

evaluating regional pulmonary deposition using patient-specific 3d printed lung models

Evaluating Regional Pulmonary Deposition using Patient-Specific 3D Printed Lung Models

We present a high-throughput, in vitro method for quantifying regional pulmonary deposition at the lobe level using CT scan-derived, 3D printed lung models with tunable air flow...

biomechanical analysis of adjacent segments after spinal fusion surgery using a geometrically parametric patient-specific finite element model

Biomechanical Analysis of Adjacent Segments after Spinal Fusion Surgery Using a Geometrically Parametric Patient-Specific Finite Element Model

Here, we used a patient-specific finite element model to analyze the mechanical changes in adjacent segments after spinal fusion surgery. The results showed that fusion surgery reduced the overall motion of the lumbar spine but increased the load on and stress in adjacent segments, especially the proximal...

a mouse model of lumbar spine instability

A Mouse Model of Lumbar Spine Instability

We developed a lumbar intervertebral disc degeneration mouse model by resection of L3&#8211;L5 spinous processes along with supra- and inter-spinous ligaments and detachment of paraspinous...

constructing a 3d digital model for any specific nodule

Constructing a 3D Digital Model for any Specific Nodule  

stereolithographic 3d printing with renewable acrylates

Stereolithographic 3D Printing with Renewable Acrylates

A protocol for additive manufacturing with renewable photopolymer resins on a stereolithography apparatus is...

multicolor 3d printing of complex intracranial tumors in neurosurgery

Multicolor 3D Printing of Complex Intracranial Tumors in Neurosurgery

The protocol describes the fabrication of fully colored three-dimensional prints of patient-specific, anatomical skull models to be used for surgical simulation. The crucial steps of combining different imaging modalities, image segmentation, three-dimensional model extraction, and production of the prints are...

fabrication of engineered vascular flaps using 3d printing technologies

Fabrication of Engineered Vascular Flaps Using 3D Printing Technologies

Engineered flaps require an incorporated functional vascular network. In this protocol, we present a method of fabricating a 3D printed tissue flap containing a hierarchical vascular network and its direct microsurgical anastomoses to rat femoral...

dissection of the 5th lumbar vertebra (l5) from the mouse carcass for uniaxial compression testing

Dissection of the 5th Lumbar Vertebra (L5) from the Mouse Carcass for Uniaxial Compression Testing

multimodal 3d printing of phantoms to simulate biological tissue

Multimodal 3D Printing of Phantoms to Simulate Biological Tissue

Spin coating, polyjet printing, and fused deposition modeling are integrated to produce multilayered heterogeneous phantoms that simulate structural and functional properties of biological...

3d printing of biomolecular models for research and pedagogy

3D Printing of Biomolecular Models for Research and Pedagogy

Physical models of biomolecules can facilitate an understanding of their structure-function for the researcher, aid in communication between researchers, and serve as an educational tool in pedagogical endeavors. Here, we provide detailed guidance for the 3D printing of accurate models of biomolecules using fused filament fabrication desktop 3D...

creation of a high-fidelity, low-cost, intraosseous line placement task trainer via 3d printing

Creation of a High-Fidelity, Low-Cost, Intraosseous Line Placement Task Trainer via 3D Printing

We describe a procedure to process computed tomography (CT) scans into high-fidelity, reclaimable, and low-cost procedural task trainers. The CT scan identification processes, export, segmentation, modeling, and 3D printing are all described, along with the issues and lessons learned in the process.

3d printing of preclinical x-ray computed tomographic data sets

3D Printing of Preclinical X-ray Computed Tomographic Data Sets

Using modern plastic extrusion and printing technologies, it is now possible to quickly and inexpensively produce physical models of X-ray CT data taken in a laboratory.  The three -dimensional printing of tomographic data is a powerful visualization, research, and educational tool that may now be accessed by the preclinical imaging...

novel process for 3d printing decellularized matrices

Novel Process for 3D Printing Decellularized Matrices

This protocol describes the production of polycaprolactone (PCL) filament with embedded polylactic acid (PLA) microspheres which contain decellularized matrices (DM) for 3D printing of structural tissue engineering...

3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache

A growing body of research, generated primarily from MRI-based studies, shows that migraine appears to occur, and possibly endure, due to the alteration of specific neural processes in the central nervous system. However, information is lacking on the molecular impact of these changes, especially on the endogenous opioid system during migraine headaches, and neuronavigation through these changes has never been done. This study aimed to investigate, using a novel 3D immersive and interactive neuronavigation (3D-IIN) approach, the endogenous &#181;-opioid transmission in the brain during a migraine headache attack in vivo. This is arguably one of the most central neuromechanisms associated with pain regulation, affecting multiple elements of the pain experience and analgesia. A 36 year-old female, who has been suffering with migraine for 10 years, was scanned in the typical headache (ictal) and nonheadache (interictal) migraine phases using Positron Emission Tomography (PET) with the selective radiotracer [11C]carfentanil, which allowed us to measure &#181;-opioid receptor availability in the brain (non-displaceable binding potential - &#181;OR BPND). The short-life radiotracer was produced by a cyclotron and chemical synthesis apparatus on campus located in close proximity to the imaging facility. Both PET scans, interictal and ictal, were scheduled during separate mid-late follicular phases of the patient's menstrual cycle. During the ictal PET session her spontaneous headache attack reached severe intensity levels; progressing to nausea and vomiting at the end of the scan session. There were reductions in &#181;OR BPND in the pain-modulatory regions of the endogenous &#181;-opioid system during the ictal phase, including the cingulate cortex, nucleus accumbens (NAcc), thalamus (Thal), and periaqueductal gray matter (PAG); indicating that &#181;ORs were already occupied by endogenous opioids released in response to the ongoing pain. To our knowledge, this is the first time that changes in &#181;OR BPND during a migraine headache attack have been neuronavigated using a novel 3D approach. This method allows for interactive research and educational exploration of a migraine attack in an actual patient's neuroimaging dataset.

3D-Neuronavigation In Vivo Through a Patient&#039;s Brain During a Spontaneous Migraine Headache

In this study, the authors report for the first time a novel 3D-Immersive &#38; Interactive Neuronavigation (3D-IIN) through the impact of a spontaneous migraine headache attack in the &#956;-opioid system of a patient's brain in vivo.

A growing body of research, generated primarily from MRI-based studies, shows that migraine appears to occur, and possibly endure, due to the alteration ...

Ovine Lumbar Intervertebral Disc Degeneration Model Utilizing a Lateral Retroperitoneal Drill Bit Injury

Intervertebral disc degeneration is a significant contributor to the development of back pain and the leading cause of disability worldwide. Numerous animal models of intervertebral disc degeneration have been developed. The ideal animal model should closely mimic the human intervertebral disc with regard to morphology, biomechanical properties and the absence of notochordal cells. The sheep lumbar intervertebral disc model fulfils these criteria. We present an ovine model of intervertebral disc degeneration utilizing a drill bit injury through a lateral retroperitoneal approach. The lateral approach significantly reduces the incision and potential morbidity associated with the traditional anterior approach to the ovine spine. Utilization of a drill-bit method of injury affords the ability to produce a consistent and reproducible injury, of precise dimensions, that initiates a consistent degree of intervertebral disc degeneration. The focal nature of the annular and nucleus pulposus defect more closely mimics the clinical condition of focal intervertebral disc herniation. Sheep recover rapidly following this procedure and are typically mobile and eating within the hour. Intervertebral disc degeneration ensues and sheep undergo necropsy and subsequent analysis at periods from eight weeks. We believe that the drill bit injury model of intervertebral disc degeneration offers advantages over more conventional annular injury models.

Intervertebral disc degeneration is a significant contributor to back pain and a leading cause of disability worldwide. Numerous animal models of intervertebral disc degeneration exist. We demonstrate an ovine model of intervertebral disc degeneration, utilizing a drill bit, which achieves a consistent disc injury and reproducible level of disc degeneration.

Intervertebral disc degeneration is a significant contributor to the development of back pain and the leading cause of disability worldwide. Numerous ...

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are two techniques for the introduction of a working cannula with respect to disc&#8212;outside-in and inside-out. The aim of this prospective study is to describe the technical aspects of a novel mobile outside-in method in dealing with different types of disc prolapse. A total of 184 consecutive patients with unilateral lower limb radiculopathy due to lumbar disc prolapse were operated on with the mobile outside-in technique of PETLD. Their clinical outcomes were evaluated based on the type of disc prolapse they had, a visual analog scale (VAS) leg pain score, the Oswestry Disability Index (ODI), and the Macnab criteria. The completeness of the decompression was documented with a postoperative magnetic resonance imaging. The mean age of the patients was 50 &#177; 16 years and the male/female ratio was 2:1. The mean follow-up was 19 &#177; 6 months. A total of 190 lumbar levels were operated on (L1&#8211;L2: n = 4, L2&#8211;L3: n = 17, L3&#8211;L4: n = 27, L4&#8211;5: n = 123, and L5&#8211;S1: n = 19). Divided into types, the patient distribution was central: n = 14, paracentral: n = 74, foraminal: n = 28, far lateral: n = 13, superior-migrated: n = 8, inferior migrated: n = 38, and high canal compromise: n = 9. The mean operative time was 35 &#177; 12 (25 - 56) min and the mean hospital stay was 1.2 &#177; 0.5 (1&#8211;3) days. The VAS score for leg pain improved from 7.5 &#177; 1 to 1.7 &#177; 0.9. The ODI improved from 70 &#177; 8.3 to 23 &#177; 5. According to the Macnab criteria, 75 patients (40.8%) had excellent results, 104 patients (56.5%) had good results, and 5 patients (2.7%) had fair results. Recurrence (including early and late) was seen in 15 out of the 190 levels that were operated on (7.89%). This article presents a novel outside-in approach that relies on a precise landing within the foramen in a mobile manner and does not solely depend upon the enlargement of the foramen. It is more versatile in application and useful in the management of all types of disc prolapse, even in severe canal compromise and high migration.

Here we present a protocol of a novel outside-in technique of transforaminal endoscopic discectomy for lumbar disc herniations. The technical aspects of the technique, the wide indications of use, and the results of the treatment in 184 patients are described in detail.

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are ...

Isometric Contractility Measurement of the Mouse Mesenteric Artery Using Wire Myography

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and drugs. It is widely used in many studies on the physiological functions of vascular smooth muscle, the pathogenesis of vascular diseases such as hypertension, and the development of smooth muscle relaxant drugs. The mouse is a widely used model animal with a large pool of disease models and genetically modified strains. We introduced this method to measure the isometric contraction of mouse mesenteric artery in detail. A 1.4-mm segment of mouse mesenteric resistance artery was isolated and mounted on a myograph chamber by passing two steel wires through its lumen. After equilibration and normalization steps, the vessel segment was potentiated by a high-K+ solution twice prior to the contraction assay. As an example of the application of this method in drug development, we measured the relaxant effect of a novel natural substance, neoliensinine, isolated from a Chinese herb, embryos of the lotus seed (Nelumbo nucifera Gaertn.) on mouse mesenteric arteries. The vessel segments mounted on the myograph chamber were stimulated with a high-K+ solution. When the force tension reached a stable sustained phase, cumulative doses of neoliensinine were added to the chamber. We found that neoliensinine had a dose-dependent relaxant effect on smooth muscle contraction, thus suggesting that it bears potential activity against hypertension. In addition, as the vessel segment can survive at least 4 hours after mounting and maintain contractility induced by the high-K+ solution for many times, we suggest that the wire myograph system may be used for the time-consuming process of drug screening.

The wire myograph technique is used to investigate vascular smooth muscle functions and screen new drugs. We report a detailed protocol for measuring the isometric contractility of the mouse mesenteric artery and for screening new relaxants of vascular smooth muscle.

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and ...

Three-dimensional (3D) printing technologies offer the possibility of visualizing patient-specific pathologies in a physical model of correct dimensions. The model can be used for planning and simulating critical steps of a surgical approach. Therefore, it is important that anatomical structures such as blood vessels inside a tumor can be printed to be colored not only on their surface, but throughout their whole volume. During simulation this allows for the removal of certain parts (e.g., with a high-speed drill) and revealing internally located structures of a different color. Thus, diagnostic information from various imaging modalities (e.g., CT, MRI) can be combined in a single compact and tangible object.
However, preparation and printing of such a fully colored anatomical model remains a difficult task. Therefore, a step-by-step guide is provided, demonstrating the fusion of different cross-sectional imaging data sets, segmentation of anatomical structures, and creation of a virtual model. In a second step the virtual model is printed with volumetrically colored anatomical structures using a plaster-based color 3D binder jetting technique. This method allows highly accurate reproduction of patient-specific anatomy as shown in a series of 3D-printed petrous apex chondrosarcomas. Furthermore, the models created can be cut and drilled, revealing internal structures that allow for simulation of surgical procedures.

The protocol describes the fabrication of fully colored three-dimensional prints of patient-specific, anatomical skull models to be used for surgical simulation. The crucial steps of combining different imaging modalities, image segmentation, three-dimensional model extraction, and production of the prints are explained.

Three-dimensional (3D) printing technologies offer the possibility of visualizing patient-specific pathologies in a physical model of correct dimensions. ...

Augmented reality (AR) has great potential in education, training, and surgical guidance in the medical field. Its combination with three-dimensional (3D) printing (3DP) opens new possibilities in clinical applications. Although these technologies have grown exponentially in recent years, their adoption by physicians is still limited, since they require extensive knowledge of engineering and software development. Therefore, the purpose of this protocol is to describe a step-by-step methodology enabling inexperienced users to create a smartphone app, which combines AR and 3DP for the visualization of anatomical 3D models of patients with a 3D-printed reference marker. The protocol describes how to create 3D virtual models of a patient&rsquo;s anatomy derived from 3D medical images. It then explains how to perform positioning of the 3D models with respect to marker references. Also provided are instructions for how to 3D print the required tools and models. Finally, steps to deploy the app are provided. The protocol is based on free and multi-platform software and can be applied to any medical imaging modality or patient. An alternative approach is described to provide automatic registration between a 3D-printed model created from a patient&rsquo;s anatomy and the projected holograms. As an example, a clinical case of a patient suffering from distal leg sarcoma is provided to illustrate the methodology. It is expected that this protocol will accelerate the adoption of AR and 3DP technologies by medical professionals.

Presented here is a method to design an augmented reality smartphone application for the visualization of anatomical three-dimensional models of patients using a 3D-printed reference marker.

Augmented reality (AR) has great potential in education, training, and surgical guidance in the medical field. Its combination with three-dimensional (3D) ...

We are in the midst of the 3D era in most aspects of life, and especially in medicine. The surgical discipline is one of the major players in the medical field using the constantly developing 3D planning and printing capabilities. Computer-assisted design (CAD) and computer assisted manufacturing (CAM) are used to describe the 3D planning and manufacturing of the product. The planning and manufacturing of 3D surgical guides and reconstruction implants is performed almost exclusively by engineers. As technology advances and software interfaces become more user-friendly, it raises a question regarding the possibility of transferring the planning and manufacturing to the clinician. The reasons for such a shift are clear: the surgeon has the idea of what he wants to design, and he also knows what is feasible and could be used in the operating room. It allows him to be prepared for any scenario/unexpected results during the operation and allows the surgeon to be creative and express his new ideas using the CAD software. The purpose of this method is to provide clinicians with the ability to create their own surgical guides and reconstruction implants. In this manuscript, a detailed protocol will provide a simple method for segmentation using segmentation software and implant planning using a 3D design software. Following the segmentation and stl file production using segmentation software, the clinician could create a simple patient specific reconstruction plate or a more complex plate with a cradle for bone graft positioning. Surgical guides can be created for accurate resection, hole preparation for proper reconstruction plate positioning or for bone graft harvesting and re-contouring. A case of lower jaw reconstruction following plate fracture and nonunion healing of a trauma sustained injury is detailed.

This protocol describes the use of 3D planning and printing for reconstruction of bony defects. We use segmentation tools to create 3D models followed by 3D design software to create patient specific implants for reconstruction purposes concomitant to ablative surgery or as a second stage.

We are in the midst of the 3D era in most aspects of life, and especially in medicine. The surgical discipline is one of the major players in the medical ...

Technological advancements in surgical planning and patient-specific implants are constantly evolving. One can either adopt the technology to achieve better results, even in the less experienced hand, or continue without it. As technology develops and becomes more user-friendly, we believe it is time to allow the surgeon the option to plan his/her operations and create his/her own patient-specific surgical guides and fixation plates allowing him full control over the process. We present here a protocol for 3D planning of the operation followed by 3D planning and printing of surgical guides and patient-specific fixation implants. During this process we use two commercial computer-assisted design (CAD) software. We also use a fused deposition&#160;modeling printer for the surgical guides and a selective laser sintering printer for the titanium patient-specific fixation implants. The process includes computed tomography (CT) imaging acquisition, 3D segmentation of the skull and facial bones from the CT, 3D planning of the operations, 3D planning of patient-specific fixation implant according to the final position of the bones, 3D planning of surgical guides for performing an accurate osteotomy and preparing the bone for the fixation plates, and 3D printing of the surgical guides and the patient-specific fixation plates. The advantages of the method include full control over the surgery, planned osteotomies and fixation plates, significant reduction in price, reduction in operation duration, superior performance and highly accurate results. Limitations include the need to master the CAD programs.

As technology develops and becomes more user-friendly, planning of operations and patient-specific surgical guides and fixation plates should be performed by the surgeon. We present a protocol for 3D planning of orthognathic skeletal movements and 3D planning and printing of patient-specific fixation plates and surgical guides.

Technological advancements in surgical planning and patient-specific implants are constantly evolving. One can either adopt the technology to achieve ...

The description of procedural task trainers includes their use as a training tool to hone technical skills through repetition and rehearsal of procedures in a safe environment before ultimately performing the procedure on a patient. Many procedural task trainers available to date suffer from several drawbacks, including unrealistic anatomy and the tendency to develop user-created &#39;landmarks&#39; after the trainer tissue undergoes repeated manipulations, potentially leading to inappropriate psychomotor skill development. To ameliorate these drawbacks, a process was created to produce a high-fidelity procedural task trainer, created from anatomy obtained from computed tomography (CT) scans, that utilize ubiquitous three-dimensional (3D) printing technology and off-the-shelf commodity supplies.
This method includes creating a 3D printed tissue mold capturing the tissue structure surrounding the skeletal element of interest to encase the bony skeletal structure suspended within the tissue, which is also 3D printed. A tissue medium mixture, which approximates tissue in both high-fidelity geometry and tissue density, is then poured into a mold and allowed to set. After a task trainer has been used to practice a procedure, such as intraosseous line placement, the tissue media, molds, and bones are reclaimable and may be reused to create a fresh task trainer, free of puncture sites and manipulation defects, for use in subsequent training sessions.

We describe a procedure to process computed tomography (CT) scans into high-fidelity, reclaimable, and low-cost procedural task trainers. The CT scan identification processes, export, segmentation, modeling, and 3D printing are all described, along with the issues and lessons learned in the process.

The description of procedural task trainers includes their use as a training tool to hone technical skills through repetition and rehearsal of procedures ...

Combining 3D-Printing and Electrospinning to Manufacture Biomimetic Heart Valve Leaflets

Electrospinning has become a widely used technique in cardiovascular tissue engineering as it offers the possibility to create (micro-)fibrous scaffolds with adjustable properties. The aim of this study was to create multilayered scaffolds mimicking the architectural fiber characteristics of human heart valve leaflets using conductive 3D-printed collectors.
Models of aortic valve cusps were created using commercial computer-aided design (CAD) software. Conductive polylactic acid was used to fabricate 3D-printed leaflet templates. These cusp negatives were integrated into a specifically designed, rotating electrospinning mandrel. Three layers of polyurethane were spun onto the collector, mimicking the fiber orientation of human heart valves. Surface and fiber structure was assessed with a scanning electron microscope (SEM). The application of fluorescent dye additionally permitted the microscopic visualization of the multilayered fiber structure. Tensile testing was performed to assess the biomechanical properties of the scaffolds.
3D-printing of essential parts for the electrospinning rig was possible in a short time for a low budget. The aortic valve cusps created following this protocol were three-layered, with a fiber diameter of 4.1 &#177; 1.6 &#181;m. SEM imaging revealed an even distribution of fibers. Fluorescence microscopy revealed individual layers with differently aligned fibers, with each layer precisely reaching the desired fiber configuration. The produced scaffolds showed high tensile strength, especially along the direction of alignment. The printing files for the different collectors are available as Supplemental File 1, Supplemental File 2, Supplemental File 3, Supplemental File 4, and Supplemental File 5.
With a highly specialized setup and workflow protocol, it is possible to mimic tissues with complex fiber structures over multiple layers. Spinning directly on 3D-printed collectors creates considerable flexibility in manufacturing 3D shapes at low production costs.

The presented method offers an innovative way for engineering biomimetic fiber structures in three-dimensional (3D) scaffolds (e.g., heart valve leaflets). 3D-printed, conductive geometries were used to determine shape and dimensions. Fiber orientation and characteristics were individually adjustable for each layer. Multiple samples could be manufactured in one setup.

Electrospinning has become a widely used technique in cardiovascular tissue engineering as it offers the possibility to create (micro-)fibrous scaffolds ...