Name: 3d printing model of a patient's specific lumbar vertebra
Uploaded: 2023-04-14T13:15:00
Description: Watch this Scientific Journal Video about 3D Printing Model of a Patient's Specific Lumbar Vertebra at JoVE.com

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...

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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'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.

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

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