PMC9468956_01
Case 1. (A) Pre-operative CT and PET-CT showing a large malignant posterior mediastinal mass; (B) X-ray and CT showing tumor recurrence on T4~7 vertebrae; (C) 3D imaging visually showing T4~7 level to be resected; (D) 3D imaging showing customized 3D-printed artificial vertebral body and screw rod internal fixation design; (E) Final 3D-printed titanium alloy vertebral body; (F) surgery performed; (G) post-operative CT showing excellent implant fit, stability, and alignment; (H) adjuvant radiotherapy.
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F2
CT revealed an aggressive appearing 16.3 x 15.9 x 11.3 cm posterior mediastinal mass, hypermetabolic on PET-CT (Figure 2A). The tumor, however, quickly recurred at the T4-7 level, enlarging rapidly just 2 months later (Figure 2B). The decision was then made to plan for en bloc resection of T4 ~ 7 (Figure 2C) by designing a 3D-printed artificial vertebral body to reconstruct her spine (Figure 2D). The 3D-printed artificial vertebral body was manufactured (Figure 2E). Surgery was successfully performed, as planned (Figure 2F). Post-operative CT demonstrated an excellent fit and stability of the implant (Figure 2G). The patient was recommended to undergo adjuvant radiotherapy (Figure 2H).
Case 1. CT imaging at the post-operative nine-month follow-up visit. Coronal and sagittal CT images show evident bone ingrowth and good biological fusion between the porous interface of the 3D-printed prosthesis and the autogenous vertebral endplate (red arrow).
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F3
At the 9-month post-operative follow-up visit, the patient was doing well, moving freely, without any pain or evidence of local recurrence; radiographic bone ingrowth was evident, with good biological fusion between the porous interface of the 3D-printed prosthesis and the autogenous vertebral endplate (Figure 3).
PMC9468956_02
Case 2. (A) Pre-operative MRI and PET-CT showing recurrent tumors on T4, T5, and T6; (B) 3D imaging visually showing T4~6, planned for resection and replacement with patient-specific 3D-printed artificial vertebral body; (C) final titanium alloy implant, including solid and porous parts; (D) post-operative X-ray showing excellent implant fit, stability, and alignment.
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F4
Unfortunately, the tumor quickly recurred again at T5 and metastasized to T4 and T6 6 months ago (Figure 4A). After tumor PR, we planned to en bloc resect T4 ~ 6 and design a 3D-printed artificial vertebral body to reconstruct her spine (Figure 4B). A final titanium alloy implant of the 3D-printed artificial vertebral body was manufactured (Figure 4C). Post-operative X-ray demonstrated excellent fit, stability, and alignment (Figure 4D).
PMC9468956_03
Case 3. (A) Pre-operative 3D imaging visually showing T6~8 reticular tumor and X-ray showing spinal kyphotic abnormality; (B) 3D imaging visually showing T6~8 level to be resected and T1~5 with corrective adjustment in alignment, and patient-specific 3D-printed artificial vertebral body design; (C) post-operative X-ray showing well positioned implant.
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F5
CT-based 3D imaging visually displayed a T6 ~ 8 reticular tumor; X-ray showed increased thoracic kyphosis (Cobb = 67.1 ) (Figure 5A). We planned to en bloc resect T6 ~ 8, adjust T1 ~ 5 alignment and design a 3D-printed artificial vertebral body to reconstruct his spine (Figure 5B). Post-operative X-ray demonstrated improved thoracic curvature (Cobb = 45.8 ) and stable artificial vertebral body implant (Figure 5C).
PMC9468956_04
Case 4. (A) Pre-operative X-ray showing T9 post-surgery imaging and soft tissue mass shadow beside T8~10; (B) 3D imaging visually showing T8~10, planned for resection and replacement with patient-customized 3D-printed artificial vertebral body; (C) post-operative X-ray and 3D reconstruction imaging visually showing excellent implant position and stability.
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F6
She was found to have local recurrence at the T8 ~ 10 level 2 months ago (Figure 6A). We planned to en bloc resect T8 ~ 10, with reconstruction using a customized 3D-printed artificial vertebral body (Figure 6B). Postoperative X-ray and 3D-imaging demonstrated an excellent position and stability of the titanium vertebral body implant (Figure 6C).
PMC9468956_05
Case 5. (A) Pre-operative X-ray showing C6 cervical decompression and internal fixation; (B) pre-operative X-ray showing cervical and thoracic tumor partial resection and internal fixation; (C) 3D imaging showing C5~7 and T1, planned for resection and replacement with patient-specific 3D-printed artificial vertebral body; (D) post-operative X-ray showing excellent implant position and stability.
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F7
She was found to have a C6 tumor and underwent anterior cervical decompression and internal fixation in another hospital 5 months ago (Figure 7A). She was referred to FUSCC and underwent partial resection of the cervical and thoracic tumor and internal fixation via a posterior approach (Figure 7B). After 2 weeks, we planned to en bloc resect C5-7 and T1 through an anterior approach, perform intraoperative radiation, and reconstruct the resulting defect using a 3D-printed artificial vertebral body (Figure 7C). Post-operative X-ray demonstrated excellent position and stability of the titanium vertebral body implant (Figure 7D).
PMC9468956_06
Case 6. (A) Pre-operative X-ray and MRI showing tumor recurrence at the T2~4 levels; (B) 3D imaging visually showing T2~4, planned for resection and replacement with patient-specific 3D-printed artificial vertebral body; (C) surgical clinical photo demonstrating the autogenous bone granule used within the porous part of the prosthesis to promote bone fusion; (D) post-operative imaging showing well positioned implant.
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F8
Although she underwent adjuvant chemotherapy and radiotherapy, the tumor recurred at the T2 ~ 4 level (Figure 8A). We planned to en bloc resect T2 ~ 4 and design a 3D-printed artificial vertebral body to reconstruct her spine (Figure 8B). Surgery was successfully performed as planned (Figure 8C). Post-operative imaging demonstrated a well-positioned titanium vertebral body implant (Figure 8D).
PMC9468956_07
Case 7. (A) Pre-operative X-ray and CT showing C1 and C2 tumor with pathological fracture and dislocation; (B) 3D imaging visually showing tumor in C1~2; (C) 3D imaging visually showing vertebrae planned to be resected and replaced with 3D-printed artificial vertebral body; (D) final titanium alloy implants; (E) post-operative X-ray showing reconstruction according to plan B, without the use of the 3D printed implant due to mismatching.
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F9
Pre-operative X-ray and CT showed a C1 and C2 tumor resulting in pathological fracture and dislocation (Figure 9A). The tumor was located in C1 ~ 2 (Figure 9B). We planned to en bloc resect C2, partially resect and correct alignment of C1, and design a customized 3D-printed artificial vertebral body to reconstruct his spine (Plan A) (Figure 9C). Final titanium alloy implants were manufactured (Figure 9D). Post-operative X-ray showed excellent reconstruction, according to Plan B (Figure 9E).
PMC9468956_08
Case 8. (A) Pre-operative X-ray showing fractured internal fixation rod and L1 artificial vertebral body subsidence; (B) 3D imaging visually showing the lesion; (C) 3D-printed artificial vertebral body and internal fixation system design; (D) post-operative X-ray showing spinal reconstruction using extendable artificial vertebra.
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F10
X-ray revealed failed hardware, with a fractured rod and L1 artificial vertebral body subsidence (Figure 10A). CT-derived 3D imaging visually displayed the lesion (Figure 10B). Individualized 3D-printed artificial vertebral body and screw rod internal fixation system were designed and modeled (Figure 10C). An alternative solution that allows for extendable artificial vertebra with incorporation of autogenous rib and allogeneic bone was performed on the patient (Figure 10D).