A 33-year-old male suffering from recurrent lumbar disc herniation L4/L5 was treated with transforaminal lumbar interbody fusion.
Main Surgeon: Dr. Júlio Sampaio, neurosurgeon, Fundacao Bahiana de Neurologia e Neurocirurgia
Assistant: Dr. George Passos, neurosurgeon, Hospital Geral do Estado da Bahia
The patient had been previously submitted to microsurgery (2017) to remove the fragment of the spinal disc that was causing pressure on the nerve. In May 2020, the patient’s condition deteriorated: sciatica and right side L5 dermatome developed, requiring the prescription of multiple painkillers, including fentanyl patches. Despite pain medications, no significant improvement was observed (visual analog scale 9/10). An MRI of the lumbar spine was performed, showing an extensive disc herniation at the L4-L5 level.
Due to the intractable pain, the medical team decided to proceed with an urgent surgical treatment: microdiscectomy with transforaminal lumbar interbody fusion. The procedure was planned with the help of a 3D printed spine model.
“Soon after the completion of the MRI, we proceeded with the segmentation and 3D rendering of the spine (L3–S1), using Rhino3DMedical. The software is very intuitive to use and allows us to post-process 3D models in a fast and accurate way,” explains Dr. Sampaio.
The physical model was printed with an Ultimaker 2+ desktop 3D printer, using PLA filament. The procedure had no cost implications to the patient or to the insurance company.
“In a 12-hour interval, we were able to perform the complete workflow, from image acquisition to obtaining the 3D printed version of the anatomical model.”
On the day of surgery, the 3D model was sterilized and taken to the operating room. The screws were inserted with the hands-free technique, reducing radiation exposure time to the surgical team and the patient.
The patient fully recovered from his symptoms. Post-surgical CT confirmed that all pedicle screws and the interbody cage are properly in place.
The Role of 3D Printing
“The model allowed us to have a better understanding of the patient’s anatomy that was already amended by prior surgery, giving a greater sense of confidence regarding the safety of the surgery. It was of great utility to perform all the crucial steps of the procedure, including the total facetectomy and insertion of the pedicle screws.”
Learn how to segment a CT scan to create a 3D-printable spine model with Rhino3DMedical here.