3D printed custom-made prosthesis for spinal stability reconstruction in the thoracolumbar spine following total en bloc resection of giant cell tumor

English Keywords:Giant cell tumor  Spine  3D printing  Custom-made prosthesis  Total en bloc resection

English Abstract:

  【Abstract】 Objectives: To evaluate 3D printed custom-made prosthesis for spinal stability reconstruction after total en bloc spondylectomy(TES) of giant cell tumor in the thoracolumbar spine. Methods: Ten patients with giant cell tumor of the thoracolumbar spine underwent TES via a posterior approach or a combined anterior and posterior approach in our department between Jan. 2017 and Dec. 2019. 3D printed custom-made prosthesis was used to reconstruct the anterior column of the spine. The clinical data including clinical characteristics, perioperative complications, neurological status, tumor local control and the status of the prosthesis were retrospectively analyzed. There were one male and nine females with average age of 38.3±13.7 years. Nine were primary cases and one was recurrent case. All the patients had intractable back pain. The mean preoperative visual analogue scale(VAS) was 4.5±1.2. Two patients had partial paralysis accompanied by hypoesthesia below the affected segment. All other patients had normal spinal cord function. By Frankel grade, there were two grade D patients and eight grade E patients. The anatomic distribution of lesions was as follows: six in thoracic spine and four in lumbar spine. Lesion involved single segment in five cases, double segments in two cases, and three segments in three cases. According to the WBB staging, both A-D and B-D were in five cases respectively. Seven patients underwent TES from posterior approach, and meanwhile a combined anterior and posterior approach was chosen for the other three patients. 3D printed custom-made prosthesis and spinal pedicle screw system were used to reconstruct the spinal stability. Results: The average operation time was 6.5±2.0 hours(ranged 4.5-12.0 hours), and the average blood loss was 4600±2444ml(ranged 2,300-11,500ml). The back pain was relieved in all the patients after operation. The mean postoperative VAS was 1.3±0.5. Cerebrospinal fluid leakage occurred in six cases and pleural effusion in three cases during the perioperation. There was no wound infection or wound healing problems occurred. The mean follow-up period was 16.0±7.9 months(ranged 7-33 months). Of neurological function according to Frankel grade, the two patients recovered to grade E from grade D preoperatively. All the patients were alive with no evidence of tumor recurrence or metastasis. All the 3D printed custom-made prostheses were in situ and no subsidence or migration was found. There was no internal fixation loosening and fracture. Conclusions: 3D printed custom-made prosthesis can be effective in managing anterior reconstruction after TES.