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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (1): 161-166. doi: 10.19723/j.issn.1671-167X.2024.01.025

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Clinical outcomes of 3D-printing stand-alone artificial vertebral body in anterior cervical surgeries

Panpan HU,Yan LI,Xiao LIU,Yanchao TANG,Zihe LI,Zhongjun LIU*()   

  1. Department of Orthopaedics, Peking University Third Hospital; Engineering Research Center of Bone and Joint Precision Medicine; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
  • Received:2023-02-07 Online:2024-02-18 Published:2024-02-06
  • Contact: Zhongjun LIU E-mail:zjliu@bjmu.edu.cn
  • Supported by:
    Institutional Clinical Research Incubating Projects of Peking University Third Hospital(BYSYZD2022023)

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Abstract:

Objective: To explore the short-term outcomes of 3D-printing stand-alone artificial vertebral body (AVB) in the surgical procedure of anterior cervical corpectomy and fusion (ACCF). Methods: Following the proposal of IDEAL (idea, development, exploration, assessment, and long-term follow-up) framework, we designed and conducted this single-armed, retrospective cohort study. The patients with cervical spondylotic myelopathy were recruited, and these patients exclusively received the surgical procedure of single-level ACCF in our single center. After the process of corpectomy, the size was tailored using different trials and the most suitable stand-alone AVB was then implanted. This AVB was manufactured by the fashion of 3D-printing. Two pairs of screws were inserted in an inclined way into the adjacent vertebral bodies, to stabilize the AVB. The participants were regularly followed-up after the operation. Their clinical data were thoroughly reviewed. We assessed the neurological status according to Japanese Orthopedic Association (JOA) scale. We determined the fusion based on imaging examination six months after the operation. The recorded clinical data were analyzed using specific software and they presented in suitable styles. Paired t test was employed in comparison analysis. Results: In total, there were eleven patients being recruited eventually. The patients were all followed up over six months after the operation. The mean age of the cohort was (57.2±10.2) years. The mean operation time was (76.1±23.1) min and the median bleeding volume was 150 (100, 200) mL. The postoperative course was uneventful for all the cases. Dysphagia, emergent hematoma, and deterioration of neurological function did not occur. Mean JOA scores were 13.2±2.2 before the operation and 16.3±0.8 at the final follow-up, which were significantly different (P < 0.001). The mean recovery rate of neurological function was 85.9%. By comparing the imaging examinations postoperatively and six months after the operation, we found that the average subsidence length was (1.2±1.1) mm, and that there was only one cases (9.1%) of the severe subsidence (>3 mm). We observed significant improvement of cervical lordosis after the operation (P=0.013). All the cases obtained solid fusion. Conclusion: 3D-printing stand-alone AVB presented favorable short-term outcome in one-level ACCF in this study. The fusion rate of this zero-profile prosthesis was satisfactory and the complication rate was relatively low.

Key words: Artificial vertebral body, Stand-alone, Zero-profile, 3D-printing, Cervical spondylotic myelopathy

CLC Number: 

  • R687.3

Figure 1

Stand-alone artificial vertebral body for the cervical spine"

Figure 2

Fluoroscopy images during operation show the effect of compressing A, little space presented between implant and endplates after nailing one screw; B, implant-endplate disappeared, and good attachment was achieved."

Table 1

Clinical features of the recruited patients"

Items Values
Age/years，$\bar x \pm s$ 57.2±10.7
Gender，male/female 7/4
BMI/(kg/m2)，$\bar x \pm s$ 24.6±2.7
Operative segment, n(%)
    C3 1(9.1)
    C4 1 (9.1)
    C5 7 (63.6)
    C6 2 (18.2)
Operative time/min，$\bar x \pm s$ 76.1±23.1
Blood loss/mL, M(min, max) 150 (100, 200)
Height loss of adjacent vertebra/mm，$\bar x \pm s$ 1.17±1.18
Severe subsidence, n(%) 1 (9.1)
Solid fusion, n(%) 11 (100)
Neurological recovery rate/%，$\bar x \pm s$ 85.9±13.2

Table 2

Changes of clinical symptoms and cervical lordosis after the operation"

Items Preoperatively Final follow-up P value
Neck pain 3.3±2.5 0.64±1.12 0.001
JOA scores 13.2±2.2 16.3±0.8 < 0.001
NDI scores 14.2±5.2 3.4±2.1 < 0.001
Global lordosis angle/(°) 10.6±9.6 17.0±15.4 0.013

Figure 3

Illustrative case presents firm bony fusion at the final follow-up A, decreased lordosis curve on lateral X-ray; B, multi-level disc herniation on magnetic resonance imaging; C, lateral X-ray before discharge; D, lateral X-ray at the final follow-up; E, sagittal reconstruction film of CT scan at the final follow-up."

Figure 4

Wide application of stand-alone artificial vertebral body in adjacent vertebral disease, multilevel surgery and spinal tumor surgery A, surgery of adjacent vertebral disease; B, combination with a Zero-P cage; C, application in spinal metastatic cases."

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