Clinical applications of 3D printing in spine surgery: a systematic review.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 2. Orthop Surg. 2024 Jul;16(7):1718-1725. doi: 10.1111/os.14091. Epub 2024 May 20. Biomechanical Properties of Novel Porous Scaffold Core and Hollow Lateral Hole Pedicle Screws: A Comparative Study in Bama Pigs. Hu Y(1), Chen X(2), Chu Z(2), Luo L(2), Gan Z(2), Zhong J(1), Yuan Z(1), Zhu B(1), Dong W(1). Author information: (1)Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China. (2)Health Science Center, Ningbo University, Ningbo, China. OBJECTIVE: Screw loosening is a common complication of internal fixation of pedicle screw. Therefore, the development of a pedicle screw with low loosening rate and high biosafety is of great clinical significance. This study aimed to investigate whether the application of a porous scaffold structure can improve the stability of pedicle screws by comparing the biomechanical properties of novel porous scaffold core pedicle screws (PSCPSs) with those of hollow lateral hole pedicle screws (HLHPSs) in a porcine lumbar spine. METHODS: Thirty-two pedicle screws of both types were implanted bilaterally into the L1-4 vertebrae of four Bama pigs, with our newly designed PSCPSs on the right and HLHPSs on the left. All the Bama pigs were sacrificed 16 weeks postoperatively, and the lumbar spine was freed into individual vertebrae. Biomechanical properties of both the pedicle screws were evaluated using pull-out tests, as well as cyclic bending and pull-out tests, while the mechanical properties were assessed using three-point bending tests. The data generated were statistically analyzed using paired-sample t-tests and two independent sample t-tests. RESULTS: We found that the maximal pull-out forces before and after cyclic bending of the PSCPSs (1161.50 ± 337.98 N and 1075.25 ± 223.33 N) were significantly higher than those of the HLHPSs (948.38 ± 194.32 N and 807.13 ± 242.75 N) (p  0.05, respectively). Additionally, both screws buckled rather than broke in the three-point bending tests, with no statistically significant differences between the maximal bending load and modulus of elasticity of the two screws (p > 0.05 and p > 0.05, respectively). CONCLUSIONS: Compared with the HLHPSs, the PSCPSs have greater pull-out resistance and better fatigue tolerance with appropriate mechanical properties. Therefore, PSCPSs theoretically have significant potential for clinical applications in reducing the incidence of loosening after pedicle screw implantation. © 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd. DOI: 10.1111/os.14091 PMCID: PMC11216838