Circumferential minimally invasive (MIS) lumbar fusion is a complex surgery that stabilizes the spine and relieves pain by implanting cages in the spinal discs to fuse the vertebrae. Stock prefabricated implants come in standard sizes, which do not precisely match the 3D topography of a patient’s vertebral bones. Failure to match the unique surface topography of each patient’s bones decreases implant stability and can result in a failure to achieve a successful fusion. Furthermore, edges of the stock cages may erode through the bone leading to a condition called subsidence.
As another concern, sometimes surgeons use cages to straighten out a patient’s scoliosis. However, standard implants do not allow a surgeon to correct spinal deformities in the coronal plane precisely—especially if an asymmetric or non-standard shaped graft would result in the most ideal correction.
Andrew K. Chan, MD, co-director of Minimally Invasive Scoliosis Surgery at Och Spine at NewYork-Presbyterian and Columbia, is using the latest technology in spine surgery to overcome those challenges: artificial intelligence (AI) and 3D printing. Below, Dr. Chan discusses performing the first MIS lumbar fusion in New York using 3D-printed personalized interbody devices and how this AI technology could be used more broadly in the future.
How the Patient Presented
I had a 75-year-old patient who had been putting off her lumber spine surgery for a long time. She had scoliosis with severe spinal degeneration from L3 to S1 and had already tried multiple non-operative strategies, including epidural steroid injections, physical therapy, and medications. Her next step would be a MIS lumbar fusion, and I felt that she would be a good candidate for this approach given the asymmetries in her bones and her need for correction in the curve of her spine.
The Surgical Planning Process
Using the patient’s CT scan, I worked with a manufacturer to create a 3D image of her lumbar spine using AI. AI helped to determine the optimal alignment of her spine and shifted her bones into their ideal positions. Afterwards, three personalized devices were created to fill in the gaps between the bones, taking into account the patient’s unique bony surfaces. I then reviewed the plan and spoke with the engineers about any needed adjustments.
Once I approved the plan, the manufacturer fabricated the personalized devices using 3D printing. The result was an implant designed specifically for the patient’s bone shape and the goals that we were trying to achieve through surgery: decompression of the nerves and re-establishment of normal spinal alignment. Achieving ideal spinal alignment is important as it helps to prevent additional surgeries and other areas of the spine from breaking down in the future.
By Dr. Andrew K. Chan | NewYork-Presbyterian Hospital
Image Credit: Carlsmed
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