Individualized artificial titanium alloy spinal lamina with 3D printing technology

Abstract

Background: Laminectomy and decompression is a common procedure for treating spine diseases. However, due to the lack of a posterior, bony braced structure, the dural sac and nerve roots can adhere to the surrounding tissues, and scar formation can occur in muscle and soft tissues. This can cause new compression post surgery, and failure of the operation. Objective: This study aimed to produce an individualized titanium alloy spine lamina using 3D printing technology, and to evaluate its effectiveness by implantation in human cadaveric spines. Methods: Six adult lumbar cadaver specimens were used, and computed tomography (CT) was used to obtain DICOM medical digital image standard data. The lumbar vertebrae structure was reconstructed by three-dimensional (3D) modeling software, and then simulated lumbar laminectomy was performed. Based on the characteristics of the original lamina, an artificial spine lamina was designed, including suture holes at the posterior ligament attachment point and a locking screw hole for fixation. A titanium alloy spine lamina was fabricated by 3D printing, and a guide plate to assist artificial lamina implantation was designed. Using the guide plated, L4 lumbar vertebrae segment laminectomy was performed on the 6 lumbar spine specimens, titanium alloy spine lamina were implanted and fixed with cortical bone trajectory screws. After implantation, CT was performed to record the length of the screw, the trajectory of the screw in the pedicle, and changes of bony spinal canal volume and anteroposterior diameter of the spinal canal. Results: The morphology of artificial spine lamina matched that of the original lamina. The artificial lamina was easy to implant, and matched the original lamina. The laminas were fixed by 12 cortical screws (diameter, 4.5 mm; median length, 34.67 ± 1.97 mm). CT scan indicated that all screws passed through the pedicle cortex by < 2 mm (2 screws penetrated the inner wall). The bony canal volume of the L4 vertebral pedicle was 311.23 ± 38.17 mm2 before operation and 356.17 ± 43.11 mm2 after operation, and there was statistical difference (P < 0.001). The anteroposterior diameter of spinal canal was 17.82 ± 2.03 mm before surgery and 20.67 ± 2.38 mm after surgery, and they were statistically different (P < 0.001). Conclusion: An individualized artificial titanium alloy spine lamina designed and produced with 3D printing technology can be used to reconstruct the structure of the posterior spine complex after lumbar laminectomy. The artificial lamina can increase the volume of the spinal canal and provide a posterior ligament reconstruction attachment point.