3D printing helps surgeons fix scoliosis

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What if your surgeon could practice your procedure before going into the operating room? An innovation team in Phoenix is 3D printing the spines of patients who have severe scoliosis so there are no surprises on operation day.

Megan Johansen was diagnosed with scoliosis at age 9. When her fourth child turned 3 years old, her spine collapsed to a 90-degree bend.

"I couldn't breathe and I was starting to have really bad heart palpitations where it just felt like it was going to be beating out my chest or it would just, like, seize up," Johansen said.

She knew she finally needed surgery.

Surgeons at Barrow Neurological Institute use CT and MRI scans to make 3D models of patients' spines before surgery.

"We know how to print these spines in such a way that we'll get the same tissue quality in the spine and the same biomechanical performance of the spine model as we would expect to in the patient," Dr. Michael Bohl said.

That really helps with complicated cases, like Johansen's. Her pedicle bones on the inside curves are small for screws to straighten her spine. After working with the model, surgeons changed their plan and didn't put them there.

"It gives us an opportunity to rehearse the case, to practice the plan that we have going into it and say, is this going to work or not? Do we need to revise our plan?" Bohl said.

Johansen had been told her surgery would be 12 hours long and her spine only corrected to about 50 degrees.

"When I woke up from surgery five hours later, I was only 13 degrees and five inches taller. It was a miracle," she said.

Even with the improvement, she still has some pain, but she's working again and even hiking with her family.

It costs $50 to $70 to print a 3D model of a spine.

Beside helping surgeons before operations, the models are used regularly in surgeon training and education for patients.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: 3D PRINTING HELPS SURGEONS FIX SCOLIOSIS
REPORT: MB #4627

BACKGROUND: Scoliosis is a sideways curvature of the spine that affects about three percent of adolescents. Outside of conditions like cerebral palsy and muscular dystrophy that can cause scoliosis, the cause for most scoliosis cases is still unknown. While most cases are mild, some children can continue to get more severe curvature of the spine as they grow. Scoliosis often starts to occur during the growth spurt just before puberty. Cases of severe scoliosis can be disabling and can possibly reduce the amount of space in the chest making it hard for lungs to function properly. Most mild cases will not need treatment, but some children may need to wear a brace or even have surgery to keep the curve from worsening. (Source: https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716)

RISK FACTORS AND COMPLICATIONS: Risk factors include things like age, sex, and family history. Signs and symptoms begin at a younger age and even though boys and girls can both develop mild scoliosis, girls are at a higher risk of the curve worsening and requiring treatment. Scoliosis can have a genetic component, but most children do not have family history of the disease. Possible complications include lung and heart damage due to the rib cage pressing against the lungs and heart, chronic back pain which can be seen in adults who had scoliosis as a child, and lastly, appearance. If a child's scoliosis worsens it can cause noticeable changes like uneven hips and shoulders, prominent ribs, and a shift in waist and trunk size. (Source: https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716)

3D PRINTING: Michael Bohl, MD, Founder and Director of the Barrow Innovation Center explains how 3D printing helped a young scoliosis patient named Meghan, "So what's unique about what we've done here is that not only do our 3D-printed models show the gross anatomy of a patient's spine, but the material we use to print the spine, the ligaments and everything also accurately reflects the patient's tissue quality," said Dr. Bohl. He adds that this was practice before was a great success for Meghan, saying, "What that means is that as surgeons when we're planning how we're going to fix the spine of a patient like Meghan it gives us an opportunity to rehearse the case, to practice the plan that we have going into it and say is this going to work or not?". The models not only look like the patient's spine, but also bend and move like the patient's spine. (Source: Michael Bohl, MD)