A 65-year-old male patient presented with mechanical axial pain and intense radicular pain – visual analogue scale (VAS) 10/10 – has been successfully treated in Brazil’s first hybrid surgery. 3D printed surgical guides and a replica of the patient’s lumbar spine have been sterilized and used in the operating room accompanied by virtual reality (VR) technology.

Neurosurgery Team :
Dr. Júlio Sampaio, neurosurgeon, Fundacao Bahiana de Neurologia e Neurocirurgia
Dr. George Passos, neurosurgeon, Hospital Geral do Estado da Bahia
Dr. Giselle Coelho, neurosurgeon, Hospital Santa Marcelina OSS
Leonardo Fraga , medical student
Engineer :
Mauricio Moriningo

The Neurosurgery Team

Diagnosis

The patient has been diagnosed with degenerative spondylolisthesis (a spinal condition where one vertebra slips forward over the vertebra below) at the L2-L3 levels. Simultaneously, a significant narrowing of the left neural foramen has been observed, causing a compression of the exiting nerve root.

Preoperative Planning

The preoperative planning was performed using Rhino3DMedical. A 3D model of the lumbar spine has been reconstructed with the software from the patient’s CT and MRI scans.

After segmentation of the structures of interest, segments L1 to L4, we 3D printed two anatomical models. The first 3D model was a prototype for studying and planning. The second one was sterilized and taken into the operating room.

– explains Dr. Sampaio.

Once the lumbar spine models have been finalized, we designed pedicle screw guides for the L2-L3 levels using the CAD features of Rhinoceros and Rhino3DMedical. After 3D printing of the guides and the replica of the patient’s lumbar spine, the compatibility of the structures was verified: the guides fit the spine model perfectly.

The trajectories for the pedicle screws guides were reviewed by the three neurosurgeons.

Surgical Treatment

3D printed surgical guides and the replica of the patient’s lumbar spine have been sterilized and used in the operating room.

In parallel, a virtual reality anatomical model of the patient’s lumbar spine was created by a support team using the EDUCSIM software in order to qualify the approach and reinforce the knowledge of anatomical structures even during the procedure.

Intraoperative X-ray

An intraoperative X-ray showed the correct placement of the pedicle screws.

Full Recovery

A post-surgical CAT-scan confirmed the adequate positioning of the the lumbar cage and the pedicle screws at the L2-L3 levels. The patient was discharged from the hospital 36 hours after the surgery. He has fully recovered from his symptoms.

The Role of 3D Printing

The surgical time of the procedure was reduced in relation to the previous experience of the group of neurosurgeons, in addition to the decreased use of fluoroscopy.

– concludes Dr. Sampaio.

Tutorial

Learn how to model surgical guides for pedicle screws with Rhino3DMedical.