Turkish Neurosurgery
Application of individualized 3D-Printed artificial vertebral body for cervicothoracic reconstruction in a six-level recurrent chordoma
Xinghai Yang1, Wei Wan1, Haiyi Gong1, Jianru Xiao1
1Changzheng Hospital, Naval Medical University, Orthopaedic Oncology, Shanghai,
DOI: 10.5137/1019-5149.JTN.25296-18.2

Background: Surgical treatment of chordoma involving multiple level in cervicothoracic spine is clinically rare and extremely challenging. It is not only because of complicated adjacent anatomy and the wide extension, but also due to the complex biomechanical reconstruction. However, the revolutionary application of individualized 3D-printed implant has provided a feasible and effective solution. Purposes: To describe the surgical planning, manufacturing and implantation of an individualized 3D-printed prosthesis for cervicothoracic reconstruction in a six-level recurrent chordoma. Methods: A 40-year-old female patient with recurrent cervicothoracic chordoma was admitted in our center. One-stage tumorectomy through combined anterior and posterior approach was performed, and a customized 3D-printed prosthesis was anatomically installed on the defect with vertebral screws from C2 to T2. Results: The whole procedure took 13 hours, and intraoperative blood loss was 7500 ml. The patient recovered uneventfully and symptoms of pain and weakness of right upper extremity were significantly diminished postoperatively. No local recurrence was found at 9-month follow-up, and no subsidence, displacement or fracture of the prosthesis was observed radiographically. Conclusion: To our best knowledge, this is the first report of biomechanical reconstruction using an individualized 3D-Printed artificial vertebral body in a six-level recurrent chordoma. Customized design of the prosthesis enables us to overcome the difficulty in fixation and simplify the surgical procedure. Especially in the spinal transition point where solid fusion is difficult to achieve, an individualized 3D-printed implant may provide excellent primary stability. Therefore, we believe that this burgeoning technique represents a promising prospect in complicated spinal oncology surgery.

Corresponding author : Jianru Xiao