Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion?

Haoyu He; Lei Fan; Guohua Lü; Xinyi Li; Yunchao Li; Ou Zhang; Zejun Chen; Hui Yuan; Changyu Pan; Xiaoxiao Wang; Lei Kuang

doi:10.1186/s12891-024-07213-7

Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion?

BMC Musculoskelet Disord. 2024 Jan 26;25(1):96. doi: 10.1186/s12891-024-07213-7.

Authors

Haoyu He¹, Lei Fan², Guohua Lü¹, Xinyi Li¹, Yunchao Li¹, Ou Zhang³, Zejun Chen¹, Hui Yuan¹, Changyu Pan¹, Xiaoxiao Wang¹, Lei Kuang⁴

Affiliations

¹ Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
² Department of Spinal Surgery, Third Hospital of Changsha, Changsha, Hunan Province, China.
³ Department of Medical Education, California University of Science and Medicine, Colton, CA, USA.
⁴ Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China. lei.kuang@csu.edu.cn.

Abstract

Background: To find out if three-dimensional printing (3DP) off-the-shelf (OTS) prosthesis is superior to titanium mesh cages in anterior cervical corpectomy and fusion (ACCF) when treating single-segment degenerative cervical spondylotic myelopathy (DCSM).

Methods: DCSM patients underwent ACCF from January 2016 to January 2019 in a single center were included. Patients were divided into the 3DP group (28) and the TMC group (23). The hospital stays, operation time, intraoperative blood loss, and the cost of hospitalization were compared. The Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) were recorded pre-operatively, 1 day, 3, 6, 12, and 24 months post-operatively. Radiological data was measured to evaluate fusion, subsidence, and cervical lordosis. Patients were sent with SF-36 to assess their health-related quality of life (HRQoL).

Results: The differences in operative time, intraoperative blood loss, and hospital stay were not statistically significant between groups (p > 0.05). Postoperative dysphagia occurred in 2 cases in the 3DP group and 3 cases in the TMC group, which all relieved one week later. The difference in improvement of JOA and NDI between the two groups was not statistically significant (p > 0.05). No hardware failure was found and bony fusion was achieved in all cases except one in the 3DP group. The difference in cervical lordosis (CL), fused segmental angle (FSA), mean vertebral height (MVH), and subsidence rates between groups at each follow-up time point was not statistically significant and the results of the SF-36 were similar (p > 0.05). The total cost was higher in the 3DP group with its higher graft cost (p < 0.05).

Conclusion: In treating single-segment DCSM with ACCF, both 3DP OTS prosthesis and TMC achieved satisfactory outcomes. However, the more costly 3DP OTS prosthesis was not able to reduce subsidence as it claimed.

Keywords: 3D-printed prosthesis; Anterior cervical corpectomy and fusion; Cervical spondylotic myelopathy; Cost-effectiveness; Subsidence.

MeSH terms

Artificial Limbs*
Blood Loss, Surgical
Cervical Vertebrae / diagnostic imaging
Cervical Vertebrae / surgery
Humans
Lordosis* / surgery
Printing, Three-Dimensional
Quality of Life
Spinal Cord Diseases* / surgery
Spinal Fusion* / adverse effects
Spinal Fusion* / methods
Surgical Mesh
Titanium
Treatment Outcome

Substances

Titanium