Anterior Lumbar Interbody Fusion Using a Personalized Approach: Is Custom the Future of Implants for Anterior Lumbar Interbody Fusion Surgery?

BACKGROUND: Spine surgery has the potential to benefit from the use of three-dimensional (3D) printing technology (additive manufacturing), particularly in cases of complex anatomic diseases. Custom devices have the potential to reduce operative times, reduce blood loss, provide immediate stability, and improve fusion rates. CASE DESCRIPTION: A 34-year-old man presented with 3-year history of bilateral L5 radiculopathy caused by bilateral L5 pars defect, L5/S1 degenerative disc disease, and severe foraminal stenosis. Anterior lumbar interbody fusion surgery was determined to be the most efficacious method for distraction of the disc space to increase the foraminal volume and stabilization of the motion segment. Surgical decompression and reconstruction was performed in combination with a 3D printed custom interbody implant. Custom design features included corrective angulation to restore lumbar lordosis, preplanned screw holes in the 3D implant, and device end plate interface geometry designed to shape-match with the patient's end plate anatomy. CONCLUSIONS: The use of patient-specific implants has reduced operative time significantly, which may offset costs of increased time spent preplanning the procedure. Surgical procedures can be preplanned using 3D models reconstructed from patient computed tomography and/or magnetic resonance imaging scans. Planning can be aided by 3D printed models of patient anatomy, which surgeons can use in training before performing complex procedures. When considering implants and prostheses, the use of 3D printing allows a superior anatomic fit for the patient compared with generic devices, with the potential to improve restoration of nonpathologic anatomy.