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A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report
1Department for Traumatology, University medical Centre Ljubljana, Ljubljana, Slovenia.
Insights
3D-printed models aid complex pediatric cervical spine surgery. This case study demonstrates successful posterior cervical fixation in a 4-year-old, improving outcomes and reducing surgical risks.
Area of Science:
- Pediatric Neurosurgery
- Spinal Instrumentation
- 3D Printing in Medicine
Background:
- Multilevel laminectomy for upper cervical spine tumor resection requires instrumented fixation to prevent kyphotic deformity and myelopathy.
- Cervical spine instrumentation in children under 8 is challenging due to anatomical variations and limited specific implants.
Observation:
- A 4-year-old child with post-laminectomy kyphotic decompensation and spinal cord injury underwent 3D virtual planning for posterior cervical fixation.
- A 3D-printed model was used to assess and confirm the feasibility of using 3.5 mm lateral mass and isthmic screws 'in vitro' preoperatively.
- Intraoperative conditions matched the preoperative plan, with successful placement of 3.5 mm polyaxial screws.
Findings:
- The 3D-printed model-assisted approach facilitated accurate screw placement and reduced the risk of implant-spine mismatch.
- The child achieved complete neurological recovery postoperatively.
- Two years after instrumented fusion, the child remains disease-free with no signs of spinal decompensation.
Implications:
- 3D-printed models are valuable tools for pre-operative planning and assessment of cervical spine instrumentation in pediatric patients.
- This technique enhances visualization and tactile feedback of spinal anatomy, aiding screw placement and minimizing intraoperative complications, particularly without intraoperative navigation.
- Conventional screw-rod techniques can be feasible in young children with careful pre-operative planning using 3D models.
Introduction:
In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation.
Case Presentation:
We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed "in vitro" in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation.
Discussion/Conclusion:
Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy "in vivo," thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.
