Michael Bohl, MD, Founder and Director of the Barrow Innovation Center talks about how 3D printing can help patients with scoliosis
Interview conducted by Ivanhoe Broadcast News in May 2019.
How were you able to 3D print Meghan’s spine and do such a beautiful job correcting the problem?
BOHL: Many of the patients who come to us with spinal deformities have very complex spinal anatomy. Many of us learn about spinal anatomy in textbooks and in cadavers. And those are all normal spines. The challenges of operating on abnormal spines becomes incrementally larger with spine curves and changes in the size of certain bones in the spine, which all contributes to the problem that these patients are facing and contributes to many of their symptoms, many of which are debilitating. And so just starting with a patient’s CT scan and looking at a bunch of two-dimensional images of the CT scan to get an idea of what you’re dealing with is the old-fashioned way of doing it. 3D printing really got its start in spine surgery as a way to visualize the 3D anatomy of a spine all at once versus looking at 2D images and trying to rebuild that 3D image in your head.
How did you use that to help Meghan particular?
BOHL: So what’s unique about what we’ve done here is that not only do our 3D-printed models show the gross anatomy of a patient’s spine, but the material we use to print the spine, the ligaments and everything also accurately reflects the patient’s tissue quality. So, if you put a screw into the model, it will perform analogously in the model as it does in the patient. The stiffness of the spine, how it bends and moves will perform analogously to how it does in the patient. So for us what that means is that as surgeons when we’re planning how we’re going to fix the spine of a patient like Meghan it gives us an opportunity to rehearse the case, to practice the plan that we have going into it and ask, “is this going to work or not? Do we need to revise our plan? Is our plan good? Where are the pitfalls going to be? Where are the challenging points going to be?” And that’s an enormous benefit. It’s a free chance to practice exactly what you’re going to do in the operating room in a completely safe environment where you can make mistakes freely and you can have redo’s. Once you get to the operating room you don’t get any of those. So it’s a great opportunity for us, and it provides a great service to the patients because they know that we’ve gone into their surgery well-planned, well thought out ahead and that we’re going in confident in the plan that we’ve presented to them.
Is there a way to measure how much better and more smoothly procedures go since you’ve started using 3D printing?
BOHL: There is. We need to do a very large study with many, many cases, probably hundreds of cases, to show it definitively. But I will say that in the majority of cases where we have printed models ahead of time and operated on the models, oftentimes our plan changes because of the work we did on the models. The fact that our plan changed means that we learned something during the process of working on the model. And we wouldn’t have changed it if we didn’t think that this was going to be a better plan. It’s much better to change it now than change it on the fly in the operating room.
Meghan had said was that her surgery was shorter and more successful then what she was originally told. How much of that was because of the printing?
BOHL: A lot of it was because of the printing. In Meghan’s specific type of scoliosis the columns of bone that we put screws down, they’re called pedicles, and in her type of scoliosis that column of bone is very, very narrow on the inside of the curve, which makes it really difficult to put screws in that area. And we rely on those screws to pull on the spine and straighten it out. Because we had practiced on the model we knew exactly where those most challenging areas were going to be. And it can be dangerous to misplace screws because you have the spinal cord nearby. You have big blood vessels nearby. In her surgery we already knew where those challenging areas were. We could skip those ahead of time because we knew, one, we got the correction we needed with fewer screws and, two, these screws are very high-risk screws to begin with. We could skip those and still be confident that we had enough fixation in place to straighten her spine out as much as we wanted to. She’s a perfect example of how this preoperative planning and rehearsal can really benefit the course of a procedure and make it go quicker, smoother, and faster. Smoother surgeries are better for patients for sure.
END OF INTERVIEW
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