Geometric and Volumetric Relationship Between Human Lumbar Vertebra and CT-based Models

Biomechanical Comparison of Subsidence Between Patient-Specific and Non-Patient-Specific Lumbar Interbody Fusion Cages

STUDY DESIGN

Biomechanical study.

OBJECTIVES

Several strategies to improve the surface of contact between an interbody device and the endplate have been employed to attenuate the risk of cage subsidence. 3D-printed patient-specific cages have been presented as a promising alternative to help mitigate that risk, but there is a lack of biomechanical evidence supporting their use. We aim to evaluate the biomechanical performance of 3D printed patient-specific lumbar interbody fusion cages in relation to commercial cages in preventing subsidence.

METHODS

A cadaveric model is used to investigate the possible advantage of 3D printed patient-specific cages matching the endplate contour using CT-scan imaging in preventing subsidence in relation to commercially available cages (Medtronic Fuse and Capstone). Peak failure force and stiffness were analyzed outcomes for both comparison groups.

RESULTS

PS cages resulted in significantly higher construct stiffness when compared to both commercial cages tested (>59%). PS cage peak failure force was 64% higher when compared to Fuse cage (P < .001) and 18% higher when compared to Capstone cage (P = .086).

CONCLUSIONS

Patient-specific cages required higher compression forces to produce failure and increased the cage-endplate construct' stiffness, decreasing subsidence risk.

Accuracy of 3D printed spine models for pre-surgical planning of complex adolescent idiopathic scoliosis (AIS) in spinal surgeries: a case series

Adolescent idiopathic scoliosis (AIS) is a noticeable spinal deformity in both adult and adolescent population. In majority of the cases, the gold standard of treatment is surgical intervention. Technological advancements in medical imaging and 3D printing have revolutionised the surgical planning and intraoperative decision making for surgeons in spinal surgery. However, its applicability for planning complex spinal surgeries is poorly documented with human subjects. The objective of this study is to evaluate the accuracy of 3D printed models for complex spinal deformities based on Cobb angles between 40° to 95°.This is a retrospective cohort study where, five CT scans of the patients with AIS were segmented and 3D printed for evaluating the accuracy. Consideration was given to the Inter-patient and acquisition apparatus variability of the CT-scan dataset to understand the effect on trueness and accuracy of the developed CAD models. The developed anatomical models were re-scanned for analysing quantitative surface deviation to assess the accuracy of 3D printed spinal models. Results show that the average of the root mean square error (RMSE) between the 3DP models and virtual models developed using CT scan of mean surface deviations for the five 3d printed models was found to be 0.5±0.07 mm. Based on the RMSE, it can be concluded that 3D printing based workflow is accurate enough to be used for presurgical planning for complex adolescent spinal deformities. Image acquisition and post processing parameters, type of 3D printing technology plays key role in acquiring required accuracy for surgical applications.

Estimating age at death by Hausdorff distance analyses of the fourth lumbar vertebral bodies using 3D postmortem CT images

The existing methods for determining adult age from human skeletons are mostly qualitative. However, a shift in quantifying age-related skeletal morphology on a quantitative scale is emerging. This study describes an intuitive variable extraction technique and quantifies skeletal morphology in continuous data to understand their aging pattern. A total of 200 postmortem CT images from the deceased aged 25-99 years (130 males, 70 females) who underwent forensic death investigations were used in the study. The 3D volume of the fourth lumbar vertebral body was segmented, smoothed, and post-processed using the open-source software ITK-SNAP and MeshLab, respectively. To measure the extent of 3D shape deformity due to aging, the Hausdorff distance (HD) analysis was performed. In our context, the maximum Hausdorff distance (maxHD) was chosen as a metric, which was subsequently studied for its correlation with age at death. A strong statistically significant positive correlation (P < 0.001) between maxHD and age at death was observed in both sexes (Spearman's rho = 0.742, male; Spearman's rho = 0.729, female). In simple linear regression analyses, the regression equations obtained yielded the standard error of estimates of 12.5 years and 13.1 years for males and females, respectively. Our study demonstrated that age-related vertebral morphology could be described using the HD method. Moreover, it encourages further studies with larger sample sizes and on other population backgrounds to validate the methodology.

Evaluation of the contact surface between vertebral endplate and 3D printed patient-specific cage vs commercial cage

Biomechanical study. To evaluate the performance of the contact surface for 3D printed patient-specific cages using CT-scan 3D endplate reconstructions in comparison to the contact surface of commercial cages. Previous strategies to improve the surface of contact between the device and the endplate have been employed to attenuate the risk of cage subsidence. Patient-specific cages have been used to help, but only finite-element studies have evaluated the effectiveness of this approach. There is a possible mismatch between the CT-scan endplate image used to generate the cage and the real bony endplate anatomy that could limit the performance of the cages. A cadaveric model is used to investigate the possible mismatch between 3D printed patient-specific cages and the endplate and compare them to commercially available cages (Medtronic Fuse and Capstone). Contact area and contact stress were used as outcomes. When PS cage was compared to the Capstone cage, the mean contact area obtained was 100 ± 23.6 mm² and 57.5 ± 13.7 mm², respectively (p < 0.001). When compared to the Fuse cage, the mean contact area was 104.8 ± 39.6 mm² and 55.2 ± 35.1 mm², respectively(p < 0.001). Patient-specific cages improve the contact area between the implant and the endplate surface, reducing the contact stress and the risk of implant subsidence during LIF surgeries.

Morphological correlates of distal fibular morphology with locomotion in great apes, humans, and Australopithecus afarensis

OBJECTIVES

Recent studies highlighted the importance of the fibula to further our understanding of locomotor adaptations in fossil hominins. In this study, we present a three-dimensional geometric morphometric (3D-GM) investigation of the distal fibula in extant hominids and Australopithecus afarensis with the aim of pointing out morphological correlations to arboreal behavior.

METHODS

Three-dimensional surface meshes of the distal fibula were obtained using computer tomography for 40 extant hominid specimens and laser scanner for five A. afarensis specimens. Distal fibula morphology was quantified positioning 11 fixed landmarks, 40 curve semilandmarks, and 20 surface landmarks on each specimen. A generalized Procrustes analysis (GPA) was carried out on all landmark coordinates followed by Procrustes ANOVA. Principal component analysis (PCA) was performed on the GPA-aligned shape coordinates. Kruskal-Wallis tests and Mann-Whitney test were performed on scores along PCs.

RESULTS

Great apes are characterized by a shorter subcutaneous triangular surface (STS), more downward facing fibulotalar articular facets, more anteriorly facing lateral malleolus and wider/deeper malleolar fossa than humans. Within great apes, orangutans are characterized by more medially facing fibulotalar articular facets. Australopithecus afarensis shows a unique distal fibular morphology with several traits that are generally associated more to arboreality and less to bipedalism such as a short STS, a more anteriorly facing, laterally pointing malleolus and deeper and larger malleolar fossa.

CONCLUSIONS

The distal fibula morphology is indicative of locomotor patterns within extant hominids. The 3D-GM method presented here can be successfully used to further our understanding of arboreal adaptations in fossil hominins.