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PERSPECTIVE ARTICLE

Application of additive manufacturing technology in

orthopedic medical implant - Spinal surgery as an example

Rong Feng Zhang , Peng Yun Wang *, Ming Yang , Xuebo Dong , Xue Liu , Yiguang Sang ,
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An Tong *
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th
1 Department of Orthopaedics, Shandong Hospital of People’s Liberation Army, 89 Hy, Weifang, Shandong Province,
Republic of China
2 Department of Spine Surgery, Central Hospital, Zibo, Zhangdian, Shandong Province, China
3 Traditional Chinese Medicine Hospital, Dongying, Hekou, Shandong Province, China
4 Qilu Hospital, Shandong University, Shandong, China
5 Department of Orthopedics, People’s Hospital of Yan’an, Qilipu Street, Yan’an, Baota, Shaanxi Province, China
Abstract: Additive manufacturing has been used in complex spinal surgical planning since the 1990s and is now increasingly
utilized to produce surgical guides, templates, and more recently customized implants. Surgeons report beneficial impacts
using additively manufactured biomodels as pre-operative planning aids as it generally provides a better representation of the
patient’s anatomy than on-screen viewing of computed tomography (CT) or magnetic resonance imaging (MRI). Furthermore,
it has proven to be very beneficial in surgical training and in explaining complex deformity and surgical plans to patients/
parents. This paper reviews the historical perspective, current use, and future directions in using additive manufacturing in
complex spinal surgery cases. This review reflects the authors’ opinion of where the field is moving in light of the current
literature. Despite the reported benefits of additive manufacturing for surgical planning in recent years, it remains a high
niche market. This review raises the question as to why the use of this technology has not progressed more rapidly despite the
reported advantages – decreased operating time, decreased radiation exposure to patients intraoperatively, improved overall
surgical outcomes, pre-operative implant selection, as well as being an excellent communication aid for all medical and
surgical team members. Increasingly, the greatest benefits of additive manufacturing technology in spinal surgery are custom-
designed drill guides, templates for pedicle screw placement, and customized patient-specific implants. In view of these
applications, additive manufacturing technology could potentially revolutionize health care in the near future.

Keywords: Additive manufacturing; biomodeling; rapid prototyping; spine deformity; complex spine surgery

*Correspondence to: Peng Yun Wang, Department of Spine Surgery, Central Hospital, Zhangdian, Zibo, Shandong Province, China;
wangpengyun1@sina.com; An Tong, Department of Orthopedics, People’s Hospital of Yan’an, Qilipu street, Yan’an, Baota, Shaanxi Province,
China; Tongangk@163.com
Received: October 31, 2018; Accepted: April 4, 2019; Published Online: July 1, 2019
Citation: Zhang RF, Wang PY, Yang M, et al., 2019, Application of additive manufacturing technology in orthopedic medical
implant – Spinal surgery as an example. Int J Bioprint, 5(2): 168. http://dx.doi.org/10.18063/ijb.v5i2.168

1. Introduction though surgical treatment strategies and implants have
evolved and improved considerably in recent decades,
Spine surgeons engage in complex and innovative surgical surgical correction of complex deformities remains very
procedures to stabilize and improve idiopathic, congenital, challenging. To evaluate the severity of spinal deformities
degenerative, and injury-related spinal deformities. Even and plan any required surgical procedures, physicians have

Application of additive manufacturing technology in orthopedic medical implant - Spinal surgery as an example © 2019 Zhang , et al. This is an Open Access
article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-
nc/4.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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