Yonsei Medical Journal

Yonsei Univ College Medicine (연세대학교의과대학)
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Sacral Reconstruction with a 3D-Printed Implant after Hemisacrectomy in a Patient with Sacral Osteosarcoma: 1-Year Follow-Up Result

  • Kim, Doyoung (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Lim, Jun-Young (Department of Biomedical Engineering, Yonsei University College of Medicine) ;
  • Shim, Kyu-Won (Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Han, Jung Woo (Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Yi, Seong (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Yoon, Do Heum (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Kim, Keung Nyun (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Ha, Yoon (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Ji, Gyu Yeul (Department of Neurosurgery, Guro Cham Teun Teun Hospital) ;
  • Shin, Dong Ah (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine)
  • Received : 2016.04.19
  • Accepted : 2016.11.03
  • Published : 2017.03.01
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Abstract

Pelvic reconstruction after sacral resection is challenging in terms of anatomical complexity, excessive loadbearing, and wide defects. Nevertheless, the technological development of 3D-printed implants enables us to overcome these difficulties. Here, we present a case of sacral osteosarcoma surgically treated with hemisacrectomy and sacral reconstruction using a 3D-printed implant. The implant was printed as a customized titanium prosthesis from a 3D real-sized reconstruction of a patient's CT images. It consisted mostly of a porous mesh and incorporated a dense strut. After 3-months of neoadjuvant chemotherapy, the patient underwent hemisacretomy with preservation of contralateral sacral nerves. The implant was anatomically installed on the defect and fixed with a screw-rod system up to the level of L3. Postoperative pain was significantly low and the patient recovered sufficiently to walk as early as 2 weeks postoperatively. The patient showed left-side foot drop only, without loss of sphincter function. In 1-year follow-up CT, excellent bony fusion was noticed. To our knowledge, this is the first report of a case of hemisacral reconstruction using a custom-made 3D-printed implant. We believe that this technique can be applied to spinal reconstructions after a partial or complete spondylectomy in a wide variety of spinal diseases.

Keywords

Acknowledgement

Supported by : National Research Foundation, KEIT

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