The use of physical biomodelling in complex spine surgery

Abstract

Prior studies have suggested that biomodels enhance patient education, pre-operative planning and intra-operative stereotaxy, however the usefulness of biomodels compared to regular imaging modalities such as x-ray, CT and MR has not been quantified. Our objective was to quantify surgeon’s perceptions on the usefulness of biomodels compared to standard visualisation modalities for pre-operative planning and intra-operative anatomical reference. Physical biomodels were manufactured for a series of 26 consecutive patients with complex spinal pathologies using a stereolithographic technique based on CT data. The biomodels were used pre-operatively for surgical planning and customising implants, and intra-operatively for anatomical reference. Following surgery, a detailed biomodel utility survey was completed by the surgeons, and informal telephone interviews were conducted with patients. Twenty one deformity and five tumour cases were performed using biomodels. Surgeons stated that the anatomical detail was better visible on the biomodel than on other imaging modalities in 65% of cases, and exclusively visible on the biomodel in 11% of cases. Preoperative use of the biomodel led to a different decision regarding the choice of osteosynthetic materials used in 52% of cases, and the implantation site of osteosynthetic material in 74% of cases. Surgeons reported that the use of biomodels reduced operating time by a mean of 8% in tumour patients, and 22% in deformity procedures. This study supports Biomodelling as a useful, and sometimes essential tool in the armamentarium of imaging techniques used for complex spinal surgery.