title: The use of physical biomodelling in complex spinal surgery.
abstract: Prior studies have suggested that biomodels enhance patient education, preoperative 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 the surgeon's perceptions on the usefulness of biomodels compared to standard visualisation modalities for preoperative 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 preoperatively 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. Using biomodels, 21 deformity and 5 tumour cases were performed. Surgeons stated that the anatomical details were 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.
authors.affiliation: Paediatric Spine Research Group, Level 2, Mater Children's Hospital, Queensland University of Technology and Mater Health Services Brisbane Ltd, Raymond Terrace, South Brisbane, QLD 4101, Australia.
authors.forename: Maree T
authors.initials: MT
authors.lastname: Izatt
authors.forename: Paul L P J
authors.initials: PL
authors.lastname: Thorpe
authors.forename: Robert G
authors.initials: RG
authors.lastname: Thompson
authors.forename: Paul S
authors.initials: PS
authors.lastname: D'Urso
authors.forename: Clayton J
authors.initials: CJ
authors.lastname: Adam
authors.forename: John W S
authors.initials: JW
authors.lastname: Earwaker
authors.forename: Robert D
authors.initials: RD
authors.lastname: Labrom
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Askin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D008954:Models, Biological; D019635:Neurosurgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013238:Stereotaxic Techniques; D036542:Tomography, Spiral Computed