Three-dimensional-Printed Computed Tomography-Based Bone Models for Spine Surgery Simulation.

We present a novel 3-dimensional (3D) printing method for low-cost and widely available reproduction of computed tomography (CT)-based synthetic bone models for spine surgery simulation, optimized to reproduce realistic haptic properties. The method allows reproduction of either normal or abnormal patient anatomy. The models are fluoroscopy compatible and contain deformities and fractures present in the underlying CT data. Spine models created from CT data were printed on a 3D printer using 2 different materials for cortical and cancellous bone. Printing parameters were iteratively optimized with surgical experts and 3 candidate spine models were evaluated in a study regarding haptic properties. X-ray images of a spine section printed with final printing parameters were evaluated by surgical experts regarding fluoroscopic properties. Eleven surgical experts performed a trocar insertion, a typical workflow step in spine surgery procedures, on the models. We observed agreement that cortical structures and strong agreement that cancellous structures of the final model are haptically comparable with human vertebral bone. Ten surgical experts evaluated x-ray images of the model. They expressed strong agreement on the similarity with x-ray images of the human spine and confirmed the presence of a fracture. Material cost of a typical spine model is around US $11. Models created using the novel methodology realistically reproduce the haptic properties during a trocar placement into the vertebral body. The models are compatible with conventional x-ray imaging. Because the models correspond to real patient CT data, those can alternatively be used in simulation environments that simulate fluoroscopy or CT image guidance to produce highly realistic, radiation-free imaging output.