3D PRINTING IN PEDIATRIC ORTHOPEDICS – THE NEW GENERATION OF PREOPERATIVE PLANNING IN THE FIELD OF PEDIATRIC ORTHOPEDICS
The evolution of modern medicine, in its continuous developing process, is highly connected with the progress achieved in the medical branch of technology. Regarding the surgical specialties, the technological progress breakthroughs may determine the appearance of new diagnosis techniques, but also shape innovative treatments, leading to superior therapeutic results. In the surgical treatment as a whole, an essential role is played by the Medical Imagistics. They either offer the much-needed visual support in order to reach an accurate diagnosis, or guide the surgeon in choosing a certain type of intervention. The importance of Imagistics is indisputable. It has also been proven so in intraoperatory guidance and monitoring the patient in post-surgery. In the evolution of medical Imagistics, after the transition to digital imaging, followed by graphic 3D reconstructions based on CT and MRI data, we find ourselves contemporary with a new turning point announcing a technological revolution: the transition from virtual 3D models to tangible 3D replica. Since the beginning, the 3D printing technology has been of great importance to the field of medical research and, once the technique gained popularity, it became a modern tool for many medical specialties, in particular for cranio-maxillofacial surgery, orthopedics, oncology, neurosurgery. The 3D printing technology managed to transgress dated barriers by facilitating the manufacturing of implants or implement new treatments in regenerative medicine. The purpose of this original paper is to present our 3D printing work protocol and general conclusions after 5 years of implementing 3D printing in pediatric orthopedics.
GA Brown, K Firoozbakhsh, TA DeCoster, JR Reyna Jr, M Moneim: Rapid prototyping: the future of trauma surgery? J Bone Surg Am 2003. 85-A Suppl 4: 49-55.
 PS D’Urso, G Askin, JS Earwaker, Merry GS, Thompson RG,Baker TM, Effeney DJ: Spinal biomodeling. Spine 1999, 24: 1247-1251.
 M Yamazaki, A Okawa, R Kadota, C Mannoji, T Miyashita, M Koda: Surgical simulation of circumferential osteotomy and correction of cervico-thoracic Kyphoscoliosis for an irreducible old C6-C7 fracture dislocation. Acta Neurochir (Wein) (2009) 151: 867-872.
 J Mizutani, T Matsubara, M Fukuoka, N Tanaka, H Iguchi, A Furuya, H Okamoto, I Wada, T Otsuka: Application of full-scale three-dimensional models in patients with rheumatoid cervical spine. Eur Spine J (2008) 17: 644-649
 JM Duncan, S Nahas, K Akhtar, J Daurka: The Use of a 3D Printer in Pre-operative Planning for a Patient Requiring Acetabular Reconstructive Surgery. Journal of Orthopaedic Case Reports 2015 Jan-March: 5(1): Page 23-25.
 F Auricchio, S Marconi: 3D printing: Clinical applications in orthopaedics and traumatology, EFORT open reviews, EOR, volume 1, May 2016, 121-127.
 YU AW, JM Duncan, JS Daurka, A Lewis, J Cobb, A Feasibility Study into the Use of Three-Dimensional Printer Modelling in Acetabular Fracture Surgery; Hindawi Publishing Corporation Advances in Orthopedics, Volume 2015, Article ID 617046, 4 pages, http://dx.doi.org/10.1155/2015/617046.
 I Ono, K Abe, S Shiotani, Y Hiramaya. Producing a full-scale model from computed tomographic data with the rapid prototyping using the binder jet method: a comparison with the laser lithohraphy method using a dry skull. J Craniofac Surg 2000;11(6):527-537.
 E Huotilainen, M Paloheimo, M Salmi, et al. Imaging requirements for medical applications of additive manufacturing. Acta Radiol 2014;55(1):78-85.
 A Fedorov, R Beichel, J Kalpathy-Cramer, J Finet, JC Fillion-Robin, S Pujol, C Bauer, D Jennings, FM Fennessy, M Sonka, J Buatti, SR Aylward, JV Miller, S Pieper, R Kikinis: 3D Slicer as an Image Computing Platform for the Quantitative Imaging Network. Magn Reson Imaging. 2012 Nov;30(9):1323-41.
 OsiriX: www.osirix-viewer.com
 S Widel, A Szczesna, A Widel, D Spinczyk: Orthopedic pre-surgical planning using a 3D printed model, Studia Informatica, Volume 37, Number 3B (126), 2016.
 GNU General Public License, Blender 2.79, release September 11, 2017, https://www.blender.org/.
 Autodesk® Meshmixer, Autodesk MeshMixer is a registered trademark of Autodesk, Inc., and/or its subsidiaries and/or affiliates in the USA and other countries, https://www.meshmixer.com/.
 Copyright © 2012 WANHAO 3D PRINTER. All Rights Re, WanhaoMaker 220.127.116.111, http://www.wanhao3dprinter.com/.
 Y Ito, Y Sugimoto, M Tomioka, Y Hasegawa, K Nakago, Y Yagata: Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine (2008) 9; 450-453;
 GA Brown, K Firoozbakhsh, TA DeCoster, JR Reyna Jr, M Moneim: Rapid prototyping: the future of trauma surgery? J Bone Surg Am 2003. 85-A Suppl 4: 49-55.
 PS D’Urso, G Askin, JS Earwaker, GS Merry, RG Thompson, TM Baker, DJ Effeney: Spinal biomodeling. Spine 1999, 24: 1247-1251;
 M Yamazaki, A Okawa, R Kadota, C Mannoji, T Miyashita, M Koda: Surgical simulation of circumferential osteotomy and correction of cervico-thoracic Kyphoscoliosis for an irreducible old C6-C7 fracture dislocation. Acta Neurochir (Wein) (2009) 151: 867-872;
 JS Matsumoto, JM Morris, TA Foley et al, Three-dimensional Physical Modeling: Applications and Experience at Mayo Clinic; RadioGraphics, vol 35(7):1989-2006;
 M Limin, Z Ye, Z Ye, L Zefeng, W Yingjun, Z Yu, Hong Xia &Chuanbin Mao: 3D-printed guiding templates for improved osteosarcoma resection, Published: 21 March 2016, www.nature.com/scientificreports;
 J Antaniou, V Arlet, T Goswami, M Aebi, M Alini: Elevated synthethic activity in the convex side of scoliotic intervertebral disc and endplates compared with normal tissues. Spine 2001, 26: E 198 – E 206.
 B Cheng, J Fellenberg, H Wang, C Carstens, W Richter: Occurence and regional distributin of apoptosis in scoliotic discs. Spine 2005. 30: 519-524.
 T Kluba, T Niemeyer, C Gaissmaier, T Grunder: Human anulus fibrosis and nucleus pulposus cells of the intervertebral disc – Effect of degeneration and culture system on cell phenotype. Spine 2005, 30: 2743-2748.
 KG Shea, T Ford, RD Bloebaum, J D’Astous, H King: A comparison of the microarchitectural bone adaptations of the concave and convex thoracic spineal facets in IS. J Bone Jt Surg 2004, 86-A 1000-1006.
 MR Urban, JCT Fairbank, SRS Bibby, JPG Urban: Intervertebral disc composition in neuromuscular scoliosis. Change in cell density and glycosaminoglycan concentration at the curve apex. Spine 2001, 26: 610-617.
 I Villemure, CE Aubin, G Grimard, J Dansereau, H Labelle: Progression of vertebral and spinal 3D deformities in AIS. A longitundinal study. Spine 2001, 26: 2244-2250.
 I Villemure, MA Chung, CS Seck, MH Kimm, JR Matyas, NA Duncan: The effects of mechanical loading on the mRNA expression of grwth-plate cells. Research into Spinal Deformities 2002, 4: 114-118.
 R Roaf: Vertebral growth and its mechanical control. J Bone Jt Surg 1960, 42B: 40.
 IAF Stokes: Hueter-Volkmann Effect. Spine: State of the Art Reviews 2000, I4: 349-357.
 MG Gardner-Morse, IAF Stokes: Trunk stiffness increases with steady state effort. J Biomechanics 2001, 34: 457-463.
 PL Mente, DD Aronsson, IAF Stokes, JC Iatridis: Mechanical modulation of growth for the correction of vertebral wedge deformities. J Orthop Res 1999, 17: 518-524.
 IAF Stokes, DD Aronsson: Disc and vertebral wedging in patients with progressive scoliosis. J Spinal Disorders 2001, I 4: 317-322.
 IAF Stokes, MG Gardner-Morse: Muscle activation strategies and spinal loading in the lumbar spine with scoliosis. Spine 2004, 2009: 2103-2107.
 IAF Stokes, H Spence, DD Aronsson, N Kilmer: Mechanical modulation of vertebral body growth. Implications for scoliosis progression. Spine 1996, 21: 1162-1167.
 MH Pope, IAF Stokes, M Moreland: The biomechanics of scoliosis. Crit Rev Biomed ENG 1984, I 1:157-188.
 Y Sugimoto, M Tanaka, R Nakahara, H Misawa, T Kunisada, T Ozaki: Surgical treatment for congenital Kyphosis corection using both spinal navigation and 3D model, Acta Med. Okayama 2012, Vol. 66, No.66: 499-502.
 I Tevanov, E Liciu, MO Chirila, A Dusca, Al Ulici. The use of 3D printing in improving patient-doctor relationship and malpractice prevention, Rom J Leg Med  279-282  DOI: 10.4323/rjlm.2017.279.