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Case Report

Role of Patient-Specific 3D-Printed Models for Complex Pediatric Craniocervical Junction Surgery: Case Description and Systematic Literature Review

by
David S. K. Mak
1,2,
Yu Tung Lo
1,
Mark B. W. Tan
3,
Dinesh S. Kumar
4 and
Sharon Y. Y. Low
1,2,5,6,*
1
Neurosurgical Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
2
Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
3
Department of Neuroradiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
4
Department of Orthopedics, Changi General Hospital, 2 Simei St. 3, Singapore 529889, Singapore
5
SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
6
SingHealth Duke-NUS Pediatrics Academic Clinical Program, 100 Bukit Timah Road, Singapore 229899, Singapore
*
Author to whom correspondence should be addressed.
Surg. Tech. Dev. 2026, 15(1), 1; https://doi.org/10.3390/std15010001
Submission received: 10 November 2025 / Revised: 27 December 2025 / Accepted: 29 December 2025 / Published: 30 December 2025
(This article belongs to the Special Issue Contemporary Surgical Strategies, Advanced Imaging, and Intelligent Technologies in Head and Neck Surgery)
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Versions Notes

Abstract

Background: Pediatric craniocervical junction (CCJ) anomalies consist of a unique subset of anatomically complex spine conditions. The aims of intervention are to achieve long-term stability, correct existing deformity, and prevent neurological compromise. However, surgery is challenging due to critical neurovascular and musculoskeletal structures in the limited operative space of a young child. Recently, the use of three-dimensional (3D) printed models has been demonstrated to be valuable neurosurgical adjuncts. We therein report the application of a 3D-printed model for a pediatric case with a complex CCJ condition. A systematic review of the related literature is concurrently performed. Case description: A 10-year-old male presented with torticollis associated with neck pain and progressive thoracic kyphosis. Neuroimaging reported an unfused os odontoideum inferior to the basion and anterior half of the C2 vertebral body and anteriorly angulated with the C1 anterior arch. Of note, there was a large vertebral vein coursing over the left C2 lamina that was predominantly draining into the CCJ venous plexus. A radiologically derived 3D model of the patient’s CCJ was printed and used for pre-operative planning, multi-disciplinary team discussion, and detailed counseling with the patient and caregivers. The patient underwent an uneventful C1–C2 posterior screw fixation and has recovered well since. Separately, we observed there is a paucity of publications specific to this topic. Conclusions: As demonstrated, a custom-made 3D model was useful for clinicians work through technical difficulties and improve the perioperative discussion process in an otherwise difficult case.

1. Introduction

Pediatric craniocervical junction (CCJ) anomalies consist of a unique subset of anatomically complex spine conditions that are often clinically challenging to manage. Broadly speaking, the cervical spine is the most mobile spinal segment, and consequent injury may lead to irreversible neurological complications [1]. For children with congenital CCJ pathologies, the aims of intervention are to achieve long-term stability, correct existing deformity, and prevent neurological compromise. However, surgery is often technically difficult due to critical neurovascular and musculoskeletal structures in the limited operative space of a young child.
In recent years, the use of three-dimensional (3D) printed models in neurosurgery has been demonstrated to be valuable adjuncts for better visuospatial planning of selected regions of interest and, hence, potentially reducing operative morbidity. Examples include the use of patient-specific 3D-printed spine models for surgeons to anticipate the technical challenges before the actual procedure [2]. Furthermore, previous studies have reported that 3D models improve the pre-operative counseling process with patients, enabling them to make better informed decisions for their respective treatments [3,4]. We therein report the application of a bespoke 3D-printed model for a pediatric patient with a complex CCJ condition and discuss its extended use case, in corroboration with contemporary literature.

2. Case Description

A previously well 10-year-old male presented with a few months’ history of persistent neck pain associated with difficulty turning his neck. There was no history of trauma, recent infection, or constitutional symptoms. On physical examination, he had a slight torticollis associated with a limited range of motion of his cervical spine due to pain. There were no upper motor neuron or long tract signs. His gait assessment and digital rectal examination were unremarkable. X-rays of his cervical spine were ordered (Figure 1).
Follow-up magnetic resonance imaging (MRI) and computed tomography (CT) of his neuroaxis was arranged. These reported an unfused os odontoideum positioned inferior to the basion and anterior half of the C2 vertebral body, associated with an anteriorly angulated C1 arch. There was widening of the atlantoaxial interval consistent with atlanto–axial subluxation. No acute fracture or facetal subluxation was present. Of note, the C2 dens was hypoplastic with a bony prominence which protruded into the spinal canal causing indentation of the cervical spinal cord. The remaining cervico–thoracic spine was anatomically unremarkable. (Figure 2). Additional computed tomographic (CT) angiography scans did not show any vertebral artery anomaly. However, we observed a large vertebral vein coursing over the left C2 lamina that was predominantly draining into the CCJ venous plexus. Follow-up magnetic resonance imaging (MRI) was performed to assess the integrity of the spinal cord and CCJ ligaments. This showed mild T2 hyperintensity in the posterior atlanto–occipital membrane. The tectorial membrane, ligamentum nuchae, and prevertebral soft tissues were unremarkable. Owing to the bony subluxation, the apical and alar ligaments were not well-visualized. Otherwise, no cervical cord signal abnormality was detected (Figure 3). Based on the patient’s clinical history, physical examination, and radiological findings, the overall impression was that of an acquired torticollis secondary to atlantoaxial subluxation—likely a consequence of a combination of congenital osseous anomalies and ligamentous laxity at the CCJ.
The decision was made for a radiologically derived model of the patient’s CCJ to be 3D-printed as part of the clinical management. Briefly, computed tomographic (CT) angiography of the head and neck was acquired at 90 kV using a Somatom Force scanner (Siemens Healthineers, Erlangen, Germany). Here, 30 mL of iodinated contrast medium (Omnipaque300, iodine concentration 300 mg/mL) was administered at a flow rate of 3 mL/s followed by 50 mL of a 0.9% normal saline chaser administered at a flow rate of 3.3 mL/s. The matrix size was 512 × 512, the field of view was 203 mm, the gantry tilt was 0 degrees, the slice thickness was 0.6 mm, and the slice increment was 0.4 mm. The total dose-length product of the CT scan was 56 mGy/cm. For the CT dataset, a smooth vascular convolution kernel (Bv 36d\3) and a slice width of 0.6 mm was used. This dataset was exported using syngo.via software (Siemens Healthineers, Erlangen, Germany) to a Digital Imaging and Communications in Medicine (DICOM) format and imported into Materialise Mimics Medical v26.0 and Materialise 3-Matics v18.0 softwares (Materialise NV, Leuven, Belgium) for image segmentation, digital modeling, and model mesh optimization. Digital models of the arterial, venous, and osseous structures were created and exported to a Standard Tessellation Language (STL) format. These STL files were imported into PreForm software (Formlabs, https://formlabs.com/global/software/, accessed on 1 February 2024) for model preparation, support structure generation, and slicing, and then printed with a vat polymerization Formlabs Form 3B stereolithography 3D printer (Formlabs, https://formlabs.com/global/software/, accessed on 1 February 2024). Formlabs Clear Resin (Formlabs, https://formlabs.com/global/software/, accessed on 1 February 2024) was used and the print time was 15 h. The support structures were removed, and the arterial structures were painted red and the venous structures in blue using acrylic paint. This workflow was performed by a radiographic technologist and a biomedical engineer, under the oversight of a senior neuroradiologist (M.B.W.T), for double-checking of the segmentations, virtual models, and final dimensional accuracy, and a quality assurance engineer ensured quality standards through the development process. Subsequently, the specialized 3D model used for pre-operative planning, multi-disciplinary team discussion, and detailed counseling with the patient and caregivers. The primary aims of intervention were safe correction of misalignment, long-term stability of the CCJ, and prevention of imminent neurological injury. Technical nuances included size and trajectory of laminar screws, approach to safe reduction in the CCJ, and avoidance of important blood vessels during the surgery (Figure 4). Also, these pre-planning efforts intended to reduce intraoperative X-ray radiation exposure and surgical time for the patient.
After the induction of general anesthesia, the patient was positioned prone with a neutral spine. Rigid skull pin fixation using the DORO® Radiolucent Skull Clamp (Black Forest Medical Group, Freburg, Germany) and intraoperative neuromonitoring (IONM) probes to assess motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) were applied. Spine surgical navigation was set up using the O-arm (MEDTRONICTM, Minneapolis, MN, USA). Under asepsis, a midline, linear incision followed by a layered tissue opening was made from the inion to C2 level. As observed in the pre-operative neuroimaging and 3D model, we encountered an incomplete dorsal C1 arch, and the C1-0 were fixed and flexed forwards in relation to C2. Next, the dorsal C1–2 venous plexus was identified and dissected out. During this process, we were particularly mindful to locate the left vertebral vein as noted on the 3D model. The draining vessels were then coagulated with a combination of bipolar cautery and oxidized cellulose. Following that, the bilateral exiting C2 nerve roots were identified with their ends cauterized. Pertaining to the bony structures, the dorsal surface and the medial and lateral borders of both C1 lateral masses were exposed, followed by trimming of the edges of the inferior dorsal arch of C1. These maneuvers were necessary to accommodate optimal placement of subsequent implants. An intraoperative CT scan was performed using the O-arm with the images registered for neuro-navigation. Under direct navigational guidance, bilateral C1 lateral mass lag screws (3.5 × 26 mm) were inserted after tapping of the screw track using navigated instruments. Following that, bilateral C2 pedicle screws (both 3.0 × 18 mm dimension) were then inserted using navigated instruments (straight pedicle probe followed by tapping and then screw insertion) (Figure 5). Follow-up fluoroscopy confirmed satisfactory placement of the screws. Confirmatory IONM readings have also confirmed no change in signals from the baseline.
After insertion of straight titanium rods, bilateral C1 reduction was performed A final check fluoroscopic image confirmed the reduction in C1 and satisfactory placement of implants. Once again, IONM have confirmed no change in signals from the baseline prior to closure. Decortication of the C2 spinous process, laminae, and C1 posterior arches was performed. To augment the bony fusion process, allografted bone matrix (Grafton™ demineralized bone matrix; MEDTRONICTM, MN, USA) was mixed with the patient’s own bone dust and packed along the relevant implant locations. Due to the patient’s congenital anatomy of an incomplete C1 arch, we did not proceed with posterior C1 arch decompression as there was already adequate ventral space accommodating the spinal cord. The wound was closed in a layered fashion. At the end of the surgery, a rigid cervical collar was applied prior to extubating. The patient’s post-operative period was uneventful. No new neurological deficit or wound-related complication was encountered. After an inpatient stay of 5 days, he was discharged home with the rigid cervical collar. The latter was removed at approximately 6 weeks after surgery. At 20 months post-surgery, he remains well. Interval X-rays confirm no implant migration or new CCJ instability (Figure 6). A consensus was made for interval X-ray imaging and continued neurological assessment as part of his outpatient follow-up. The rationale for the choice of imaging was to, firstly, avoid substantially higher levels of exposure to radiation from CT scans in a young person; and next, potential mis-interpretation of artifacts in the operated site in MRI images [5,6]. Nonetheless, there is consideration for detailed CT and MRI scans when the patient is older, prior to transition of care to the adult service.

3. Systematic Literature Review

3.1. Database Search

A comprehensive literature search was conducted in the PubMed database, including records up to April 5, 2025. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [7,8]. The following search terms were used: (“3D print*” OR “three-dimensional print*”) AND (“atlantoaxial” OR “occipitocervical” OR “craniocervical” OR “craniovertebral”). Additionally, reference lists of included studies and relevant reviews, as well as a Google Scholar search using the above terms, were manually searched to identify additional eligible studies. A summary of the findings is represented in Figure 1.

3.2. Eligibility Criteria and Study Selection

Studies were included if they met the following criteria: children (age less than 18 years old) that used 3D printing for CCJ or high cervical spine pathology. Owing to paucity of publications specific to this topic, all article types such as case reports, case series, and topic-centric abstracts (if applicable) were considered. Non-English language articles were excluded. Briefly, all titles and abstracts of identified records were first assessed for eligibility. Next, the full-text articles of potentially relevant studies were retrieved and assessed for inclusion based on the abovementioned predefined eligibility criteria.

3.3. Data Extraction

A standardized data extraction form was used to extract the data. The following information was collected: author and year, total number of patients, number of children, chronological age of the individual pediatric cases, material used for printing, the type and model of printer, pathology, indication. Key findings were summarized.

3.4. Results

A total of 71 publications up to 31 March 2025 relevant to our study were selected from the database search. Following that, a final list of 17 studies was identified after full-text review [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23] (Figure 7).
Of note, the use of 3D printing was typically applied for the following: surgical precision (i.e., spinal screw accuracy, tumor margins), intra-operative safety awareness of critical neurovascular structures such as the vertebral artery, and as a perioperative adjunct for discussion with other clinical for management strategies. Of note, the pre-operative planning with 3D-printed models also helped to reduce overall radiation exposure for the patient and operating team during the surgeries. Table 1 summarizes the relevant findings of the systematic review.

4. Discussion

4.1. Overview of Craniocervical Junction Surgery in the Pediatric Population

In a growing child, the CCJ is uniquely vulnerable due to a disproportionately large cranium, relatively weak cervical musculature, lax ligamentous structures, and a shallow occipito–atlantal articulation [26,27]. Under such circumstances, concurrent congenital or acquired disease processes may further exacerbate these predisposing factors to potentially life-threatening CCJ conditions [27]. Put together, this combination of immature neuroanatomy, biomechanical processes, and evolving physiology in the young inevitably increases their risk of occipito–cervical (OC) and/or atlantoaxial instability (AAI). In normal individuals, the C1–C2 joint is responsible for as much as 60% of the total rotation of the neck [28,29,30]. The unique configuration of the atlantoaxial complex lends itself to behaving as the main rotational pivot of the cervical spine, but these same anatomic features also predispose this complex to a disorder characterized by a persistent, rotational deformity (known as atlantoaxial rotatory fixation or ‘AARF’) because of its apparent ‘fixed’ state to voluntary or involuntary correction [30]. Here, the C1–C2 instability due to loss of normal articulation may occur in all age groups, but tends to be prevalent in adolescents [9]. Congruent with the principles of most spine surgeries, the management of this condition aims at multiplanar alignment correction followed by stabilization to prevent devastating neurological injury [9,31,32].
Nonetheless, the treatment of CCJ conditions in the pediatric population can be challenging because of the frequently superimposed complex skull base and upper cervical anatomy that result from acquired or inherited disease processes [27,33,34]. Examples include close proximity to criterial neurological structures, associated bony anomalies and the innately variable course of the vertebral artery at this location [35,36]. Additionally, the ossification process and synchondroses tends to vary between children of different age, gender, or ethnicity [37]. Put together, the complexity of the anatomical structure adjacent to the pedicle of the upper cervical spine and the individual differences make it difficult and risky to place pedicle screws through the posterior approach. When establishing the channel during the operation, even experienced spine surgeons find it difficult to quickly and accurately complete the placement of the upper cervical pedicle screw [38]. Here, misplacement of the pedicle screw leads to nerve root and spinal cord injury, especially in the cervical spine where the morphometric variation in the pedicles and their proximity to vital structures make it difficult to place the pedicle screws accurately [39,40,41]. High cervical pedicle screws mandate a very low margin for error. Medial breaches may compromise the spinal cord resulting in severe neurological sequelae, infero-lateral breaches may result in damage to the V2 segment of the vertebral artery and C3 nerve root, direct lateral breaches may damage the V3 segment of the vertebral artery and result in poor mechanical stability, whilst superior breaches may compromise the C2 nerve root [20]. Furthermore, free-hand and fluoroscopy-assisted techniques have been associated with higher rates of incorrect pedicle screw placement [39,42]. Although the advent of image-guidance systems has improved the accuracy and safety of spinal screw placements, there are still limitations faced by the operating surgeons. For example, conventional neuro-navigational setups usually involve the preoperative image to be displayed on flat computer screens in the operating theater. The screen is divided into three separate two-dimensional (2D) images in sagittal, coronal, and axial directions, respectively. Here, the neurosurgeon mentally combines the images to create a single 3D composite image [43,44]. The critical part of this exercise requires one to integrate the 2D information to obtain a 3D spatial relationship in the anatomical region of interest in order to choose the best surgical trajectory [43]. Under such circumstances, the availability of a 3D model for clearer visualization will enable the surgical team to make safer decisions for implant insertion. In the context of our patient, the true-to-size 3D model assisted the operating team to identify specific structural landmarks that was correlated to the neuro-navigation of the O-arm (MEDTRONICTM, MN, USA) and choose appropriately sized spinal implants.

4.2. The Role of 3D Printing in Neurosurgery

Presently, 3D printing applications are used in several industries, including healthcare [45]. For the latter, 3D printing is increasingly applied in various surgical subspecialities due its rapid prototyping technology and ease of use [20,38,46]. In neurosurgery, 3D printing has been used for surgical planning, resident training and patient education [20,47,48,49]. These 3D reproductions of the anatomical region of interest enable surgeons to make better surgical strategy choices, leading to improved clinical outcomes and reduced operative times [11,24,45]. In the operating theater, the patient-specific anatomical models derived from 3D printing have successfully assisted various surgical procedures [19,22]. Specifically, for more complex spine procedures, several studies have demonstrated that customized 3D-printed surgical guides have assisted spine surgeons with more accurate implant placements [38,45,50,51]. Based on a recent review by Vezirska et al., its benefits have been demonstrated in the planning of pedicle screw insertion and fixation for difficult CCJ and high cervical spine procedures using pre-printed 3D training models [47,52,53]. Also, most author feedback has stated that these training models improve patient safety by providing hands-on simulation trials for technically complex procedures [52,53,54]. At this juncture, the overall applications of 3D printing in pediatric spine surgery are comparatively less than their adult counterparts. Beyond its adjunct benefit from a technical perspective, our patient’s bespoke 3D-printed model facilitated important discussions with, firstly, the anesthesia team in regard to intubation and blood loss concerns; and, next, the patient’s caregivers on the visuospatial understanding of the surgical process. The following table provides a comparative overview between conventional image-fused neuro-navigation and 3D-printed models for spine surgery (Table 2).

4.3. Critique of Systematic Literature Review

Across the studies in our systematic review, we observe that patient-specific 3D-printed models are primarily adopted for complex CCJ anomalies, followed by high-cervical tumors, spine trauma, and rare pathologies such as Grisel’s syndrome and eosinophilic granuloma [13,21,23,24,25]. These bespoke models demonstrated value in several phases of care, including preoperative surgical planning, intraoperative screw-trajectory guidance, and patient/family or resident education. Collectively, the studies reported no vertebral artery (VA) injuries and high screw-placement accuracy, including scenarios with anomalous VA courses or small osseous corridors [17]. These translated into shorter operative times, reduced blood loss [22], and lower radiation exposure compared with freehand or navigation-only approaches [24], as well as stable fusion on follow-up imaging across cases involving arthrodesis or oncologic reconstruction. For oncology cases, implants designed from 3D-printed patient anatomy showed no subsidence or displacement and in the context of a pediatric spine, the relevance of early osseointegration—thus, supporting the biomechanical utility of these models.
Despite these favorable clinical outcomes, notable methodological limitations temper the strength of evidence. Existing literature is dominated by small case series and single-patient reports, with heterogeneous pathologies, workflow integration, and imaging validation standards, making broad generalizations challenging. Furthermore, standardized outcome metrics are lacking, especially those pertaining to quantitative screw-deviation thresholds or long-term quality of life measures. Notably, economic analyses are also absent, despite the recognized additional cost and resource burden of 3D-printing workflows—an important factor in today’s healthcare setting. Moreover, we acknowledge the lack of major complications attributed to 3D printing-related procedures may be due to reporting bias. Last but not least, the studies rarely reported learning-curve effects, production turnaround times, or regulatory considerations, which may limit widespread clinical adoption. Overall, we hope that our experience is able to contribute to the growing body of literature on the clinical value of patient-specific 3D-printed models in the management of children with complex CCJ conditions.

4.4. Study Reflections and Future Directions

It is noteworthy to highlight that the use of 3D printing in neurosurgery has not been validated in large-scale, randomized multi-center trials. Despite the purported benefits of its use as described in several case series (including our patient), we believe that formal validation via prospective efforts is necessary to establish the feasibility of 3D printing in the clinical setting. Furthermore, the cost–benefit of 3D printing in healthcare is not yet proven to be superior to conventional methods of intraoperative imaging or neuro-navigation. To date, the impact of additional healthcare costs by medical technology-related adjuncts, including 3D printing, are considerable. Under such circumstances, the substantial expenses covering operational, infrastructure, and expertise may not be feasible in some settings. Also, we should be cognizant of the wider impacts of 3D printing beyond the healthcare setting. First and foremost, 3D printing uses potentially hazardous materials and generates carbon emissions [56]. Like all manufacturing processes, 3D printing processes have an inevitable environmental impact that should not be overlooked [56,57]. Moving forward, there is a role to work with related industries to look at sustainable practices that can minimize its environmental footprint [56]. Examples include using biodegradable filaments, materials that require less thermal input, and so forth. Alternative operative adjuncts such as mixed reality systems that rely on re-usable headsets also have been gaining traction in neurosurgery [43,58]. Similarly to 3D printing, it remains uncertain at this stage if these technologies will be adopted into mainstream use due to lack of clinical evidence and high costs [43].

5. Conclusions

As demonstrated in our patient, a patient-specific 3D-printed model was useful for clinicians work through technical difficulties and improve the perioperative discussion and planning processes in a clinically complex case. Nonetheless, we acknowledge the limitations of our single case experience and the lack of robust literature on this topic. In the meantime, we advocate for international collaborative efforts for this initiative as part of improving the management of children with complex CCJ anomalies.

Author Contributions

Conceptualization, D.S.K. and S.Y.Y.L.; methodology, D.S.K.M., M.B.W.T., Y.T.L. and D.S.K.; software, M.B.W.T. and S.Y.Y.L.; validation, D.S.K.M. and D.S.K.; formal analysis, D.S.K.M., M.B.W.T., Y.T.L. and S.Y.Y.L.; investigation, D.S.K.M., M.B.W.T. and S.Y.Y.L.; resources, D.S.K.M., M.B.W.T., D.S.K. and S.Y.Y.L.; data curation, D.S.K.M., M.B.W.T., Y.T.L. and S.Y.Y.L.; writing—original draft preparation, D.S.K.M., M.B.W.T., Y.T.L. and S.Y.Y.L.; writing—review and editing, S.Y.Y.L.; visualization, D.S.K.M., Y.T.L. and M.B.W.T.; supervision, D.S.K.; project administration, S.Y.Y.L. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the SingHealth Centralized Institutional Review Board (CIRB) (Reference: 2022-2501, approved on 13 September 2020 and approval to 26 November 2025).

Informed Consent Statement

Informed consent to participate in this study was provided by the participants’ legal guardian/next of kin. The informed consent for publication is part of the written consent form to participate in this study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Acknowledgments

The authors thank Giselle Goh for assisting with some of the research material for this manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Ghanem, I.; El Hage, S.; Rachkidi, R.; Kharrat, K.; Dagher, F.; Kreichati, G. Pediatric cervical spine instability. J. Child. Orthop. 2008, 2, 71–84. [Google Scholar] [CrossRef] [PubMed]
  2. Garg, B.; Mehta, N. Current status of 3D printing in spine surgery. J. Clin. Orthop. Trauma. 2018, 9, 218–225. [Google Scholar] [CrossRef] [PubMed]
  3. Jimenez, J.E.; Shaffer, A.D.; Hammersley, E.; Ghodadra, A.; Stapleton, A.L. Use of patient-specific 3D printed models in pre-operative counseling for pediatric skull base surgery. Int. J. Pediatr. Otorhinolaryngol. 2023, 171, 111655. [Google Scholar] [CrossRef] [PubMed]
  4. Joseph, F.J.; Vanluchene, H.E.R.; Goldberg, J.; Bervini, D. 3D-Printed Head Model in Patient’s Education for Micro-Neurosurgical Aneurysm Clipping Procedures. World Neurosurg. 2023, 175, e1069–e1074. [Google Scholar] [CrossRef]
  5. Smith-Bindman, R.; Lipson, J.; Marcus, R.; Kim, K.P.; Mahesh, M.; Gould, R.; Berrington de González, A.; Miglioretti, D.L. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch. Intern. Med. 2009, 169, 2078–2086. [Google Scholar] [CrossRef]
  6. Alvord, E.C., Jr.; Lofton, S. Gliomas of the optic nerve or chiasm. Outcome by patients’ age, tumor site, and treatment. J. Neurosurg. 1988, 68, 85–98. [Google Scholar] [CrossRef]
  7. Liberati, A.; Altman, D.G.; Tetzlaff, J.; Mulrow, C.; Gøtzsche, P.C.; Ioannidis, J.P.A.; Clarke, M.; Devereaux, P.J.; Kleijnen, J.; Moher, D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J. Clin. Epidemiol. 2009, 62, e1–e34. [Google Scholar] [CrossRef]
  8. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. bmj 2021, 372, n71. [Google Scholar] [CrossRef]
  9. Agarwal, P.; Chopra, S.; Sinha, V.D.; Kataria, R. Three-Dimensional-Printed Model-Assisted Management of Craniovertebral Junction Abnormalities: An Institutional Experience with Literature Review. Asian Spine J. 2020, 14, 204–211. [Google Scholar] [CrossRef]
  10. Chhabra, S.; Chopra, S.; Kataria, R.; Sinha, V.D. Use of 3D printer model to study vertebral artery anatomy and variations in developmental craniovertebral junction anomalies and as a preoperative tool-an institutional experience. J. Spine Surg. 2017, 3, 572–579. [Google Scholar] [CrossRef]
  11. Coote, J.D.; Nguyen, T.; Tholen, K.; Stewart, C.; Verter, E.; McGee, J.; Celestre, P.; Sarkar, K. Three-Dimensional Printed Patient Models for Complex Pediatric Spinal Surgery. Ochsner J. 2019, 19, 49–53. [Google Scholar] [CrossRef] [PubMed]
  12. Goel, A.; Jankharia, B.; Shah, A.; Sathe, P. Three-dimensional models: An emerging investigational revolution for craniovertebral junction surgery. J. Neurosurg. Spine 2016, 25, 740–744. [Google Scholar] [CrossRef] [PubMed]
  13. He, S.; Ye, C.; Zhong, N.; Yang, M.; Yang, X.; Xiao, J. Customized anterior craniocervical reconstruction via a modified high-cervical retropharyngeal approach following resection of a spinal tumor involving C1-2/C1-3. J. Neurosurg. Spine 2020, 32, 432–440. [Google Scholar] [CrossRef] [PubMed]
  14. Kagami, Y.; Nakashima, H.; Segi, N.; Ito, S.; Ouchida, J.; Shinjo, R.; Imagama, S. A novel technique for C1-C2 posterior screw insertion using patient-specific guides created by CT-based 3D printing. Nagoya J. Med. Sci. 2024, 86, 487–496. [Google Scholar] [CrossRef]
  15. Malikov, A.; Secen, A.E.; Divanlioglu, D.; Gunerhan, G.; Ocal, O.; Gunduz, U.K. The Feasibility of Creating Image-Based Patient-Specific Drill Guides for the Atlantoaxial Instabilities Using Open-Source CAD Software and Desktop 3D Printers. World Neurosurg. 2022, 163, e377–e383. [Google Scholar] [CrossRef]
  16. Pijpker, P.A.J.; Kuijlen, J.M.A.; Kaptein, B.L.; Pondaag, W. Three-Dimensional-Printed Drill Guides for Occipitothoracic Fusion in a Pediatric Patient with Occipitocervical Instability. Oper. Neurosurg. 2021, 21, 27–33. [Google Scholar] [CrossRef]
  17. Rashim, K.; Verma Pawan, K.; Sinha, V.D. Increasing the safety of surgical treatment for complex Cranio-vertebral anomalies using customized 3D printed models. J. Clin. Neurosci. 2018, 48, 203–208. [Google Scholar] [CrossRef]
  18. Sakai, T.; Tezuka, F.; Abe, M.; Yamashita, K.; Takata, Y.; Higashino, K.; Nagamachi, A.; Sairyo, K. Pediatric Patient with Incidental Os Odontoideum Safely Treated with Posterior Fixation Using Rod-Hook System and Preoperative Planning Using 3D Printer: A Case Report. J. Neurol. Surg. A Cent. Eur. Neurosurg. 2017, 78, 306–309. [Google Scholar] [CrossRef]
  19. Texeira da Silva, L.E.C.; Cuéllar, D.J.; Campos de Barros, A.G.; Khan, A.A. Three-dimensional biomodel use in the surgical management of basilar invagination with congenital cervical scoliosis; correction by unilateral C1-C2 facet distraction. J. Craniovertebr. Junction Spine 2020, 11, 347–350. [Google Scholar] [CrossRef]
  20. Vakharia, V.N.; Smith, L.; Tahir, Z.; Sparks, R.; Ourselin, S.; Tucker, S.; Thompson, D. Occipitocervical instrumented fixation utilising patient-specific C2 3D-printed spinal screw trajectory guides in complex paediatric skeletal dysplasia. Child’s Nerv. Syst. 2021, 37, 2643–2650. [Google Scholar] [CrossRef]
  21. Wang, J.; Zhu, C.; Xia, H. Management of Unique Basilar Invagination Combined with C1 Prolapsing into the Foramen Magnum in Children: Report of 2 Cases. World Neurosurg. 2019, 127, 92–96. [Google Scholar] [CrossRef]
  22. Wang, Y.T.; Yang, X.J.; Yan, B.; Zeng, T.H.; Qiu, Y.Y.; Chen, S.J. Clinical application of three-dimensional printing in the personalized treatment of complex spinal disorders. Chin. J. Traumatol. 2016, 19, 31–34. [Google Scholar] [CrossRef] [PubMed]
  23. Xu, N.; Wei, F.; Liu, X.; Jiang, L.; Cai, H.; Li, Z.; Yu, M.; Wu, F.; Liu, Z. Reconstruction of the Upper Cervical Spine Using a Personalized 3D-Printed Vertebral Body in an Adolescent with Ewing Sarcoma. Spine 2016, 41, E50–E54. [Google Scholar] [CrossRef] [PubMed]
  24. Jug, M.; Tomaževič, M.; Cimerman, M. 3D model-assisted instrumentation of the pediatric spine: A technical note. J. Orthop. Surg. Res. 2021, 16, 586. [Google Scholar] [CrossRef] [PubMed]
  25. Malikov, A.; Secen, A.E.; Ocal, O.; Divanlioglu, D.; Belen, A.D.; Dalgic, A. Accuracy of Axis Drill Guides in the Cases of Atlantoaxial Instabilities Associated with High-Riding Vertebral Arteries, Narrow Pedicles, and Complex Deformities: Comparison of 3 Fixation Methods. World Neurosurg. 2022, 168, e336–e343. [Google Scholar] [CrossRef]
  26. Dogan, S.; Safavi-Abbasi, S.; Theodore, N.; Horn, E.; Rekate, H.L.; Sonntag, V.K. Pediatric subaxial cervical spine injuries: Origins, management, and outcome in 51 patients. Neurosurg. Focus 2006, 20, E1. [Google Scholar] [CrossRef]
  27. Richards, O.; Saeed, F.; Derham, C.; Tyagi, A. Craniocervical fusion in the paediatric population—Case series of 21 patients. Br. J. Neurosurg. 2024, 38, 116–121. [Google Scholar] [CrossRef]
  28. Pang, D.; Li, V. Atlantoaxial rotatory fixation: Part 1—Biomechanics of normal rotation at the atlantoaxial joint in children. Neurosurgery 2004, 55, 614–625, discussion 625–616. [Google Scholar] [CrossRef]
  29. Pang, D.; Li, V. Atlantoaxial rotatory fixation: Part 2—New diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging. Neurosurgery 2005, 57, 941–953. [Google Scholar] [CrossRef]
  30. Pang, D. Atlantoaxial rotatory fixation. Neurosurgery 2010, 66, 161–183. [Google Scholar] [CrossRef]
  31. Salunke, P.; Behari, S.; Kirankumar, M.V.; Sharma, M.S.; Jaiswal, A.K.; Jain, V.K. Pediatric congenital atlantoaxial dislocation: Differences between the irreducible and reducible varieties. J. Neurosurg. 2006, 104, 115–122. [Google Scholar] [CrossRef][Green Version]
  32. Wang, C.; Yan, M.; Zhou, H.; Wang, S.; Dang, G. Atlantoaxial transarticular screw fixation with morselized autograft and without additional internal fixation: Technical description and report of 57 cases. Spine 2007, 32, 643–646. [Google Scholar] [CrossRef] [PubMed]
  33. Menezes, A.H. Evaluation and treatment of congenital and developmental anomalies of the cervical spine. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J. Neurosurg. Spine 2004, 1, 188–197. [Google Scholar] [CrossRef] [PubMed]
  34. Ahmed, R.; Traynelis, V.C.; Menezes, A.H. Fusions at the craniovertebral junction. Child’s Nerv. Syst. 2008, 24, 1209–1224. [Google Scholar] [CrossRef] [PubMed]
  35. Cacciola, F.; Phalke, U.; Goel, A. Vertebral artery in relationship to C1-C2 vertebrae: An anatomical study. Neurol. India 2004, 52, 178–184. [Google Scholar]
  36. Tian, Y.; Xu, N.; Yan, M.; Chen, J.; Hung, K.-L.; Hou, X.; Wang, S.; Li, W. Vertebral Artery Variations at the Craniovertebral Junction in “Sandwich” Atlantoaxial Dislocation Patients. Neurospine 2021, 18, 770–777. [Google Scholar] [CrossRef]
  37. Lee, H.J.; Lee, J.J.; Hong, J.T.; Kim, J.T. Quantification of pediatric cervical growth: Anatomical changes in the sub-axial spine. J. Korean Neurosurg. Soc. 2015, 57, 185–191. [Google Scholar] [CrossRef]
  38. Niu, G.; Chen, H.; Liu, L.; Zhou, G.; Zhou, Q.; Li, C.; Dai, J.; Nie, H.; Bai, J.; Zhang, J. Surgical treatment for upper cervical deformity with atlantoaxial joint dislocation using individualized 3D printing occipitocervical fusion instrument: A case report and literature review. Medicine 2021, 100, e25202. [Google Scholar] [CrossRef]
  39. Shree Kumar, D.; Ampar, N.; Wee Lim, L. Accuracy and reliability of spinal navigation: An analysis of over 1000 pedicle screws. J. Orthop. 2020, 18, 197–203. [Google Scholar] [CrossRef]
  40. Flynn, J.M.; Sakai, D.S. Improving safety in spinal deformity surgery: Advances in navigation and neurologic monitoring. Eur. Spine J. 2013, 22, 131–137. [Google Scholar] [CrossRef]
  41. Munusamy, T.; Thien, A.; Anthony, M.G.; Bakthavachalam, R.; Dinesh, S.K. Computed tomographic morphometric analysis of cervical pedicles in a multi-ethnic Asian population and relevance to subaxial cervical pedicle screw fixation. Eur. Spine J. 2015, 24, 120–126. [Google Scholar] [CrossRef] [PubMed]
  42. Weinstein, J.N.; Spratt, K.F.; Spengler, D.; Brick, C.; Reid, S. Spinal pedicle fixation: Reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Spine 1988, 13, 1012–1018. [Google Scholar] [CrossRef] [PubMed]
  43. Liang, S.; Teo, J.C.; Coyuco, B.C.; Cheong, T.M.; Lee, N.K.; Low, S.Y.Y. Mixed Reality for Pediatric Brain Tumors: A Pilot Study from a Singapore Children’s Hospital. Surgeries 2023, 4, 354–366. [Google Scholar] [CrossRef]
  44. Tagaytayan, R.; Kelemen, A.; Sik-Lanyi, C. Augmented reality in neurosurgery. Arch. Med. Sci. 2018, 14, 572–578. [Google Scholar] [CrossRef]
  45. Mansour, N.K.; Callera, A.; Potere, F.; Micalizzi, S.; Costantino, M.L.; De Gaetano, F.; Oliva, P. Circular economy and 3D printing in the healthcare sector. Front. Bioeng. Biotechnol. 2025, 13, 1548550. [Google Scholar] [CrossRef]
  46. Vukicevic, M.; Puperi, D.S.; Jane Grande-Allen, K.; Little, S.H. 3D Printed Modeling of the Mitral Valve for Catheter-Based Structural Interventions. Ann. Biomed. Eng. 2017, 45, 508–519. [Google Scholar] [CrossRef]
  47. Pacione, D.; Tanweer, O.; Berman, P.; Harter, D.H. The utility of a multimaterial 3D printed model for surgical planning of complex deformity of the skull base and craniovertebral junction. J. Neurosurg. 2016, 125, 1194–1197. [Google Scholar] [CrossRef]
  48. Liew, Y.; Beveridge, E.; Demetriades, A.K.; Hughes, M.A. 3D printing of patient-specific anatomy: A tool to improve patient consent and enhance imaging interpretation by trainees. Br. J. Neurosurg. 2015, 29, 712–714. [Google Scholar] [CrossRef]
  49. Waran, V.; Narayanan, V.; Karuppiah, R.; Owen, S.L.; Aziz, T. Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons. J. Neurosurg. 2014, 120, 489–492. [Google Scholar] [CrossRef]
  50. Aimar, A.; Palermo, A.; Innocenti, B. The Role of 3D Printing in Medical Applications: A State of the Art. J. Healthc. Eng. 2019, 2019, 5340616. [Google Scholar] [CrossRef]
  51. Zhang, F.; Zhang, H.; Zhao, H.; He, Z.; Shi, L.; He, Y.; Ju, N.; Rong, Y.; Qiu, J. Design and fabrication of a personalized anthropomorphic phantom using 3D printing and tissue equivalent materials. Quant. Imaging Med. Surg. 2019, 9, 94–100. [Google Scholar] [CrossRef]
  52. Vezirska, D.; Milev, M.; Laleva, L.; Nakov, V.; Spiriev, T. Three-Dimensional Printing in Neurosurgery: A Review of Current Indications and Applications and a Basic Methodology for Creating a Three-Dimensional Printed Model for the Neurosurgical Practice. Cureus 2022, 14, e33153. [Google Scholar] [CrossRef]
  53. Govsa, F.; Ozer, M.A.; Biceroglu, H.; Karakas, A.B.; Cagli, S.; Eraslan, C.; Alagoz, A.K. Creation of 3-Dimensional Life Size: Patient-Specific C1 Fracture Models for Screw Fixation. World Neurosurg. 2018, 114, e173–e181. [Google Scholar] [CrossRef]
  54. Thayaparan, G.K.; Owbridge, M.G.; Thompson, R.G.; D’Urso, P.S. Patient-specific processes for occipitocervical fixation using biomodelling and additive manufacturing. J. Clin. Neurosci. 2020, 71, 251–256. [Google Scholar] [CrossRef]
  55. Iqbal, J.; Zafar, Z.; Skandalakis, G.; Kuruba, V.; Madan, S.; Kazim, S.F.; Bowers, C.A. Recent advances of 3D-printing in spine surgery. Surg. Neurol. Int. 2024, 15, 297. [Google Scholar] [CrossRef]
  56. Li, H.; Alkahtani, M.E.; Basit, A.W.; Elbadawi, M.; Gaisford, S. Optimizing environmental sustainability in pharmaceutical 3D printing through machine learning. Int. J. Pharm. 2023, 648, 123561. [Google Scholar] [CrossRef]
  57. Malik, A.; Ul Haq, M.I.; Raina, A.; Gupta, K. 3D printing towards implementing Industry 4.0: Sustainability aspects, barriers and challenges. Ind. Robot 2022, 49, 491–511. [Google Scholar] [CrossRef]
  58. De Jesus Encarnacion Ramirez, M.; Chmutin, G.; Nurmukhametov, R.; Soto, G.R.; Kannan, S.; Piavchenko, G.; Nikolenko, V.; Efe, I.E.; Romero, A.R.; Mukengeshay, J.N.; et al. Integrating Augmented Reality in Spine Surgery: Redefining Precision with New Technologies. Brain Sci. 2024, 14, 645. [Google Scholar] [CrossRef] [PubMed]
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Figure 1. X-ray images of patient’s cervical spine at initial presentation in (a) antero-posterior (AP) and (b) lateral directions, respectively. Images show marked anterolisthesis of C1 over C2. Otherwise, the remaining vertebral bodies and corresponding disc spaces are maintained. There is also no significant prevertebral soft tissue thickness to indicate a possible underlying infective etiology. (Abbreviations: R = right and L = left).
Figure 1. X-ray images of patient’s cervical spine at initial presentation in (a) antero-posterior (AP) and (b) lateral directions, respectively. Images show marked anterolisthesis of C1 over C2. Otherwise, the remaining vertebral bodies and corresponding disc spaces are maintained. There is also no significant prevertebral soft tissue thickness to indicate a possible underlying infective etiology. (Abbreviations: R = right and L = left).
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Figure 2. Representative CT images of the patient’s cervical spine: (a) Image 3D reconstruction highlights the atlanto–axial subluxation associated with an unfused posterior arch of C1 in anterior-posterior (AP) view for (A), and the anterior arch of C1 is angled inferiorly in relation to an orthotopic os odontoideum in sagittal view for (B). (yellow arrows); (b) CT bone image in axial direction depicts an abnormal altanto–dens index (ADI) with narrowing of the spinal canal at C1–C2 level (yellow arrow, measured to be 9.4 mm) for (A), and CT bone image in coronal direction demonstrating an unfused os odontoideum and widening of the atlantoaxial interval in (B).
Figure 2. Representative CT images of the patient’s cervical spine: (a) Image 3D reconstruction highlights the atlanto–axial subluxation associated with an unfused posterior arch of C1 in anterior-posterior (AP) view for (A), and the anterior arch of C1 is angled inferiorly in relation to an orthotopic os odontoideum in sagittal view for (B). (yellow arrows); (b) CT bone image in axial direction depicts an abnormal altanto–dens index (ADI) with narrowing of the spinal canal at C1–C2 level (yellow arrow, measured to be 9.4 mm) for (A), and CT bone image in coronal direction demonstrating an unfused os odontoideum and widening of the atlantoaxial interval in (B).
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Figure 3. Representative MRI T2-weighted sequence images of the patient’s cervical spine in (a) sagittal and (b) axial directions, respectively: (a) Sagittal image depicts an unfused os odontoideum superior-anterior to the anterior half of the C2 vertebral body. The C2 dens has a focal bony posterior prominence that protrudes into the spinal canal and indents the cervical spinal cord (yellow arrow); (b) axial image shows the cervical cord thinned out (yellow arrow, 4.7 mm) at the level of compression highlighted in (a).
Figure 3. Representative MRI T2-weighted sequence images of the patient’s cervical spine in (a) sagittal and (b) axial directions, respectively: (a) Sagittal image depicts an unfused os odontoideum superior-anterior to the anterior half of the C2 vertebral body. The C2 dens has a focal bony posterior prominence that protrudes into the spinal canal and indents the cervical spinal cord (yellow arrow); (b) axial image shows the cervical cord thinned out (yellow arrow, 4.7 mm) at the level of compression highlighted in (a).
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Figure 4. Photographic images of the patient-specific 3D-printed model that was created true to size of the patient. (A) Photo depicts the relevant neurovasculature highlighted in blue (vein) and red (artery). A large vertebral vein draining into the CCJ venous plexus is seen to course over the left C2 lamina. Of note, this vessel would not have been as well-visualized by the clinical teams and caregivers in a traditional two-dimensional format. (B) Photo depicts the use of a spinal screw for real-life planning.
Figure 4. Photographic images of the patient-specific 3D-printed model that was created true to size of the patient. (A) Photo depicts the relevant neurovasculature highlighted in blue (vein) and red (artery). A large vertebral vein draining into the CCJ venous plexus is seen to course over the left C2 lamina. Of note, this vessel would not have been as well-visualized by the clinical teams and caregivers in a traditional two-dimensional format. (B) Photo depicts the use of a spinal screw for real-life planning.
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Figure 5. Screenshots of the intraoperative screw placement process from the S8 Stealth Station (MEDTRONIC, MN, USA). (A) Image-guided C1 lateral mass screw inserted via real-time neuro-navigation. (B) Image depicting final positions of all the inserted screws and their corresponding sizes.
Figure 5. Screenshots of the intraoperative screw placement process from the S8 Stealth Station (MEDTRONIC, MN, USA). (A) Image-guided C1 lateral mass screw inserted via real-time neuro-navigation. (B) Image depicting final positions of all the inserted screws and their corresponding sizes.
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Figure 6. X-ray scans of patient’s cervical spine at 18 months after surgery, taken in (a) anterior-posterior (AP) and (b) lateral directions, respectively. Images show patient is status post posterior fixation of C1 and C2. The spinal implants are intact there is improvement of the previous C1–C2 anterolisthesis and high cervical spine alignment. (Abbreviations: L = left).
Figure 6. X-ray scans of patient’s cervical spine at 18 months after surgery, taken in (a) anterior-posterior (AP) and (b) lateral directions, respectively. Images show patient is status post posterior fixation of C1 and C2. The spinal implants are intact there is improvement of the previous C1–C2 anterolisthesis and high cervical spine alignment. (Abbreviations: L = left).
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Figure 7. PRISMA flow diagram depicting results of the systematic review (adapted from [8]).
Figure 7. PRISMA flow diagram depicting results of the systematic review (adapted from [8]).
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Table 1. Summary of studies from systematic review. (Abbreviations: 3D = three-dimensional, AAI = atlanto–axial instability, CCJ = craniocervical junction, CT = computed tomographic, DS = Down syndrome, JOA = Japanese Orthopedic Association, VA = vertebral artery).
Table 1. Summary of studies from systematic review. (Abbreviations: 3D = three-dimensional, AAI = atlanto–axial instability, CCJ = craniocervical junction, CT = computed tomographic, DS = Down syndrome, JOA = Japanese Orthopedic Association, VA = vertebral artery).
S/NAuthor/YearNumber of Pediatric Patients in Study (% Total Patients)Clinical PathologyUse CaseKey Findings
1Goel et al., 2016 [12]3 (27.3%)CCJ anomalies
  • Surgical planning Intraoperative guidance
  • Resident training
  • Patient education
  • 3D models provided superior anatomical visualization compared to conventional 3D CT reconstructions
  • Key benefits included preoperative rehearsal of screw placement, identification of VA anomalies, and determination of joint accessibility.
  • All patients improved postoperatively, with no VA injuries or implant-related complications.
  • 3D models also served as educational tools for trainees and patients.
2Xu et al., 2016 [23]1 (100%)C2 spinal tumor
  • Patient-specific spine implant
  • No implant subsidence or displacement at 1-year follow-up, with CT evidence of osseointegration.
  • Neurologic improvement: JOA score improved from 8/17 preoperatively to 16/17 postoperatively.
3Wang et al., 2016 [22]2 (50%)1 AAI and 1 high-cervical eosinophilic granuloma
  • Surgical planning
  • Intraoperative guidance
  • Patient education
  • Complete tumor resection
  • Successful C1–C2 fusion with accurate screw placement (no cortical breaches on CT).
  • Reduced operative time/blood loss and no neurovascular complications.
4Chhabra et al., 2017 [10]1 (10%)CCJ anomalies
  • Surgical planning
  • 3D models provided a tangible, hands-on tool for preoperative rehearsal, improving surgical precision.
  • 3D models also aided in selecting appropriate screw sizes and trajectories.
5Sakai et al., 2017 [18]1 (100%)AAI
  • Surgical planning
  • 3D-printed model facilitated safe surgical planning, avoiding complications such as VA injury.
  • At 2-years follow-up, complete fusion of the posterior C1–C2 elements and unexpected bone formation at the os odontoideum gap were observed, suggesting the potential for biologic fusion.
6Rashim et al., 2018 [17]2 (15.4%)AAI
  • Surgical planning
  • 3D models helped identify anomalous VA courses and optimize screw trajectories.
  • Both pediatric patients showed clinical improvement postoperatively, with reduced basilar invagination and stable fixation.
7Coote et al., 2019 [11]1 (33.3%)AAI and cervical stenosis (DS)
  • Surgical planning
  • Patient and family education
  • 3D models improved surgical planning efficiency and precision
  • 3D models facilitated patient-specific rehearsals.
  • Family reported better understanding of pathology and procedure.
8He et al., 2020 [13] 1 (14.3%)C1–C3 spine tumor
  • Patient-specific spine implants
  • 3D-printed implants facilitated precise anterior reconstruction, with no intraoperative VA or spinal cord injuries.
  • At a mean follow-up of 14.8 months, all patients showed stable circumferential fixation without tumor recurrence.
  • 3D-PTMIs provided immediate stability and long-term fusion potential.
9Wang et al., 2019 [21]2 (100%)CCJ anomalies
  • Surgical planning
  • Both cases benefited from 3D printing by optimizing surgical strategy and avoiding intraoperative surprises.
10Agarwal et al., 2020 [9]6 (33.3%)CCJ anomalies
  • Surgical planning
  • No direct VA injury or screw malposition occurred, though 1 case involved VA compression by a screw.
  • There was successful reduction in AAI and basilar invagination in all applicable cases.
11da Silva et al., 2020 [19]1 (100%)CCJ anomalies
  • Surgical planning
  • Intraoperative guidance
  • Surgical success with no perioperative complications
  • Resolution of pre-operative neurological signs and symptoms.
12Jug et al., 2021 [24]1 (50%)Grisel’s syndrome
  • Surgical planning
  • 3D models enabled precise and safe placement of screws.
  • There was reduced intraoperative radiation exposure and overall costs.
13Pijpker et al., 2021 [16]1 (100%)CCJ anomalies
  • Surgical planning
  • 3D-printed guides enabled accurate screw placement without breaches, confirmed by intraoperative CT.
  • The patient had an uneventful recovery with no neurological deterioration.
  • There was reduced intraoperative time due to preplanned screw trajectories.
14Vakharia et al., 2021 [20]2 (100%)CCJ anomalies
  • Surgical planning
  • Intraoperative guidance
  • 3D-printed guides enabled accurate screw placement.
  • Surgical time was reduced and both patients had uneventful recoveries with no complications at 5-month follow-up.
15Malikov et al., 2022 (a) 1 [15]4 (25%)CCJ anomalies and traumatic spine injury
  • Surgical planning
  • 3D-printed guides demonstrated high accuracy in screw placement.
  • 3D-printed guides improved surgical planning by accounting for pediatric anatomical variations and reducing the risk of VA injury.
16Malikov et al., 2022 (b) [25]8 (26.7%)CCJ anomalies, high-cervical spine tumor and traumatic spine injury
  • Surgical planning
  • 3D-printed navigation templates improved accuracy in pediatric cases with complex deformities, in comparison to traditional freehand techniques.
  • No pediatric-specific complications were reported.
17Kagami et al., 2024 [14]1 (16.7%)AAI
  • Surgical planning
  • 3D-printed models helped to achieve higher accuracy for screw placement compared to navigation-only group.
  • Lower operative times and reduced radiation exposure in the group were observed in the group that used 3D-printed models.
1 First author has 2 separate publications labeled (a) and (b), accordingly, in table.
Table 2. Brief summary of differences between image-fused neuro-navigation and 3D-printed models.
Table 2. Brief summary of differences between image-fused neuro-navigation and 3D-printed models.
Application3D-Printed ModelImage-Fused Neuro-Navigation
Pre-operative counselingAble to use in outpatient clinic as part of consultation with patient and caregiversComputer stealth-station bulky to transport to outpatient clinic
Pre-operative planning by surgical teamAllows physical 3D visuospatial orientation of complex anatomy and trial placement of spinal implants Allows 2D visualization of anatomy for planning only
Intraoperative usePhysical model does not allow real-time changes during implant insertion [55] Allows intraoperative decisions changes during implant insertion
Neurosurgical educationAble to create multiple models for hands-on training to increase deeper understanding of complex spine anatomy Not applicable
Added benefits of technologyPotential for bio-engineering of patient-specific spinal implants and drug-delivery systems [2,55]Not applicable
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Mak, D.S.K.; Lo, Y.T.; Tan, M.B.W.; Kumar, D.S.; Low, S.Y.Y. Role of Patient-Specific 3D-Printed Models for Complex Pediatric Craniocervical Junction Surgery: Case Description and Systematic Literature Review. Surg. Tech. Dev. 2026, 15, 1. https://doi.org/10.3390/std15010001

AMA Style

Mak DSK, Lo YT, Tan MBW, Kumar DS, Low SYY. Role of Patient-Specific 3D-Printed Models for Complex Pediatric Craniocervical Junction Surgery: Case Description and Systematic Literature Review. Surgical Techniques Development. 2026; 15(1):1. https://doi.org/10.3390/std15010001

Chicago/Turabian Style

Mak, David S. K., Yu Tung Lo, Mark B. W. Tan, Dinesh S. Kumar, and Sharon Y. Y. Low. 2026. "Role of Patient-Specific 3D-Printed Models for Complex Pediatric Craniocervical Junction Surgery: Case Description and Systematic Literature Review" Surgical Techniques Development 15, no. 1: 1. https://doi.org/10.3390/std15010001

APA Style

Mak, D. S. K., Lo, Y. T., Tan, M. B. W., Kumar, D. S., & Low, S. Y. Y. (2026). Role of Patient-Specific 3D-Printed Models for Complex Pediatric Craniocervical Junction Surgery: Case Description and Systematic Literature Review. Surgical Techniques Development, 15(1), 1. https://doi.org/10.3390/std15010001

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