The diagnosis of ulnar nerve entrapment at the elbow has relied primarily on clinical and electrodiagnostic findings. Magnetic resonance imaging (MRI) has been used in the evaluation of peripheral nerve entrapment disorders to document signal and configurational changes in nerves. In this case report we review the MRI and operative findings of a rare constriction band causing ulnar nerve compression at the elbow. We review the sensitivity and specificity in diagnosing ulnar nerve entrapment at the elbow as defined by MRI findings.
1NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney; 2Prince of Wales Private Hospital, Sydney; 3University of New South Wales, Sydney; 4Anatomics Pty. Ltd., Melbourne, Australia; and 5Department of Neurosurgery, University of Florida, Gainesville; 6Spinal Health International, Inc., Longboat Key, Florida; and 7ProCRO Pty. Ltd., Sydney, New South Wales, Australia
There has been a recent renewed interest in the use and potential applications of 3D printing in the assistance of surgical planning and the development of personalized prostheses. There have been few reports on the use of 3D printing for implants designed to be used in complex spinal surgery.
The authors report 2 cases in which 3D printing was used for surgical planning as a preoperative mold, and for a custom-designed titanium prosthesis: one patient with a C-1/C-2 chordoma who underwent tumor resection and vertebral reconstruction, and another patient with a custom-designed titanium anterior fusion cage for an unusual congenital spinal deformity.
In both presented cases, the custom-designed and custom-built implants were easily slotted into position, which facilitated the surgery and shortened the procedure time, avoiding further complex reconstruction such as harvesting rib or fibular grafts and fashioning these grafts intraoperatively to fit the defect. Radiological follow-up for both cases demonstrated successful fusion at 9 and 12 months, respectively.
These cases demonstrate the feasibility of the use of 3D modeling and printing to develop personalized prostheses and can ease the difficulty of complex spinal surgery. Possible future directions of research include the combination of 3D-printed implants and biologics, as well as the development of bioceramic composites and custom implants for load-bearing purposes.
3D printing; model; surgery; simulation; implant; design; chordoma; lumbar fusion; cervical
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