RU2845521C1 - Method of treatment planning for deformations of transition zones of the spinal column using an assessment of the interaction of bone, myeloredicular and vascular structures - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to traumatology, orthopaedics and neurosurgery, and can be used in treating severe deformities of transient spinal regions. A virtual three-dimensional model including bone structures and a spinal cord is created by CAD/CAM technology on the basis of data obtained by computed tomography of the deformed regions of the spine together with myelography. A life-size combined individual three-dimensional model of the deformed regions of the spine, consisting of two parts and demountable in a sagittal or frontal plane, is made by 3D printing. Obtained three-dimensional model is examined, on the basis of which at least one of the parameters is entered into the treatment plan: the shape and size of the metal structure; length of fixation with a metal structure; metal structure support elements introduction trajectory; bone structures resection zones; place and volume of spinal cord decompression; required area for osteotomy, and degree of required correction.

EFFECT: method provides a more complete assessment of the nature of deformation, additional spatial information, an assessment of the interaction of bone and neural structures of the spine in this area, which, in turn, allows to create a more accurate and effective treatment plan for restoring the shape and function of the spine and myeloredicular structures, resolving extremely severe situations in patients with spinal deformations, including on background of congenital anomalies, tumours of the spine and post-traumatic defects by creating a combined individual demountable three-dimensional model of the deformed regions of the spine, including bone structures and the spinal cord.

2 cl, 8 dwg, 2 ex

Description

Field of technology

The invention relates to the field of traumatology, orthopedics and neurosurgery, namely to methods for producing and using individual three-dimensional models in the treatment of deformities, including in the treatment of severe deformities of the transition zones of the spine.

State of the art

Kyphotic and scoliotic spinal deformities are the most complex from the point of view of biomechanics. Injuries, idiopathic or congenital deformities, developmental anomalies, formation and segmentation of the spine lead to the formation of severe spinal deformities. The progression of deformities leads to a change in the geometry of the spinal canal (stenosis). The development of spinal cord (SC) compression leads to the development of neurological deficit and patient disability. Patients with this pathology are at high risk of loss of ability to work, which determines the social significance of this problem.

However, there is no single optimal approach to treatment planning and selection of surgical tactics in patients with a risk of spinal cord compression or developed spinal cord compression.

Modern technologies of computer spatial modeling and creation of individual structures by 3D printing allow a more conscious approach to the choice of methods and surgical techniques for surgical treatment of patients with severe spinal deformities, having more information about the pathology. Full-size volumetric models of the spine allow a more complete assessment of the nature of the deformation, its degree (severity), to assume compression zones, to obtain additional spatial information.

In the article by Baindurashvili A.G., Vissarionov S.V., Poznovich M.S., Ovechkina A.V., Zaletin A.V. APPLICATION OF 3D PRINTING IN SPINE SURGERY AND OTHER BONE PATHOLOGIES // Modern Problems of Science and Education. - 2019. - No. 6. ; URL: https://science-education.ru/ru/article/view?id=29359 (date of access: 14.05.2024), it is revealed that one of the areas of medicine where 3D printing has great potential is orthopedics, and in particular spinal surgery, due to the complex anatomy, as well as the delicate nature of the surrounding structures. The advantage of 3D printed spine models is realistic surgical modeling in preoperative planning, which makes an invaluable contribution to the preparation for surgical treatment of spinal pathology. The use of three-dimensional technologies helps to reduce the time of surgical intervention, intraoperative blood loss, increase the accuracy of surgical manipulations and the introduction of metal structures into bone tissue, especially when using transpedicular screws used for various congenital and acquired (post-traumatic) spinal deformities, including in children.

In the work of 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. V. 19(1). P. 31-34. DOI: 10.1016/j.cjtee.2015.09.009, it is revealed that the use of individual models created using 3D printing allows for detailed preoperative planning of surgical intervention, reduces surgical trauma, which contributes to its rapid healing, and thereby accelerates postoperative rehabilitation, making the procedure more cost-effective.

In the article by Kokushin D.N., Vissarionov S.V., Baindurashvili A.G., Ovechkina A.V., Poznovich M.S. Comparative analysis of the position of transpedicular screws in children with congenital scoliosis: the "free hand" method (in vivo) and template guides (invitro) // Traumatology and Orthopedics of Russia. 2018. Vol. 24. No. 3. Pp. 53–63. DOI: 10.21823/2311-2905-2018-24-4-53-63, the advantage of using 3D technologies in the treatment of children with congenital deformities of the thoracolumbar and lumbar spine using template guides for transpedicular screws is shown.

Also, the advantages of using three-dimensional modeling technologies, prototyping and three-dimensional printing of navigation templates for preoperative preparation for congenital deformities of the thoracic and lumbar spine in children are revealed in the work of Boyko A.E., Kokushin D.N., Baindurashvili A.G., Vissarionov S.V., Mul'diyarov V.P. SURGICAL TREATMENT OF CHILDREN WITH CONGENITAL DEFORMITIES OF THE THORACIC AND LUMBAR SPINE USING 3D PROTOTYPING TECHNOLOGIES // International Journal of Applied and Fundamental Research. - 2020. - No. 7. - P. 57-61; URL: https://applied-research.ru/ru/article/view?id=13101 (accessed: 14.05.2024).

In general, it can be said that there are a large number of solutions used in the planning and treatment of spinal deformities, based on 3D modeling of the area of the spine of interest.

The prior art (RU 2389439 C1, publication date 20.05.2010) discloses a method for selecting a surgical treatment method for patients with injuries to the transitional thoracolumbar spine, according to which, upon admission to treatment, the patient is examined clinically, undergoes standard radiography in 2 projections and a CT scan with 3D modeling. The injury to the thoracolumbar transitional spine is assessed using a number of criteria, each of which is assigned a specific score depending on its severity and significance: from 1 to 3. The parameters characterizing the patient's condition are determined: the degree of vertebral compression, the angle of kyphosis, the degree of neurological deficit and subsequent mathematical calculation of the integral indicator, age, gender, somatic status, significant concomitant pathology, the number of damaged supporting columns, spinal canal deficiency, fracture of the articular processes of the vertebra, the number of damaged vertebrae and dysfunction of the pelvic organs. The above parameters are assessed in points and summed up. Depending on the sum of points, a treatment method is selected: transpedicular system, ventral correction and corporodesis, or combined fixation.

Another example of such solutions is invention RU 2750415 C1, 06/28/2021, which can be used to make a preoperative model of the spine in children with congenital developmental anomalies and deformities. According to this solution, multispiral computed tomography (MSCT) is performed with 64 slices per gantry rotation with a slice thickness of 0.625 mm, without tilting the gantry with a voltage of 120 kV, a current of 175 mA, in 2.2 seconds at a pitch of 0.516: 1. Using a 150-700 mm long overview scanogram, multiplanar image reconstructions are constructed in two mutually perpendicular planes - frontal and sagittal. The images reveal the localization, volume and nature of the internal structure of the child's spine. The obtained tomographic information is saved in DICOM format and transferred to Dolphin Imaging. A solid STL 3D model of the spine is formed with the display of all affected bone anatomical structures and anomalies of the spine that are of interest in the preoperative examination. A G-code is formed based on the STL model data. A model of the patient's spine with all its anomalies is printed on an FDM printer with a printing layer height of no more than 0.2 mm at a scale of 1:1. In this case, the spine model is made of a biologically compatible and non-toxic polymer material. Moreover, acrylonitrile butadiene styrene (ABS), or polyethylene terephthalate with glycol (PET-G), or polylactide (PLA), or polyamide are used as biologically compatible and non-toxic polymer material for the manufacture of the spine model. Virtual planning of the stages of surgical treatment of the patient's spine is performed using the manufactured model of the spine or its part with the determination of the placement points of the implants and the malposition of the fixing screws of the metal fixation during corrective osteotomy.

The absence of myeloradicular and vascular structures in the above-described method of printing only bone structures of the spine does not allow a full assessment of the bone-myeloradicular conflict in spinal deformity, which affects the trajectory of the screws and their installation, the location and volume of decompression, the required area for osteotomy, and the degree of correction required if necessary.

Also known are a number of patents RU 2802396 C1, 28.08.2023, RU 2762771 C1, 22.12.2021, RU 2784945 C1, 01.12.2022, which disclose methods for treating various spinal deformities with treatment planning using 3D modeling. What these solutions have in common is that before creating a 3D model using magnetic resonance imaging, the condition of the surrounding soft tissues, vascular and nerve structures that are not visualized when performing multilayer spiral computed tomography is assessed.

Radiation examination methods, such as CT with myelography, include the possibility of multiplanar reconstruction of the study in the form of a volumetric image, but only of the bone structures of the spine. It is impossible to fully visualize the anatomical volumetric-spatial relationships of all structures of the spine, including neural and vascular. Thus, the model clearly shows the anatomical danger zones that arise during various types of surgical interventions. At the preoperative stage, the studies performed (X-ray, MRI, CT) and the manufactured model are compared. However, the 3D model itself does not contain neural and vascular structures, which does not allow for a full analysis of the defect area and the relationship of the surrounding structures (in particular neural and vascular).

Thus, there is a need to create a method for treatment planning using a combined individual three-dimensional model of deformed areas of the spine, with the ability to take into account the anatomical interactions of the bone and neural structures of the spine.

Revealing the essence

The invention is aimed at developing a method for planning treatment using a combined individual three-dimensional model of deformed areas of the spine, ensuring that the anatomical interactions of the bone and neural structures of the spine are taken into account.

The solution to this problem will improve the results, increase the safety of surgical intervention, and often simply make it possible to treat patients with severe spinal deformities.

The technical result of the claimed invention consists in obtaining a more complete assessment of the nature of the deformation, additional spatial information, an assessment of the interaction of bone and neural structures of the spine in this area, which, in turn, allows for the creation of a more accurate, safe and effective treatment plan for restoring the shape and function of the spine and myeloradicular structures, resolving extremely difficult situations in patients with spinal deformities, including those against the background of congenital anomalies, spinal tumors and post-traumatic defects.

The specified technical result is achieved through a method of planning treatment for spinal deformities, including:

a) production of a life-size, combined individual three-dimensional model of deformed areas of the spine using 3D printing, consisting of two parts and disassemblable in the sagittal or frontal plane, with the preliminary creation of a virtual three-dimensional model including bone structures and the spinal cord, using CAD/CAM technology, based on data obtained using computed tomography of the deformed areas of the spine together with myelography;

b) study of the obtained three-dimensional model;

c) determining, based on the study of the obtained three-dimensional model, and introducing into the treatment plan at least one of the parameters: the shape and size of the metal structure; the length of fixation with the metal structure; the trajectory of insertion of the supporting elements of the metal structure; the resection zone of bone structures; the location and volume of spinal cord decompression; the necessary zone for osteotomy, and the degree of required correction.

Due to the presence of the spinal cord structure in the 3D model being produced in addition to the bone structures, it is possible to assess the nature of the deformation, additional spatial information, and assess the interaction of the bone and neural structures of the spine in this area.

The advantages of the 3D printed model for surgical planning are based on the realistic anatomical representation of pathological areas, which improves the understanding of the complex anatomy of the deformity, the routes of screw insertion and placement, the area and volume of decompression of myeloradicular structures.

The creation of a 3D model that is disassembled in the sagittal or frontal plane, consisting of at least two parts, provides easier access to hard-to-reach areas of the model and allows for a more accurate analysis of the deformation.

The study of the obtained 3D model provides the ability to determine the location and volume of spinal cord decompression, and also allows for the determination of a more accurate and safe trajectory for the introduction of supporting elements of the metal structure, its shape and size, the length of fixation with the metal structure, the necessary zone for osteotomy, and the degree of required correction, taking into account the studied interactions of the bone and myeloradicular structures of the spine.

Thus, an effective treatment plan can be developed to restore the shape and function of the spine and myeloendorphanous structures, to resolve extremely difficult situations in patients with spinal deformities, including those due to congenital anomalies, spinal tumors and post-traumatic defects.

If necessary, the vascular structures and their interaction with the bone and myeloradicular structures of the spine are also examined using the appropriate 3D model.

If necessary, based on the conducted studies and the drawn up treatment plan, it may be additionally planned to re-manufacture a combined individual three-dimensional model of the deformed areas of the spine, after the planned treatment has been carried out, based on the analysis of the primary three-dimensional model.

Description of drawings

Fig. 1 shows postural radiographs of the spine at 2 years of age 1a , at the time of admission 1b, 1c , for the first clinical example.

Fig. 2 shows an individual three-dimensional model of the deformed areas of the spine, for the first clinical example, with the possibility of dividing the model into 2 parts in the sagittal plane, using neodymium magnets, for visualization of the spinal cord (colored red) and bone structures of the spine (colored yellow). View from behind 2a , from the front 2b and in disassembled form 2c .

Fig. 3 shows a postural radiograph of the spine on the 3rd day after surgery, for the first clinical example.

Fig. 4 shows a sagittal CT section of the craniocervical spine for the second clinical example. The red line highlights the SAC index (C1), which is equal to 7 mm.

Fig. 5 shows a sagittal section of MRI of the craniocervical spine in T2 mode, for the second clinical example. At the level of C0-C2, signs of myelopathy formation are determined.

Fig. 6 shows an axial CT section at the level of the C2 vertebra, for the second clinical example. The red arrow indicates the area of aberrant location of the a.vertebralis.

Fig. 7 shows an individual 3D model of the crinio-vertebral region (posterior view, frontal plane), for the second clinical example: bone structures – white, vessels and spinal cord – red, yellow – individual guide templates for C1 and C2 vertebrae.

Fig. 8 shows an individual 3D model of the crinio-vertebral region (posterior view, frontal plane) in a disassembled state; for the second clinical example, the zone of compression of the spinal cord is visualized along the passage of the a.vertebralis: bone structures are white, vessels and spinal cord are red, yellow are individual guide templates for the C1 and C2 vertebrae.

Implementation of the invention

The production of a combined individual three-dimensional model of deformed areas of the spine is carried out as follows.

In the dressing room, in the left lateral position, after treating the skin with an antiseptic solution, a lumbar puncture is performed in the interanginal space L4-L5 to obtain cerebrospinal fluid. Up to 20 ml for patients over 18 years of age and up to 10 ml for patients under 18 of an X-ray contrast solution containing 300 mg iodine/ml is injected into the subarachnoid space. An aseptic pressure bandage is applied to the injection site. If it is necessary to visualize the vessels, the patient is given an intravenous injection of up to 50 ml of an X-ray contrast solution containing 300 mg iodine/ml. An aseptic bandage is applied to the injection site.

When maximum radiopacity is achieved, computed tomography of the spine is performed using a standard program with a slice thickness of 0.625 mm, followed by multiplanar and three-dimensional reconstruction of the image using CAD/CAM technology using the RadiAnt DICOM Viewer 2024.1 software, which includes bone structures, myeloradicular structures, and, if necessary, the rib area and vascular structures.

Next, the design of the 3D model parts is performed using the Materialise software, to obtain a model of at least two parts, and which is disassemblable in the sagittal or frontal plane, and functionally contains recesses made on the corresponding planes of the model parts, for the subsequent placement of permanent magnets in them.

After the design, all parts of the model are manufactured in full size using 3D printing using a Concept Laser M2 Cusing printer.

Printing is carried out using a biocompatible and non-toxic polymer material, such as polyethylene terephthalate with glycol (PET-G).

In some variants, the bone, vascular and myeloradicular structures of the spine in the resulting model have different colors, in particular white, yellow, red, and blue.

After creating a 3D model, a detailed analysis is performed to determine: the shape and size of the metal structure; the length of fixation with the metal structure; the trajectory of insertion of the supporting elements of the metal structure; the resection zone of bone structures; the location and volume of spinal cord decompression; the necessary zone for osteotomy, and the degree of required correction.

Next, a detailed treatment plan is drawn up based on the data obtained, and a repeat production of a combined individual three-dimensional model of the deformed areas of the spine can be planned after the first stage.

The implementation of the claimed invention, as well as the achievement of the claimed technical result, is confirmed by the following clinical examples.

Example 1.

Patient S. was admitted to the 14th Department of Vertebrology of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics at the age of 15 with complaints of inability to walk and independently support his limbs, and spinal deformity. He had been under the care of an orthopedist since the age of 2 due to scoliotic deformity of the thoracic spine (Fig. 1a) . At the age of 13, he first noticed gait disturbance, episodes of stumbling and falling. Over the next year, foot deformity and progressive weakness in the legs developed. A genetic examination was performed with a preliminary diagnosis of "hereditary motor and sensory neuropathy". Clinical exome sequencing of 6640 genes was performed. A variant of the nucleotide sequence in exon 11 of the SH3TC2 gene in a heterozygous state was detected. In exon 15 of the SH3TC2 gene, a previously undescribed variant of the nucleotide sequence in a heterozygous state was identified, assessed as pathogenic mutations in the SH3TC2 gene. These mutations are characteristic of patients with Charcot-Marie-Tooth disease type 4C.

Charcot-Marie-Tooth disease (CMT) 4C typically presents in the first decade of life with a high incidence of scoliosis. Some patients progress slowly, allowing walking into their fifth decade, while others become wheelchair-dependent in adolescence (Senderek et al., 2003).

Peculiarities of local status: the patient is in bed, cannot get up, does not walk, muscle tone in the upper limbs is unchanged, in the lower limbs it is increased by a spastic type with a tendency to cross the legs. Contractures of the feet with an equinus position, shortening of the Achilles tendons. Tendon and periosteal reflexes in the upper limbs are lively and symmetrical; knee and Achilles reflexes are not evoked. Lower mixed paraparesis: proximally up to 2 b., up to plegia in the feet. Hypoesthesia was revealed from the level of the knee joints with a violation of superficial and deep sensitivity (two-dimensional spatial sense). The patient does not control the functions of the pelvic organs, a violation of the incontinence type.

According to postural radiographs of the spine in 2 projections (Fig. 1b, 1c) : a picture of left-sided kyphoscoliosis of the thoracolumbar spine of the 4th degree, the Cobb angle of the scoliotic arc is 85° with the apex of Th6-7, the angle of the kyphotic arc is 115° with the apex of Th6-7.

The patient was further examined in the department, CT, CT myelography and MRI of the thoracolumbar spine were performed. According to MRI data, at the Th5-Th7 level, the spinal canal is filled with fatty tissue, the spinal cord is displaced to the right, the cerebrospinal fluid space is not traced at this level, signs of myelopathy are not determined.

Based on the anamnesis data, genetic examination, neuroorthopedic status and results of radiological examination methods, the following diagnosis was made: "Hereditary Charcot-Marie-Tooth neuropathy type 4C. Neurogenic left-sided kyphoscoliosis of the thoracolumbar spine grade 4. Spinal cord compression at the level of Th6-9. Lower mixed deep paraparesis. Neurogenic equinoxal varus deformity of the feet."

Due to the complexity of the deformation, spinal cord compression, and progressive worsening of the neurological status, it was decided to make an individual anatomical model of the spine and spinal cord based on the data from CT myelography (Fig. 2) . During preoperative planning, based on the individual 3D model of the spine and spinal cord, the zone of greatest compression of the myeloradicular structures at the level of Th6-9 was identified, caused by the roots of the arches, costotransverse joints, and heads of the ribs on the concave side of the deformation.

Under intraoperative neuromonitoring, transpedicular fixation was performed at the Th2-L2 level, the rods were fixed in situ. Laminectomy was performed at the Th6-9 level. Spinal cord compression was detected at the Th7-8 level by the costotransverse joints and the rib heads on the left - they were resected with a high-speed bur. Resection was performed according to preoperative planning on a three-dimensional model. Spinal cord pulsation appeared 10 minutes after its mobilization. Expansion in diameter of the spinal cord at the apex of the deformity was noted. Posterior spondylodesis with autobone was performed.

In the early postoperative period, a decrease in the severity of spasticity was noted (there is no crossing of the lower limbs), proximal muscle strength is 2 b. (the left leg can be actively bent at the hip and knee joints, on the right only in a concomitant manner; active flexion-extension of the left foot within the contracture has appeared). Pathological Babinski reflexes are noted (they were not present before the operation). Conductive hypoesthesia from the L3 level has regressed; hyperesthesia from L2 and below on the right has appeared. No topical focal symptoms according to the level of the Th8 root were detected.

Despite the severity of the deformation and the posterolateral decompression performed, the position of the metal structure is correct on the control postural radiographs; no signs of instability or malposition of the supporting elements are noted.

As a result of surgical treatment, the patient's neurological status had positive dynamics from the moment of surgery (group C according to Frankel, Ashworth 3, ASIA movement 84, tactile 82, pain 84) with restoration of the neurological status (group D according to Frankel, Ashworth 1, ASIA movement 92, tactile 108, pain 110).

Example 2.

A 10-year-old patient was admitted to the 14th Department of Vertebrology of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics with complaints of gait disturbance and progressive weakness in the upper and lower extremities. According to the patient's mother, gait peculiarities were noticed from the first steps of life. The patient was involved in gymnastics. From the age of 9, he began to stumble when walking, then weakness in the right hand occurred, and he began to use his left hand awkwardly. He was observed by a neurologist at the m/f level. CT and MRI of the cervical spine revealed stenosis of the spinal canal at the level of C1-C2; odontoid bone of the C2 vertebra; with anterior atlantoaxial dislocation. Indirect signs of aberrant location of the a.vertebralis were revealed ( Fig. 4-6 ).

According to the physical examination and neurological status, the patient moves independently, gait is impaired by a spastic type, clinically determined by smoothing of the cervical lordosis, movements in the cervical spine are in full range, painless, muscle tone is increased in the lower limbs by a spastic type. Tendon and periosteal reflexes: high on the arms and legs D = S. Spastic tetraparesis: distal in the arms up to 3-4 points, in the lower limbs up to 4 points. Can walk, but uncertainly. Pathological foot signs: Babinski on both sides. Pain during palpation of the paravertebral points is not detected. Sensitivity is normal. Stable in the Romberg pose. Coordinate tests: PNP is satisfactory, PKP is satisfactory. Controls the functions of the pelvic organs.

Taking into account the anamnesis data, clinical and radiological examination methods, the following diagnosis was established: "Spinal canal stenosis at the level of C1-C2. Odontoid bone of the C2 vertebra. Anterior altantoaxial dislocation. Cervical myelopathy. Spastic tetraparesis. (mJOA - 14, Nurick - 3, Ashworth - arms: 1, legs: 1+)"

Taking into account the presence of MR signs of myelopathy and signs of spinal canal stenosis, signs of atlantoaxial dislocation, as well as signs indicating a possible aberrant location of a.vertebralis, a decision was made to perform CT myelography with simultaneous angiography of the vessels of the craniocervical spine using the described technique. Based on the obtained results, an individual 3D model of the craniocervical spine in natural size was made, including bone structures (bones of the skull base and vertebrae), the dura mater and a.vertebralis at this level, and individual guide templates for installing transpedicular screws ( Fig. 7 and Fig. 8 ).

Visual and tactile analysis of the model revealed spinal cord compression at the level of the C1-C2 segment of the vertebrae, confirmed atlantoaxial dislocation, and confirmed aberrant position of the a.vertebralis. Based on the analysis, the tactics of surgical treatment were selected in the volume: "Closed reduction of subluxation of the C1 vertebra. Indirect decompression under conditions of intraoperative halo-traction. Dorsal stabilization with a metal structure at the level of C1-C2 using the Harms method. Posterior spondylodesis with an autorib."

The availability of an individual 3D model and previously performed visual and tactile analysis made it possible to abandon multi-stage surgical treatment by performing indirect decompression of the spinal canal. Taking into account the congenital anomaly of the cranio-cervical region and the anatomical features visualized in the individual 3D model and the use of individual templates-guides, it was possible to achieve correct placement of screws, reducing the risk of damage to the a.vertebralis and myoradicular structures. The use of individual templates-guides in combination with an individual 3D model made it possible to adhere to the pre-selected trajectories of the screws based on the individual 3D model, reduced the volume of blood loss and the time of the operation. The ability to separate the model in the frontal plane, the ability to freely remove the spinal cord model, made it possible to fully visualize the volumetric-spatial mutual arrangement of the spinal cord and the posterior sections of the cranio-cervical region in the spinal canal.

The outcome of the surgical treatment performed using an individual 3D model of the craniocervical spine, vessels and spinal cord was clinically noted to be a partial regression of myelopathy manifestations, a decrease in muscle spasticity (distal in the arms up to 2-3 b., in the lower limbs up to 2-3 b.). Confidence in gait is noted. (mJOA - 15, Nurick - 1, Ashworth - 0).

Thus, these clinical examples confirm the necessity and effectiveness of creating a combined individual three-dimensional model of deformed areas of the spine, providing an assessment of the interaction of bone, myeloradicular and vascular structures, as well as the use of the obtained data for treatment planning for spinal deformities.

Claims (5)

1. A method for planning treatment for spinal deformities including: a) production of a life-size, 3D-printed combined individual three-dimensional model of deformed areas of the spine, consisting of two parts and disassemblable in the sagittal or frontal plane, with the preliminary creation of a virtual three-dimensional model, including bone structures and the spinal cord, using CAD/CAM technology based on data obtained using computed tomography of the deformed areas of the spine together with myelography; b) study of the obtained three-dimensional model; c) determining, based on the study of the obtained three-dimensional model, and introducing into the treatment plan at least one of the parameters: the shape and size of the metal structure; the length of fixation with the metal structure; the trajectory of insertion of the supporting elements of the metal structure; the resection zone of bone structures; the location and volume of spinal cord decompression; the necessary zone for osteotomy, and the degree of required correction. 2. The method according to paragraph 1, characterized in that it is additionally planned to re-manufacture a combined individual three-dimensional model of the deformed areas of the spine, after treatment, in accordance with the parameters determined at stage c).