{"id":19644,"date":"2019-11-26T14:47:33","date_gmt":"2019-11-26T14:47:33","guid":{"rendered":"https:\/\/todaysveterinarypractice.com\/?p=19644"},"modified":"2022-02-18T21:04:52","modified_gmt":"2022-02-18T21:04:52","slug":"veterinary-surgery-planning-and-training-in-3d","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/news\/veterinary-surgery-planning-and-training-in-3d\/","title":{"rendered":"Veterinary Surgery Planning and Training in 3D"},"content":{"rendered":"

Oscar the French bulldog was so agile when he was a puppy that his owners joked that he was part cat. \u201cHe\u2019d leap up on the couch and walk across the back,\u201d Julie Van der Feen said.<\/p>\n

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\"oscar<\/p>\n

Oscar the French bulldog (Courtesy of Julie Van der Feen)<\/p>\n

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But when Oscar was four, he started having difficulty jumping. Van der Feen said her veterinarian took x-rays, which revealed that Oscar \u201chad lost the genetic lottery.\u201d The Frenchie had been born with a malformed spine, an inherited problem in pugs, English bulldogs, and other breeds with flat faces and corkscrew tails. The veterinarian warned that the spine\u2019s S-shape could start to squash Oscar\u2019s spinal cord, leading to worsening pain, loss of the use of his hind legs, and incontinence.<\/p>\n

To relieve that pressure and prolong his mobility, Oscar needed a complicated and rarely performed surgery. Fortunately, his surgical team was able to practice the tricky operation and make customized implants in advance of Oscar\u2019s operation by using a 3D model of his spine\u2014an approach that Cummings School veterinarians are embracing to improve outcomes for complex procedures.<\/p>\n

A short course of anti-inflammatory medication along with daily pain medication relieved Oscar\u2019s symptoms last fall, and he was able to jump again. However, his veterinarian warned that if he started wobbling in his rear limbs, he would need surgery immediately.<\/p>\n

When Oscar became unsteady on his feet eight months later, Van der Feen heeded her veterinarian\u2019s advice and rushed him to\u00a0Cummings Veterinary Medical Center<\/a>. There, an MRI showed veterinary neurologist\u00a0Ane Uriarte<\/a>\u00a0just how severely Oscar\u2019s vertebrae were affecting his spinal cord.<\/p>\n

It is not possible to transform a crooked spine back into a straight one and make things \u201cnormal,\u201d according to Uriarte. But she said that surgeons could remove the bones damaging Oscar\u2019s spinal cord. Because removing bone would increase the instability of Oscar\u2019s already-shaky spine, the surgical team also would need to create custom titanium plates to shore up the remaining vertebrae. \u201cWe needed to do the surgery straight away because if you wait until a dog cannot walk to treat this condition you cannot reverse that,\u201d Uriarte said. \u201cThe surgery stops that progression so the dog doesn\u2019t get any worse.\u201d<\/p>\n

The day before Oscar\u2019s surgery, veterinary orthopedic surgeon\u00a0Mike Karlin<\/a>\u00a0cradled a resin replica of Oscar\u2019s tiny spine in his hands. Karlin closely studied the model\u2014which he had created from a CT scan of Oscar\u2019s back using a 3D printer\u2014to decide exactly where he needed to remove bone.<\/p>\n

At Cummings School, Karlin is leading the charge to use 3D models printed from patients\u2019 CT scan and MRIs to improve outcomes for complicated procedures, such as Oscar\u2019s. Karlin\u2019s lab at Cummings School acquired six 3D printers with the help of a donation from Stan Kovak, the father of Cummings School Advisor Janet Kovak McClaran, V98.<\/p>\n

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\"karlin<\/p>\n

Orthopedic surgeon Mike Karlin used this 3D-printed replica of Oscar\u2019s spine, made from his CT scan, to prepare for his surgery. (Alonso Nichols\/Tufts University)<\/p>\n

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Depending on the complexity of cases being seen in a given week at the Henry and Lois Foster Hospital for Small Animals, \u201cwe may use 3D-printing multiple times in a week or go a few weeks without needing to use it,” Karlin said.<\/p>\n

\u201cWith 3D printing, a lot of your decision making takes place preoperatively,\u201d Karlin said. \u201cYou make a plan, execute it on the printed bone, and then check to see if the plan worked. If you are happy, you\u2019re good to go. If not, you adjust the plan and print a second set of bones to test how that works. It saves you time in surgery, and pets spend a lot less time under anesthesia.\u201d<\/p>\n

Karlin sawed the harmful pieces of \u201cbone\u201d off the model of Oscar\u2019 spine. He then started shaping a pair of metal plates to align tightly alongside the remaining bones\u2019 twists and turns. Forty-five minutes later\u2014after much measuring, clamping, cutting, more measuring, and strenuous bending\u2014the orthopedist had two tailor-made implants. These were sterilized and ready to stabilize Oscar\u2019s backbone when Karlin headed into surgery with Uriarte the following morning.<\/p>\n

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\"karlin
\nDr. Karlin shapes a titanium plate using a 3D printed spine made from a CT scan of Oscar’s back. This is one of two tailor-made implants that were later sterilized and used to stabilize Oscar\u2019s backbone during surgery. (Alonso Nichols\/Tufts University)<\/p>\n

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Today, four months post-surgery, Van der Feen said Oscar is still walking\u2014and getting stronger through physical therapy at Paws in Motion, a veterinary rehabilitation center run by Cummings School alum Suzanne Starr, V96.<\/p>\n

Uriarte said 3D printing is valuable for planning surgeries for complex spinal diseases, as well as for reconstructing the skulls of pets that suffer major head injuries or require surgery on their brains.<\/p>\n

3D printing also is a great aid in teaching, Uriarte said. \u201cIt helps veterinary students and residents better visualize the anatomy when they can play with a 3D-printed body part in real time while we discuss our approach. Surgeons, of course, know what\u2019s going on from the MRI or CT. But it\u2019s simpler for learners of all types to understand when the problem is right there in their hands.\u201d<\/p>\n

Karlin said \u201cthe potential applications for 3D printing are endless\u201d when it comes to providing veterinary students with\u00a0ways to gain surgical and other clinical skills<\/a>\u00a0before working with actual patients.<\/p>\n

Because different resins can be used to create many different textures, he said it\u2019s possible to print a host of inexpensive teaching models. Students can palpate a resin abdomen to find a \u201ctumor\u201d in an organ, for example, or do a blood draw that feels realistic on a leg mold with an artery in it. Over the 2018-19 school year, Karlin worked with students at Tufts\u2019\u00a0School of Engineering<\/a>\u00a0to develop a more realistic 3D-printable model for Cummings School students to practice spay surgery on. That teaching tool is now being used at Cummings School in a slightly modified form, Karlin said.<\/p>\n

The 3D-printed spay\/neuter model does not look as realistic as some intensely lifelike animal models used for medical simulation on the veterinary campus. But that\u2019s fine with Karlin, who said the low cost of creating the model allows more students to get time using one to practice the common surgical procedure. Teaching tools \u201cdon\u2019t always have to be fancy looking,\u201d Karlin said. \u201cThey just need to reproduce the skill students need to learn.\u201d<\/p>\n

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\"oscar<\/em><\/p>\n

Oscar is recovering well after undergoing a rare and complicated spinal surgery assisted by 3-D printing. (Courtesy of Julie Van der Feen)<\/p>\n

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Originally written by Genevieve Rajewski and reprinted from https:\/\/now.tufts.edu\/articles\/veterinary-surgery-planning-training-3d<\/a> with permission from Taraneh Pettinato, Associate Director of Media Relations, Cummings School of Veterinary Medicine at Tufts University.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Read about Oscar the French bulldog’s journey through spinal surgery with the help of 3D printing and Tuft’s Cummings School of Veterinary Medicine.<\/p>\n","protected":false},"author":9,"featured_media":19645,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":25,"footnotes":""},"categories":[342],"tags":[],"class_list":["post-19644","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-digital-exclusive","column-digital-exclusive","clinical_topics-news"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"\nVeterinary Surgery Planning and Training in 3D<\/title>\n<meta name=\"description\" content=\"Read about Oscar the French bulldog's journey through spinal surgery with the help of 3D printing and Tuft's Cummings School of Veterinary Medicine.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, 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