• Yue-Qi Du, Guang-Yu Qiao, Yi-Heng Yin, Teng Li, Huai-Yu Tong, and Xin-Guang Yu.
• Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China.
• World Neurosurg. 2020 Jan 1; 133: e722-e729.

ObjectiveTo evaluate the usefulness of 3-dimensional (3D) printed models as an aid for the treatment of complex CVJ anomalies.Methods3D printed models were fabricated for 21 patients with complex CVJ anomalies, including vertebral artery anomaly, thin C2 pedicle, vertical atlantoaxial facet joint, or rotational dislocation combined with atlantoaxial dislocation and basilar invagination. Preoperative planning, surgical simulation, and intraoperative reference were achieved using the 3D model during the surgical treatment. The usefulness of 3D printed models, and postoperative clinical and radiological outcomes were assessed.ResultsDirect posterior reduction and atlantoaxial fixation were achieved in 19 patients. Transoral odontoidectomy followed by posterior fixation was implemented for 2 patients with vertical facet joint and rotational dislocation. All screws were safely inserted with no complication, and 90% patients achieved a >60% reduction of both horizontal and vertical dislocation. Clinical symptoms improved in all patients, with the averaged Japanese Orthopedic Association scores increasing from 11.14 to 14.43 (P < 0.01).ConclusionsThe patient-specific 3D printed model would be an effective tool for evaluation of the reducibility of the atlantoaxial dislocation and basilar invagination, decision making in choosing the optimal surgical approach and way of fixation, and precise placement of the screw while protecting the vertebral artery and spinal cord. The risk of neurovascular injury was minimized, and encouraging outcomes were achieved with the aid of this technique.Copyright © 2019 Elsevier Inc. All rights reserved.

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