Poster Presentation Sydney Spinal Symposium 2026

One-stage revision of TLIF non-union using 3D printed titanium custom made implants; a case series (#100)

William Parr 1 2 , Kris Dalzell 3 4 , Ralph Mobbs 5 , Kevin Seex 6 , Marc Coughlan 7 , Jack Hill 1 , Charles Furtado 1
  1. 3DMorphic, Matraville, NSW, Australia
  2. Surgical and Orthopaedic Research Laboratories (SORL), Randwick, NSW, Australia
  3. St Georges Hospital, Christchurch, New Zealand
  4. Forte Health, Christchurch, New Zealand
  5. Neurosurgery, Prince Of Wales Private, Randwick, NSW, Australia
  6. Neurosurgery, Macquarie Neurosurgery, Macquarie Park, NSW, Australia
  7. Neurosurgery, Gosford Private Hospital, Gosford, NSW, Australia

Introduction

Non-union following Transforaminal Lumbar Interbody Fusion (TLIF) can be a challenging complication. There are reports in the literature where Anterior Lumbar Interbody Fusion (ALIF) is used to treat these cases.

In cases where the posterior hardware (rods and screws) is intact, custom-made implants alongside detailed virtual surgery planning can be incorporated into a one-stage revision of TLIF non-union.

Here, we investigate radiographic results for a cohort of patients who underwent ALIF with custom implants for TLIF non-union.

Methods

The surgical method involved a standard ALIF approach, followed by removal of the TLIF device. Custom-made 3D printed titanium cages were then inserted into the interbody space with minimal bone burring/reshaping to preserve the cortical endplates. Cages were then packed with graft material. Due to limitations with the interbody height, the cages featured an integrally formed plate to allow for screw fixation.

Results

In some patients, the interbody space is narrow with unusual endplate topology following a non-union, whereby standard off-the-shelf cages cannot directly accommodate the unique interbody shapes. The design of the custom cages in the present study allowed for minimal endplate preparation and reshaping of the interbody space.

Virtual surgery planning that is tailored to the patient can reduce the intraoperative complications with detailed planning of the patient’s vasculature and the location of the existing TLIF device.

Conclusion

In this cohort of patients, a one-stage procedure involving custom made implants for revision of TLIF non-union proved to be an effective strategy, with no revisions reported.