Customized 3-dimensional-printed Vertebral Implants for Spinal Reconstruction After Tumor Resection

Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models. 6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine. 2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction. Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17. 7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3. 1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16. 9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection. A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection. Study Design: Systematic review.To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.Eleven studies (65 patients; mean age, 40.9 +/- 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 +/- 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 +/- 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.Level V, systematic review of level I-V studies.An aggressive intralesional resection (ILR) or an en bloc spondylectomy (EBS) is often indicated for the treatment of primary malignant, solitary metastatic, and aggressive benign spinal tumors.1 Due to the destabilizing nature of these procedures, a complex spinal reconstruction is often necessary to restore the stability of the spine.2 Three-dimensional (3D)-printed titanium or titanium alloy implants have recently been introduced into spine surgery and possess the advantage of preoperatively determining the precise implant dimensions necessary for adequate reconstruction and stability.3-7 Furthermore, these implants harbor the potential for excellent bony ingrowth and biological stability at the implant-bone interface in animal models.6,7 Three-dimensional-printed custom implants have also been applied successfully in other areas of orthopedic oncology including reconstruction after extensive tumor resections of the pelvis and shoulder girdle.8,9 A single-institution case series by Zoccali et al9 demonstrated in a series of 14 patients that a 3D-printed titanium implant can effectively be used for reconstruction after extensive pelvic tumor resection with adequate osteointegration at an average follow-up of 42 months. These prior data suggest that 3D-printed implants may also be an effective method, which reconstructs the spine after tumor resection. However, the current evidence to clinically support the use of these implants in spine surgery is limited to a few cases reports and case series.6-9 The purpose of the current study was to develop a comprehensive systematic review that examines the outcomes of customized 3D-printed implants for spinal reconstruction after tumor resection.