Surgical Planning of Sacral Nerve Stimulation Procedure in Presence of Sacral Anomalies by Using Personalized Polymeric Prototypes Obtained with Additive Manufacturing Techniques.

Sacral nerve stimulation or sacral neuromodulation involves the implantation of a stimulating electrode lead through the sacral foramina. In patients with anatomical sacral anomalies, it can constitute a challenging procedure due to a lack of common reference points present in the normal anatomy. In this study, we present an innovative application of additive manufacturing for the planning of sacral nerve stimulation techniques and related surgical procedures in complex cases, and we verify that the use of personalized patient models may help to manage the presence of sacral anomalies. The use of two alternative additive manufacturing technologies working with thermoplastic and thermoset polymers, including fused deposition modeling as low-cost alternative and laser stereolithography as industrial gold standard, is compared in terms of viability, precision and overall production costs. They pay special attention to fidelity in terms of the bone microstructure reconstruction, which is necessary for adequately planning electrode insertion. Advantages and limitations of the alternative approaches are discussed and ideas for future developments and for solving current challenges are presented.