East Carolina University doctors used a life size 3D printed rib cage to perform a life changing surgery for a Goldsboro man suffering from chronic pain.
3D printing has come a long way since 2013, when Public Radio East first reported how East Carolina University was using the technology. Just ask 45 year old Franklin Arnold from Goldsboro. He was born with a twisted spine. But it wasn’t until he was a teenager that he found out he had a serious condition.
“When we were younger, they usually tested us in school-like 6th or 7th grade – for scoliosis. And I was tested in 6th or 7th grade, and they said I had a mild case of it at that time.”
After multiple trips to the University of North Carolina at Chapel Hill for treatment, Franklin decided to forego surgery because the nine month recovery time.
“As time passed, as I started getting older, I started having bouts every now and then with huge pain. As a guy, I’m thinking this what we’re supposed to deal with, with everyday bumps and bruises through life.”
As the scoliotic curve progressed in his 20’s and 30’s, it put more pressure on his lungs making it difficult to breathe. It also caused severe back pain that lasted weeks. Prompted by his wife, he underwent spinal fusion surgery. A metal rod was inserted in his spine and two of his ribs were removed.
“After that initial surgery, my ribs kept breaking on my right side because the structure has been compromised because those two huge ribs were gone. Nobody couldn’t do anything. Duke couldn’t do anything… they told me you’re going to be like this the rest of your life, deal with it. You know, I was kind of a little distraught.”
After surgery, Franklin worked with a pain management doctor to help alleviate his persistent back pain and difficulty breathing. But it wasn’t working. He was later referred to Dr. Carlos Anciano, a thoracic surgeon at the Brody School of Medicine and an East Carolina University assistant professor.
“I remember clearly when I walked in the room, he was in a very classic position that patients that have scapular entrapment do, which is kind of try to keep the tip of the wing bone out from stabbing into their chest. And he looked like the picture of the textbook as soon as we walked in.”
Dr. Anciano took an updated MRI of the chest wall and the arm in different positions to determine if the scapula was being entrapped. When he saw the images, he knew he would have try an unconventional and potentially groundbreaking procedure to help alleviate Franklin’s pain.
“I had worked before at the University of Pittsburg with some prosthesis and some chest wall reconstruction and we had always kind of seen the technology coming along in terms of 3D printing. And talking with my fellow, Preston Sparks, we decided to reach out to the bioengineering team.”
Dr. Anciano contacted ECU’s College of Engineering and Technology and Joyner Library for help with printing a 3D model of Franklin’s rib cage. This would serve as a topographical map to help physicians to plan in detail – prior to the March 22 surgery – exactly how they would rebuild the chest wall with titanium mesh. 29 year old ECU student Joshua Stevens was tasked with using MRI images to construct a 3D printed model.
“I grabbed the opportunity and tried to learn the software that was, first get the software and then learn it. And I was able to figure it out and get something done with it in about a week and a half, during spring break.”
Stevens took the design to Dan Zuberbier, the Education and Instructional Technology Librarian at Joyner Library who helped him print it on the university’s 3D printer.
“In the software he was using, he was able to isolate certain aspects of the model. So he took out the muscle tissue, he was able to take out the cartilage. And so for the most part, it’s a pretty accurate model of his bone structure.”
The life-sized lime green and florescent orange model is made out of ABS plastic, the same material as Legos. It looks like something from high school anatomy class, except two of the ribs – from Franklin’s previous surgery- are missing. Dr. Anciano says the 3D printed rib cage was invaluable to planning the procedure.
“It also allowed us to pinpoint certain areas where clearly the problem is going on. And it allowed us to target them directly as opposed to very big incisions to create big exposures, to kind of look in and figure out what’s going on. We knew exactly where we had to go.”
Surgeons were able to place the titanium mesh that had been shaped using the 3D model into Franklin’s rib cage with minimal chest wall damage. This, Dr. Anciano says significantly sped up recovery time.
“He did very well, we see him on a regular basis and we’ve seen his progress. There’s been a lot of work with physical therapy.”
It’s been four months since his surgery and Franklin says the pain – and his quality of life – is much improved.
“My breathing is a lot better because they lifted my ribs up off my lungs, for one. My pain- I’m dealing with chronic pain now. The trauma pain is pretty much gone.”
Since the procedure, Franklin says he’s been able to go on walks with his wife and daughter. He’s able to get more sleep and has greatly reduced the amount of medications he takes. After enduring nearly three decades of pain, the thing he’s looking forward to the most is being able to get a job and eventually go for a run.
“I wake up every day wanting to swing for the fence. I don’t want a base hit, I don’t want to bunt, I want a home run. I want to swing for the fence every day. So I’m struggling, I’m fighting everyday.”
This is the first time a 3D printer has been used to help plant a prosthesis in a patient at the Brody School of Medicine. Dr. Anciano believes this surgery only scratches the surface of what the technology can do to help patients in eastern North Carolina, from creating printouts of organs, synthetic skin and blood vessels.
“It’s priceless and I think this is going to explode… like it has done already. It’s going to change not just how we practice medicine but how we teach medicine.”