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. 2022 Apr 16;14(4):e24185.
doi: 10.7759/cureus.24185. eCollection 2022 Apr.

A Low-Cost Three-Dimensional Printed Retractor for Transforaminal Lumbar Interbody Fusion

Manuel de Jesus Encarnacion Ramirez  1 , Renat Nurmukhametov  1 , Edwin Bernard  2 , Ismael Peralta  3 , Ibrahim E Efe  4
Affiliations

A Low-Cost Three-Dimensional Printed Retractor for Transforaminal Lumbar Interbody Fusion

Manuel de Jesus Encarnacion Ramirez et al. Cureus. .

Abstract

The authors developed a low-cost surgical retractor to improve surgeon's comfort and facilitate pedicle screw insertion in transforaminal lumbar interbody fusion surgery. The retractor was designed using three-dimensional (3D) modeling software and produced with the help of a 3D printer. It was attached to a mechanic retractor arm. The retractor was anchored to the transverse process through a concave notch at its tip, visualizing the junction between the transverse process and the superior articular process. The gutter-shaped body of the retractor helped stay within the ideal trajectory during screw insertion. The retractor was tested in 20 patients undergoing transforaminal lumbar interbody fusion with satisfactory results. Future models will be generated suitable for surgery of the cervical and thoracic spine.

Keywords: 3d modeling; 3d printing; low cost; lumbar spine; retractor; tlif.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Technical drawings showing the LERA retractor (A) in the side view (B), top view (C), and frontal view (D). Lengths are shown in millimeters.
LERA: Lumbar Expander/Retractor Assistant
Figure 2
Figure 2. The LERA has a concave notch through which it can be anchored to the transverse process (A). The end of the gutter-shaped retractor points at the junction between the transverse process and the superior articular process, centering the screw entry point (B).
LERA: Lumbar Expander/Retractor Assistant
Figure 3
Figure 3. The LERA retractor was secured to a flexible retractor arm through a mounting hole (A). During the TLIF procedure, the retractor aimed at the junction between the superior articular process and the transverse process, protecting the paraspinal muscles (B).
LERA: Lumbar Expander/Retractor Assistant; TLIF: transforaminal lumbar interbody fusion surgery
Figure 4
Figure 4. The LERA retractor can help guide the pedicle screw trajectory (A). In the absence of a flexible retractor arm, the retractor can be used manually (B). The inserted pedicle screw can be appreciated.
LERA: Lumbar Expander/Retractor Assistant
See this image and copyright information in PMC

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