Selected Podcast

3D Spine Modeling for Spinal Deformities

As 3D technology transforms health care and becomes more commonly used, St. Louis Children’s Hospital now has “in-house” 3D printing capabilities. Munish Gupta, MD, Washington University orthopedic spine surgeon, discusses this technology and how it has been life-changing for patients with spinal deformities.
3D Spine Modeling for Spinal Deformities
Featured Speaker:
Munish Gupta, MD
Munish Gupta, MD, is a Washington University pediatric orthopedic surgeon at St. Louis Children’s Hospital.

Learn more about Munish Gupta, MD

Melanie Cole (Host): As 3-D technology transforms healthcare and becomes more commonly used, St. Louis Children’s Hospital now has an in-house 3-D printing capabilities. This technology has been lifechanging for patients with spinal deformities. My guest today is Dr. Munish Gupta. He’s a Washington University Pediatric Orthopedic Surgeon at St. Louis Children’s Hospital. Dr. Gupta, you are one of the few surgeons in the Midwest to perform complex pediatric spinal deformity surgeries. Can you tell us a little bit about the conditions that you see?

Munish Gupta, MD (Guest): Sure. The complex pediatric spinal deformities are basically deformities that have – are severe in nature, meaning scoliosis or kyphosis that has gotten much worse than the normal scoliosis kyphosis you may see. And it’s frequently from not having proper care initially, or these deformities are just fast-paced, and they’ve gotten out of control.

Host: Tell us how these conditions had typically been treated and what’s different now about what you are doing in advance?

Dr. Gupta: So, as these severe deformities come to us, operating on them is a little bit more dangerous. Traditionally, when you have your normal scoliosis kyphosis; you can treat it with correction and then fusion with instrumentation and bone graft and they do quite well. When they get severe and are complex in nature; they are more risky to correct. So, we have to do everything possible to ensure the safety in the correcting the deformity and also, make sure that we have a good result long-term in terms of getting a fusion. So, when you see some of these deformities, a lot of them can have very bad anatomy that is not fully defined by just an x-ray or a CAT scan. And this is how the 3-D printing has really helped us.

Host: How did you identify the need for the more advanced technology to treat these severe cases doctor, and how was training beginners of the pedicle screw instrumentation technique in the operating room limited, maybe because of issues related to patient safety or surgical efficiency and what is the learning curve involved?

Dr. Gupta: So, these cases of – since they have a severe deformity are more difficult to instrument safely and this is where the 3-D printing is very helpful because you can have the printed deformity in your hand. You can see all the anomalous structures, all the little problems with the anatomy, the bony anatomy. The print looks exactly like what you are going to see in the operating room. So, it is very helpful to have it our hand. You can look at the front of the spine, the back of the spine. It really helps in preop planning so, you can see where your screws and rods need to go. You can see what you need to decompress in terms of the spinal cord and what the 3-D printing allows you to see which the CT scan doesn’t is where are the problems of the bone. So, the spinal cord may be exposed when you are trying to decompress, so you know where to approach the spine in a safe manner. So, inserting pedicle screws, decompressing the spinal cord and also doing corrective osteotomies is greatly more efficient and safer with using these 3-D models.

Host: When you are using the 3-D models, what’s involved in the presurgical planning and how long does it take you to prepare for a particular case?

Dr. Gupta: So, there are several stages of preparing for a case. First, as soon as you meet the patient, you start thinking about it in your mind. So, when you see the patient, initially, we will examine the patient, we get the x-rays, the plain radiographs then we order specialized tests like MRIs and CT scans to really analyze the anomaly perfectly. After those scans are done, especially the CT scans, the CT scans are used to make these 3-D models. As you know, the 3-D models are made by deposition of material in a serial manner like a CT scan as they are taking picture of your spine. So, they use the same method, so they use the deposition of material and they make the 3-D model from the CT scan.

Host: The 3-D medical printing center is located right on the medical campus. How does having this technology in-house benefit patient care and how does it benefit physicians and bioengineers who work with the technology?

Dr. Gupta: It’s extremely good for us to have it here because before, since I’ve been using it for a while, I used to order a 3-D model. Now, with the bioengineers, we discuss the 3-D situation of the spine, we look at the video after they have done the 3-D rendering and we tell them to subtract this or add this and this interaction between the bioengineers and the surgeon is extremely helpful. They can color code rods and plates and screws so if you a doing a revision; you know exactly where things are. So, the advantage of having a bioengineer and a surgeon talking is to make sure that the bioengineer makes the model exactly to what the surgeon needs to make the procedure more efficient and effective.

Host: Speaking of spinal deformities in general, are there certain red flags that a pediatrician should be looking for when assessing a potential deformity and what do you want them to know about these types of deformities and the 3-D spine modeling for spinal deformities?

Dr. Gupta: Well, as they have already been trained, looking at patients with spinal deformities, if there is somebody that presents you with a very severe deformity or a deformity that’s rapidly progressing within a few months; there should be an appropriate referral to a spine surgeon or a pediatric orthopedic surgeon that does spine surgery so that can be taken care of earlier than later. If they are having neurologic problems, like their legs don’t work as well or they’re having troubles with their bowel or bladder; that should alert them that there is something going on in their spine. And associated anomalies. A lot of these congenital kyphosis scoliosis patients have other anomalies of their heart and kidneys that go along with them because it all happens in the first trimester. So, that should alert them to looking – to look at the spine.

Host: What can a referring pediatrician expect from the orthopedic surgery team at St, Louis Children’s Hospital?

Dr. Gupta: Well, I can tell you and speak for all my partners that do spine surgery here that we will give you an honest, straightforward assessment of the patient and a plan for the patient and as we proceed through the surgery and all the treatment that the patient goes through; we will keep you informed. And if there is any questions that you may have, you are more than welcome to contact us.

Host: Dr. Gupta, do you have a patient story you’d like to share as we wrap up Dr. Gupta? Something that you feel has really made a big difference in a family’s life?

Dr. Gupta: Yes, you know actually the St. Louis Children’s Hospital published this story about the 3-D printing of a patient with a severe congenital kyphosis and this progressed very rapidly, and she was very conscious of this deformity, but not just that, she started developing neurologic symptoms in her legs. She couldn’t run or walk as much. She was having pain and if she was left to the symptoms and the condition had progressed, she would be paralyzed. So, she was sent to us for treatment. We did the corrective surgery with 3-D modeling first and then did the surgery and it turned out to be very successful and she is essential pain-free with normal neurology and feels much better. That would be probably the best story for this 3-D modeling system.

Host: Then give us your best information Dr. Gupta and what you would like other providers to know about this amazing technology and the availability of it at St. Louis Children’s Hospital.

Dr. Gupta: Well I think that we are just starting with this technology because in the future I think it will even model soft tissue, nerves and vessels and make our life as surgeons much easier. I know that some cardiac surgeons are making models of a congenitally deformed heart and the veins are blue and the arteries are red. So, it’s an extremely helpful adjunct to preop planning and doing the surgery. So, I think we are just getting started in 3-D modeling. Not only for the patient but I think for teaching, as I’m in the Washington University School of Medicine, it’s a – it’s going to be a great tool and we are just getting started.

Host: Wow, thank you so much Dr. Gupta. What a fascinating topic and it is so interesting and amazing, really what you are doing there at St. Louis Children’s. Thank you again, for coming on and sharing this with us. To consult with a specialist or learn more about services offered at St. Louis Children’s Hospital; call Children’s Direct Physician Access Line at 1-800-678-HELP. That’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital, you can go to, that’s This is Melanie Cole. Thanks so much for tuning in.