Virtual Surgical Planning and Clinical 3D Printing from Medical Imaging for Orthopedic, Hand, and Spine Surgery.

Virtual surgical planning (VSP) and clinical 3D printing (C3DP) enable patient-specific anatomic models and surgical guides to be developed and produced from medical imaging using additive manufacturing techniques in a health care facility. This affords a level of precision beyond that allowed with conventional techniques, shortens surgical times, decreases rates of surgical complications and blood loss, and improves patient outcomes. The authors outline the general principles of VSP-C3DP used by subject matter experts in the clinical, imaging, engineering, and manufacturing domains, including image acquisition (eg, thin-section imaging, dual-energy CT, pediatric imaging, MRI bone imaging, interpolation, multimodal imaging); image segmentation (eg, manual and automated); virtual modeling and surgical guide design (eg, segmentation to model conversion, design principles); printing, processing, and delivery of models (eg, material selection); quality assurance (eg, risk assessment and mitigation, validation, troubleshooting, and rescue strategies); and knowledge of the current regulatory and reimbursement landscape. The authors describe how VSP-C3DP is used through case samples in specific orthopedic, hand, and spine surgical procedures to simulate, rehearse, and execute the preoperative plan in the broad categories of arthroplasty (ie, shoulder arthroplasty), joint realignment (eg, periacetabular osteotomy and distal femoral and high tibial osteotomy), deformity correction (eg, high cervical fusion, correction of lumbar spondylolisthesis, distal radius deformities, distal ulna malunions, alunions, pediatric metatarsal deformities, pelvic fracture fixation, treatment of Blount disease), and tumor excision (eg, humerus osteochondroma, pelvic iliac wing osteosarcoma, and giant cell tumors of the distal femur). Current limitations and potential future directions of VSP-C3DP are discussed. ©RSNA, 2026 Supplemental material is available for this article.