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Background  Medical simulation is an emerging field for resident training. Three-dimensional printing has accelerated the development of models for spine surgical simulation. Previous models have utilized augmented infill ratios to simulate the density difference between cortical and cancellous bone; however, this does not fully account for differences in the material properties of these components of human vertebrae. In order to replicate the differences in both density and material characteristics for realistic spinal simulation, we created a three-dimensional model composed of multiple thermoplastic polymers.  Materials and methods  Three lumbar vertebrae and 20 C2 vertebrae models using an experimental dual material fabrication method were printed on an Ultimaker S5 3D printer. Assessment of model integrity during instrumentation as well as user tactile feedback were points of interest to determine prototype viability for educational and biomechanical use. The experimental cohort was compared with a control cohort consisting of a single material print, resin print, and polyurethane mold.  Results  Based on tactile feedback, the experimental dual material print (polylactic acid [PLA]/polyvinyl alcohol [PVA]) more accurately represented the sensation of in vivo instrumentation during pedicle probing, pedicle tapping, and screw placement. There were no instrumentation or material failures in the PLA/PVA experimental model cohort.  Conclusions  This feasibility study indicates that multiple material printing using PLA and PVA is a viable method to replicate the cortico-cancellous interface in vertebral models. This concept and design using our unique infill algorithm have not been yet reported in the medical literature. Further educational and biomechanical testing on our design is currently underway to establish this printing method as a new standard for spinal biomimetic modeling.

A Feasibility Study for the Production of Three-dimensional-printed Spine Models Using Simultaneously Extruded Thermoplastic Polymers