How Additive Manufacturing Is Reducing Tissue Disruption: Evidence From the 2025 European Spine Journal Review

Additive manufacturing (AM or 3d Printing) in spine surgery is evolving every year beyond porous titanium implants. A 2025 systematic review published in the European Spine Journal evaluated the clinical use of 3D printing across spinal procedures and provides one of the clearest recent summaries of its measurable impact in the operating room. 

For doctors, the key finding is straightforward: across the majority of reviewed studies, 3D-printed guides, models, and implants were associated with improved surgical accuracy and reduced operative time—two factors directly tied to cumulative tissue disruption. 

Improved Implant Placement Accuracy 

The review found that patient-specific 3D-printed drill guides and navigation templates consistently improved pedicle screw placement accuracy compared with conventional freehand or fluoroscopic techniques. 

Several studies reported Grade A placement rates >95%, with reductions in cortical breach and repositioning. Fewer breaches and fewer redrilling attempts reduce: 

• Repeated probe and tap passes 

• Pedicle microfracture risk 

• Excessive torque and shear stress 

• Intraoperative imaging adjustments 

In LESS surgery, each avoided correction lowers cumulative mechanical stress on bone and surrounding soft tissue. 

Reduced Operative Time 

Most studies included in the review reported shorter operative times when 3D-printed guides or patient-specific planning models were used. 

Reported time reductions ranged from approximately 10–25%, depending on procedure complexity. 

Shorter operative duration decreases: 

• Time under paraspinal retraction 

• Muscle ischemic exposure 

• Repetitive access corridor manipulation 

Time is not just a workflow variable—it is a tissue variable. 

Preoperative Planning and Predictability 

Patient-specific anatomical models were also widely studied. Surgeons using 3D-printed models for deformity or complex reconstruction planning reported improved intraoperative confidence and fewer unplanned adjustments. 

Preparation reduces intraoperative variability. Less variability means fewer corrective movements, fewer passes, and lower cumulative tissue stress. 

Table 1. Key Findings From 2025 European Spine Journal Systematic Review on 3D Printing in Spine Surgery 

Outcome Measure	Reported Trend Across Studies	Clinical Implication
Pedicle screw accuracy	Frequently >95% Grade A placement with guides	Fewer breaches and redrilling attempts
Cortical breach rate	Reduced vs. freehand techniques	Lower risk of structural and soft tissue disruption
Operative time	10–25% reduction in most comparative studies	Reduced muscle retraction duration
Intraoperative adjustments	Decreased need for trajectory correction	Fewer corrective passes
Surgical planning confidence	Improved with printed anatomical models	Greater procedural predictability

Less Exposure Surgery Implications 

The review does not suggest additive manufacturing eliminates tissue trauma. Rather, it demonstrates that 3D-printed tools—especially patient-specific guides and planning models—are associated with greater precision and procedural efficiency. 

In LESS surgery, tissue disruption accumulates through time, force, repetition, and correction. When 3D-printed reduces re-drilling, shortens case duration, and stabilizes execution, it reduces cumulative physiologic insult—even when incision size remains unchanged. 

Additive manufacturing is becoming less about novelty and more about predictability. 

And predictability protects tissue. 

Reference 

1. [Authors]. Clinical applications of three-dimensional printing in spinal surgery: a systematic review. Eur Spine J. 2025;[Volume(Issue)]:[Page numbers]. doi:[DOI]