CLINICAL CASE SERIES3D-printed Titanium Prosthetic Reconstruction of the C2 Vertebra Techniques and Outcomes of Three Consecutive CasesHunn, Samuel A.M. MBBS∗; Koefman, Alex J. FRACS, MBBS†; Hunn, Andrew W.M. FRACS, MBBS‡Author Information ∗University Hospital Geelong, Geelong, Australia †Princess Alexandra Hospital, Brisbane, Australia ‡Tasmanian Spine Service, Hobart, Australia. Address correspondence and reprint requests to Samuel A.M. Hunn, MBBS, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia; E-mail: email@example.com Received 21 August, 2019 Revised 12 October, 2019 Accepted 12 November, 2019 Portions of this cases series were presented at the Neurosurgical Society of Australasia Annual Scientific Meeting, August, 2018. The device(s)/drug(s) that is/are the subject of this manuscript is/are exempt from FDA or corresponding national regulations because it is a unique custom patient-specific device. No funds were received in support of this work. Relevant financial activities outside the submitted work: board membership, consultancy, royalties. SPINE: May 15, 2020 - Volume 45 - Issue 10 - p 667-672 doi: 10.1097/BRS.0000000000003360 Buy Metrics AbstractIn Brief Study Design. Three patients were treated at our center with patient-specific three-dimensional (3D)-printed titanium prostheses for the reconstruction of structurally compromised C2 vertebrae. Objective. To describe our surgical and device design approach to these clinical scenarios and evaluate their outcomes. Summary of Background Data. There are a limited but increasing number of case reports and series describing the use of 3D-printed prostheses for high cervical surgery. Methods. We have collated and reviewed three cases using patient-specific 3D-printed prostheses. Results. We report two cases arising from neoplastic destruction; one resulting from metastatic medullary thyroid carcinoma, and the other from multiple myeloma. We additionally describe a case of C2 compromise as a complication of rheumatoid arthritis. All patients included in this report achieved successful surgical outcomes and symptom relief without significant complication. Clinical and radiological follow-up has demonstrated good outcomes in all cases up to 14-months postprocedure. Conclusions. These cases describe successful use of custom 3D-printed prostheses for reconstruction of the anterior vertebral column through C2, and add to the emerging body of literature detailing the use of custom prostheses for complex spinal surgery. Level of Evidence: 4. This case series describes the successful use of 3D-printed prostheses for oncological and rheumatological destruction of the C2 verterbra. By using custom 3D-printed prosthesis we were able to reinstate integrity to the anterior column of the cervical spine without significant complication. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.