Just after her 15^th birthday, Kylee Findley started to complain of increasing back pain.

Concerned that Kylee might have scoliosis, her mother, Jamie Findley took her to have her spine examined.

At the University of Michigan Health C.S. Mott Children’s Hospital, Kylee was diagnosed with osteosarcoma tumor, with one of the best treatment options being to surgically remove the tumor. But doing so meant also removing Kylee’s three ribs that held the grapefruit size mass.

“As a toddler, Kylee had rhabdomyosarcoma tumor that spread to her lungs and involved liver, requiring intense chemotherapy and radiation,” said Rama Jasty Rao, M.B.B.S., a pediatric oncologist at Mott. “The osteosarcoma that formed in her teenage years is most likely secondary to high dose radiation that she received as a child.”

Replacing that section of her ribs that were being removed was no easy feat – Kylee needed replacement ribs that would allow her to continue moving with ease as a teenager.

The best solution? A set of 3D printed ribs that are currently only being made in Spain.

Finding the perfect fit across the ocean

Kylee’s team enlisted the help of the 3D imaging lab at Michigan Medicine to plan the procedure. The team took her scans and made both computerized and physical 3D printed models of the tumor wrapped around her ribs.

Physicians showed Kylee and her family the model, a plastic replica of the section of her ribs in white and the tumor wrapped around them in red, to help explain what section would be removed along with the long 12.6cm tumor.

Mott surgery and radiology teams also used the model to create a plan that would save time in the operating room and help to successfully remove ribs three, four and five.

Their removal, though, would require finding replacement ribs to protect her chest as well as prevent future spinal issues due to the difference in width of the chest wall on either side of her chest.

Most replacement ribs are made of titanium, which doesn’t move with the lungs when breathing or the rest of the body like human ribs do.

With the goal of Kylee having a long and healthy life with her new ribs, James Geiger, M.D., the pediatric surgeon heading Kylee’s case at Mott, researched other implant material options that would give Kylee the best chance of moving like a normal teenager.

Through his research, Geiger found an implant out of Spain where the “rib bones” were made of a more flexible material with grooves in each “bone” that allows the implant to flex with the patient as natural ribs would.

An “experimental” treatment

But this type of replacement hasn’t been FDA approved yet in the United States. Since it’s considered an “experimental” and needed to go through an approval process before it could be used by the team.

“I prepared materials to present to the FDA that proved the implant was safe and effective in order to receive their approval,” Geiger said. “Using an implant like this one creates opportunities for exploring new improvements to medical care that benefit patients of all sizes.”

“The surgical team at Mott is grateful to Kylee and her family for trusting us throughout this process,” said Erika Newman, M.D., section head of pediatric surgery and surgical director of the Mott Solid Tumor Oncology Program.

“The experience gained throughout this process is valuable for our team and excites us for the potential for 3D printing innovations to help other children and teens.”

While waiting for the piece to be approved by the FDA, Kylee received five months of chemotherapy to reduce the size of the tumor.

Her care team believes that a gene mutation caused her to be more susceptible to the cancer cells forming in her body. The intense radiation treatment Kylee experienced as a child most likely resulted in the second tumor forming, so it was crucial that her treatments were perfect for her body to decrease the chance for any future tumors.

The intense treatment Kylee had received as a child also left her heart and kidneys weaker than ideal for her current treatment. Rao tailored Kylee’s chemotherapy treatments with this in mind so that the doses were low enough to protect her organs while fighting off as much of the tumor as possible.

“Everyone was cautious of what was being used to treat her,” said Jamie Findley. “They all wanted to give Kylee the best chance of fighting this tumor without risking her fighting future tumors.”

The procedure

Once the implant was approved by the FDA, Kylee’s surgical team started operating. Since osteosarcoma tumors present locally, it was even more important to remove the entire tumor all at once so that there was lesser chance of it spreading.

“Typically, osteosarcomas are found in extremities where part of a bone is removed from a limb or the limb is amputated,” Rao said. “The location of Kylee’s tumor presented a challenge since her chest wall was already weak from past treatments in addition to the tumor being in a central area to the body.”

The surgical team was able to carefully remove the entire tumor from her body, and once the tumor was removed, the prosthetic was connected to the sternum and the spine with screws. In addition to the flexibility the implant would offer, these connection points in her body would help her spine stay aligned and adjust to the new implant over time.

A life with new ribs

After the procedure, Kylee received an additional five months of chemotherapy to ensure that no part of the tumor survived.

Before her most recent diagnosis, Kylee was playing softball, field hockey, and riding horses, which she hopes to return to soon, but at her own pace. For now, Kylee is focused on her drawing skills and her new-found hobby: watching horror films.

“I’m giving myself time to adjust to my new ribs,” Kylee said. “Even though they are made to be felt less, it is still a new piece in my body that is going to take some time getting used to.”

“We can’t express how grateful we are that her care team was willing to look as far as Spain to find treatment options for her,” Jamie Findley said. “It showed how much they cared about her case and wanted to make sure the treatment was successful.”