There is an unmet need for developing a new class of smart medical implants with novel properties and advanced functionalities. Here, the concept of “self‐aware implants” is proposed to enable the creation of a new generation of multifunctional metamaterial implantable devices capable of responding to their environment, empowering themselves, and self‐monitoring their condition. These functionalities are achieved via integrating nano energy harvesting and mechanical metamaterial design paradigms. Various aspects of the proposed concept are highlighted by developing proof‐of‐concept interbody spinal fusion cage implants with self‐sensing, self‐powering, and mechanical tunability features. Bench‐top testing is performed using synthetic biomimetic and human cadaver spine models to evaluate the electrical and mechanical performance of the developed patient‐specific metamaterial implants. The results show that the self‐aware cage implants can diagnose bone healing process using the voltage signals generated internally through their built‐in contact‐electrification mechanisms. The voltage and current generated by the implants under the axial compression forces of the spine models reach 9.2 V and 4.9 nA, respectively. The metamaterial implants can serve as triboelectric nanogenerators to empower low‐power electronics. The capacity of the proposed technology to revolutionize the landscape of implantable devices and to achieve better surgical outcomes is further discussed.

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With increasing numbers of patients requiring spine surgery, there has been an emphasis on technological advances designed to enhance surgical outcomes and improve patient safety. In particular, the number of elective spinal fusion surgeries in the USA continues to increase. Instrumentation of the spine with pedicle screws is frequently used for indications including deformity and instability. With neurovascular structures near the pedicle, accurate screw placement is of paramount importance to ensure good outcomes. Reported complications related to pedicle screw malposition range from 1% to 54% (Molliqaj et al., Neurosurg Focus 42(5): E14, 2017). Currently, there are several techniques described for inserting pedicle screws, including freehand manual insertion based on anatomic landmarks and fluoroscopy, manual insertion with navigation assistance systems, and robotic-assisted methods.

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