71. Rapid subsidence in lumbar interbody fusions with resorbable implants

Herceg, Milan B; Slosar, Paul; Josey, Robert; Reynolds, James B.; Schofferman, Jerome

doi:10.1016/j.spinee.2004.05.072

Cited by 3 publications

(3 citation statements)

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“…Jiya et al [8] describe a 16% osteolysis rate in their paper and a worrying rate of subsidence and failure of fusion compared to PEEK cages. Herceg et al [9] presented a similar results at the North American Spine Society meeting. Jiya raises the possibility that osteolysis may be due to low-grade infection, but we feel the supplementary evidence from this report does not support this hypothesis.…”

Section: Discussionmentioning

confidence: 61%

“…These demonstrate good resorption of the cage with excellent bony incorporation and bone remodelling leading to a sound arthrodesis [5][6][7]. There is evidence, however, that resorbable cages may cause osteolysis [8,9]. In the study by Jiya et al, 2 out of the 12 patients undergoing interbody fusion with resorbable poly-L-lactide-co-D, L-lactide (PLDLLA) cages developed osteolysis.…”

Section: Introductionmentioning

confidence: 99%

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Osteolysis following resorbable poly-l-lactide-co-d, l-lactide PLIF cage use: a review of cases

et al. 2011

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Study design Report of case seriesObjective To report a problem with bioabsorbable poly-Llactide-co-D, L-lactide, PLDLLA, posterior lumbar instrumented fusion (PLIF) cage implants. Summary of background data Synthetic bioabsorbable implants have recently been introduced to spinal surgery and their indications and applications are still being explored. There is evidence that the use of bioabsorbable cages may be of benefit in interbody spinal fusion. Methods We present a case series of nine patients who have undergone PLIF with bioabsorbable cages in the lumbar spine. Results At follow-up over at least 1 year, four of these patients were found to have osteolysis around the implant on CT scanning. One of these patients underwent an operation to remove the cage and histology sent during surgery suggested that the implant had caused the bone loss and there was no evidence of infection. Another patient had ongoing pain in relation to the lysis, while the other two patients with lysis remained asymptomatic. Conclusions PLDLLA cage, which has high osteolytic nature, is considered not suitable as a fusion cage.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Osteolysis following resorbable poly-l-lactide-co-d, l-lactide PLIF cage use: a review of cases

et al. 2011

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“…Recently, Herceg et al 42 reported the results of large diameter thin-walled (2 mm) PLDLA spacers with rhBMP-2 in a series of 22 patients treated anterior interbody fusion and posterior pedicle screw fixation at one or two levels (total of 40 levels fused). Although a high percentage of the levels fused (88%) went on to solid fusion, 60% of levels fused experienced significant subsidence (Ͼ7 mm).…”

Section: Discussionmentioning

confidence: 99%

Instrumented Transforaminal Lumbar Interbody Fusion With Bioresorbable Polymer Implants and Iliac Crest Autograft

Coe¹,

Vaccaro²

2005

Spine

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Bioresorbable implants have significant potential for use in spine surgery. This potential is realized in this first published clinical series using bioresorbable implants as interbody spacers with a minimum follow-up of 2 years, significantly exceeding the biologic "life expectancy" (12-18 months) of the implant material. Both the clinical and radiographic results of this study support the use of interbody devices manufactured from bioresorbable polymers for structural interbody support in the TLIF procedure.

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Time-dependent failure in load-bearing polymers: a potential hazard in structural applications of polylactides

Smit

Engels

Söntjens

et al. 2009

J Mater Sci: Mater Med

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With their excellent biocompatibility and relatively high mechanical strength, polylactides are attractive candidates for application in load-bearing, resorbable implants. Pre-clinical studies provided a proof of principle for polylactide cages as temporary constructs to facilitate spinal fusion, and several cages already made it to the market. However, also failures have been reported: clinical studies reported considerable amounts of subsidence with lumbar spinal fusion cages, and in an in vivo goat study, polylactide spinal cages failed after only three months of implantation, although mechanical testing had predicted sufficient strength for at least eight months. The failures appear to be related to the long-term performance of polylactides under static loading conditions, a phenomenon which is common to all glassy polymers and finds its origin in stress-activated molecular mobility leading to plastic flow. This paper reviews the mechanical properties and deformation kinetics of amorphous polylactides. Compression tests were performed with various strain rates, and static stress experiments were done to determine time-to failure. Pure PLLA appeared to have a higher yield strength than its co-polymers with d-lactide, but the kinetic behaviour of the polymers was the same: an excellent short-term strength at higher loading rates, but lifetime under static stress is rather poor. As spinal implants need to maintain mechanical integrity for a period of at least six months, this has serious implications for the clinical application of amorphous polylactides in load bearing situations. It is recommended that standards for mechanical testing of implants made of polymers be revised in order to consider this typical time-dependent behaviour.

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71. Rapid subsidence in lumbar interbody fusions with resorbable implants

Cited by 3 publications

References 0 publications

Osteolysis following resorbable poly-l-lactide-co-d, l-lactide PLIF cage use: a review of cases

Osteolysis following resorbable poly-l-lactide-co-d, l-lactide PLIF cage use: a review of cases

Instrumented Transforaminal Lumbar Interbody Fusion With Bioresorbable Polymer Implants and Iliac Crest Autograft

Time-dependent failure in load-bearing polymers: a potential hazard in structural applications of polylactides

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