Bone bonding, displacement, and absorption in cases of double-door laminoplasty with unidirectional porous hydroxyapatite spacers

Noguchi, Hiroshi; Koda, Masao; Funayama, Toru; Kumagai, Hiroshi; Abe, Tetsuya; Nagashima, Katsuya; Miura, Kousei; Mataki, Kentaro; Fujii, Kengo; Yamazaki, Masashi

doi:10.1016/j.jocn.2019.01.012

Cited by 12 publications

(16 citation statements)

References 11 publications

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“…In literature, higher-porosity HA spacers have a trend of higher bone bonding: 27.5%-83.9% in spacers with a porosity of 40%, [19][20][21] 8.7%-60.5% with a porosity of 60%, 7,10 and 67.0%-90% with a porosity of 75%. 11,13 In the current study, highporosity (50%) HA spacers showed an accelerated bone bonding compared to low-porosity (35%) HA spacers, which is in agreement with reported evidence. Then, although the bone volume of laminae in contact with the inserted HA spacer showed a trend of time-dependent absorption both in high-porosity (50%) and lowporosity (35%) HA spacers, a relatively reduced severity of bone absorption was found in high-porosity (50%) HA spacers compared to in low-porosity (35%) HA spacers.…”

Section: Discussionsupporting

confidence: 92%

“…This study's comparison between the two alternating HA spacers in each patient is useful to minimize the association of metabolic disorders, for example, diabetes and osteoporosis, in elderly patients and also the difference among baseline pathologies for cervical myelopathy. In literature, higher‐porosity HA spacers have a trend of higher bone bonding: 27.5%–83.9% in spacers with a porosity of 40%, 8.7%–60.5% with a porosity of 60%, and 67.0%–90% with a porosity of 75% . In the current study, high‐porosity (50%) HA spacers showed an accelerated bone bonding compared to low‐porosity (35%) HA spacers, which is in agreement with reported evidence.…”

Section: Discussionsupporting

confidence: 92%

“…Higher‐porosity HA spacers have been reported to have a high breakage rate, ranging from 2.9% to 21.3% . In this study, the breakage rate was 4.7% in high‐porosity (50%) HA spacers and 1.2% in low‐porosity (35%) HA spacers.…”

Section: Discussionmentioning

confidence: 55%

“…This is the first prospective study to demonstrate the feasibility of HA spacers with a high porosity (50%) compared to with a low porosity (35%) for double-door laminoplasty in patients with cervical myelopathy. Although prior studies have analyzed bone bonding and/or fusion between the HA spacer and laminae subjectively based on the gap disappearance 13,19 or the Ichikawa bone-bonding classification, 7,10,11,20 we used a more objective, quantitative CTbased method to assess bone bonding and absorption. In addition, this study's prospective design is advantageous to reduce bias compared to other retrospective studies, [10][11][12] as published prospective studies have still been limited.…”

Section: Discussionmentioning

confidence: 99%

“…6 The bone bonding and osteoconductive capability of the material, as well as the contact between the spacer and spinous processes, are essential to maintain the enlarged spinal canal and reduce the complications. Although bone bonding between the HA spacer and spinous processes have been examined with computed tomography (CT), [10][11][12][13] it is difficult to evaluate bony fusion in objective, quantitative manners. In addition, only a few studies have been conducted prospectively.…”

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confidence: 99%

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Improved bone bonding of hydroxyapatite spacers with a high porosity in a quantitative computed tomography‐image pixel analysis: A prospective 1‐year comparative study of the consecutive cohort undergoing double‐door cervical laminoplasty

Takeoka

Yurube

Maeno³

et al. 2020

JOR Spine

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Laminoplasty using hydroxyapatite (HA) spacers is widely performed in patients with cervical myelopathy. However, spacer dislocation is a critical complication caused by bone absorption and inadequate bone conductivity, and can result in dural damage and restenosis. We thus designed a prospective cohort study to clarify the feasibility of increased porosity HA spacers for double‐door laminoplasty by analyzing computed tomography (CT) images. Forty‐seven patients underwent cervical laminoplasty. Two different types of CERATITE HA spacer were used, either high porosity (50%) or low porosity (35%). These HA spacers were placed in an alternating manner into the laminae in each patient. In total, 85 high‐porosity (50%) HA spacers and 84 low‐porosity (35%) HA spacers were implanted. At postoperative 2 weeks, 3 months, 6 months, and 1 year, CT images were obtained. In both groups, the percentage of bone‐bonding boundary area of the HA spacer in contact with laminae and bone volume of the spinous process relative to the 2‐week value were calculated by a 3D and 2D CT‐image pixel analysis. The bone‐bonding ratio was significantly higher in high‐porosity (50%) than low‐porosity (35%) HA spacers at 3 months and thereafter (1 year, 69.3 ± 27.8% and 49.7 ± 32.9% respectively, P < .01). The bone volume in both groups significantly decreased with time (1 year, 73.2 ± 29.8% and 69.0 ± 30.4% respectively, P < .01), indicating bone absorption. This showed no significant difference between the HA spacers (P = .15) but was higher in high‐porosity (50%) than low‐porosity (35%) HA spacers throughout the study period. Meanwhile, spacer breakage was found in 4.7% of high‐porosity (50%) HA spacers and 1.2% of low‐porosity (35%) HA spacers (P = .37). In summary, high‐porosity (50%) HA spacers have the advantages of accelerated bone bonding and relatively decelerated bone absorption compared to low‐porosity (35%) HA spacers; however, possibly more frequent breakage of HA spacers with a high porosity (50%) requires careful, extended postoperative follow‐up.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Improved bone bonding of hydroxyapatite spacers with a high porosity in a quantitative computed tomography‐image pixel analysis: A prospective 1‐year comparative study of the consecutive cohort undergoing double‐door cervical laminoplasty

Takeoka

Yurube

Maeno³

et al. 2020

JOR Spine

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Reconstruction of critical‐size segmental defects in rat femurs using carbonate apatite honeycomb scaffolds

Sakemi

Hayashi

Tsuchiya

et al. 2021

J Biomedical Materials Res

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Critical‐size segmental defects are formidable challenges in orthopedic surgery. Various scaffolds have been developed to facilitate bone reconstruction within such defects. Many previously studied scaffolds achieved effective outcomes with a combination of high cost, high‐risk growth factors or stem cells. Herein, we developed honeycomb scaffolds (HCSs) comprising carbonate apatite (CO3Ap) containing 8% carbonate, identical to human bone composition. The CO3Ap HCSs were white‐columned blocks harboring regularly arranged macropore channels of a size and wall thickness of 156 ± 5 μm and 102 ± 10 μm, respectively. The compressive strengths of the HCSs parallel and perpendicular to the macropore channel direction were 51.0 ± 11.8 and 15.6 ± 2.2 MPa, respectively. The HCSs were grafted into critical‐sized segmental defects in rat femurs. The HCSs bore high‐load stresses without any observed breakage. Two‐weeks post‐implantation, calluses formed around the HCSs and immature bone formed in the HCS interior. The calluses and immature bone matured until 8 weeks via endochondral ossification. At 12 weeks post‐implantation, large parts of the HCSs were gradually replaced by newly formed bone. The bone reconstruction efficacy of the CO3Ap HCSs alone was comparable to that of protein and cell scaffolds, while achieving a lower cost and increased safety.

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Unidirectional porous beta-tricalcium phosphate and hydroxyapatite artificial bone: a review of experimental evaluations and clinical applications

et al. 2021

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In Japan, where allograft bone transplantation is not widespread, prospects for artificial bones are very high. Therefore, artificial bones with various compositions, porous structures, and porosities have been developed and employed for clinical use. Both Affinos® and Regenos® (made of beta-tricalcium phosphate and hydroxyapatite, respectively) are artificial bones with a unique unidirectional porous structure, in which pores with a diameter suitable for tissue penetration (25–300 μm) are aligned in one direction. The unidirectional porous structure allows rapid penetration of blood deep into the materials by a capillary effect. In animal experiments, Affinos® showed well-balanced resorption and was replaced with the host’s own bone from an early stage after implantation and new bone formation and remodeling were observed in the cortical bone and medullary cavity. When implanted for clinical situation, resorption from an early stage and good replacement with the patient’s own bone were also observed. Regenos® has an internal osteon-like material and a vascular-like structure that is maintained within the pores even after long-term implantation, as noted in an animal experiment. When implanted for clinical situation, good osteoconductivity was observed from an early stage of implantation. In addition, the material was observed to be slowly absorbed over time in some cases. We have discussed the beneficial effects of combining teriparatide and platelet-rich plasma impregnation and the potential prospects of these artificial bones.

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Bone bonding, displacement, and absorption in cases of double-door laminoplasty with unidirectional porous hydroxyapatite spacers

Cited by 12 publications

References 11 publications

Improved bone bonding of hydroxyapatite spacers with a high porosity in a quantitative computed tomography‐image pixel analysis: A prospective 1‐year comparative study of the consecutive cohort undergoing double‐door cervical laminoplasty

Improved bone bonding of hydroxyapatite spacers with a high porosity in a quantitative computed tomography‐image pixel analysis: A prospective 1‐year comparative study of the consecutive cohort undergoing double‐door cervical laminoplasty

Reconstruction of critical‐size segmental defects in rat femurs using carbonate apatite honeycomb scaffolds

Unidirectional porous beta-tricalcium phosphate and hydroxyapatite artificial bone: a review of experimental evaluations and clinical applications

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