Cervical Intervertebral Cages: Past, Present, Innovations, and Future Trends with Review of the Literature.

Elkazaz, Mohamed; Koptan, Marwan W; Al-Shatoury, Hassan; Alkosha, Hazem M.; Abou-Madawi, Ali

doi:10.21608/esj.2020.49913.1155

Cited by 4 publications

(11 citation statements)

References 83 publications

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“…44,60 It is imperative to create mechanically robust implant surfaces and constructs that reduce the potential for micro-movement, particle loss, and adaptive immune response. 5,61,62 Altering build parameters can affect either the surface properties or the internal structure of the template depending on the parameter changed. 16,33 Substantial changes to infill or contour traces affect struts in complex parts.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 These implants have grown in use in multiple fields such as endosseous dental implants, stems and cups for hip arthroplasty; knee reconstruction prosthesesl and interbody fusion devices for spine, reducing co-morbidities' associated with autografts and allografts. [3][4][5] While these implants have achieved widespread use, there are still limitations such as mechanical modulus mismatch with native bone tissue, limitations in machining components to create strategic porosities, and difficulty in creating personalized implants with appropriate size and shapes for patients on demand. 6,7 There is growing trend to use metal 3D printing (M3D) for implant manufacturing for biomedical applications to overcome these limitations by creating macroporous implants with mechanical moduli more closely related to cortical bone and possessing architectural properties that promote osteogenesis of cells that migrate onto the absorbed proteins of a placed implant.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 There is growing trend to use metal 3D printing (M3D) for implant manufacturing for biomedical applications to overcome these limitations by creating macroporous implants with mechanical moduli more closely related to cortical bone and possessing architectural properties that promote osteogenesis of cells that migrate onto the absorbed proteins of a placed implant. 5,[8][9][10] The machined implants present a two-dimensional surface to bone tissue, even with complex surface processing. In contrast, M3D printing adds the extra complexities of thin-walled structures, altered atomic packing structure, and surface properties, all of which are dependent on the M3D method used, laser scan strategy, and powder size.…”

Section: Introductionmentioning

confidence: 99%

“…Orthopedic and dental implants have traditionally been manufactured by metal working and computer numerical control (CNC) machining 1,2 . These implants have grown in use in multiple fields such as endosseous dental implants, stems and cups for hip arthroplasty; knee reconstruction prosthesesl and interbody fusion devices for spine, reducing co‐morbidities' associated with autografts and allografts 3–5 . While these implants have achieved widespread use, there are still limitations such as mechanical modulus mismatch with native bone tissue, limitations in machining components to create strategic porosities, and difficulty in creating personalized implants with appropriate size and shapes for patients on demand 6,7 …”

Section: Introductionmentioning

confidence: 99%

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Bone marrow stromal cells are sensitive to discrete surface alterations in build and post‐build modifications of bioinspired Ti6Al4V 3D‐printed in vitro testing constructs

Berger

Cohen

Snyder³

et al. 2022

J Biomed Mater Res

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Current standards in bone‐facing implant fabrication by metal 3D (M3D) printing require post‐manufacturing modifications to create distinct surface properties and create implant microenvironments that promote osseointegration. However, the biological consequences of build parameters and surface modifications are not well understood. This study evaluated the relative contributions of build parameters and post‐manufacturing modification techniques to cell responses that impact osseointegration in vivo. Biomimetic testing constructs were created by using a M3D printer with standard titanium–aluminum–vanadium (Ti6Al4V) print parameters. These constructs were treated by either grit‐blasting and acid‐etching (GB + AE) or GB + AE followed by hot isostatic pressure (HIP) (GB + AE, HIP). Next, nine constructs were created by using a M3D printer with three build parameters: (1) standard, (2) increased hatch spacing, and (3) no infill, and additional contour trace. Each build type was further processed by either GB + AE, or HIP, or a combination of HIP treatment followed by GB + AE (GB + AE, HIP). Resulting constructs were assessed by SEM, micro‐CT, optical profilometry, XPS, and mechanical compression. Cellular response was determined by culturing human bone marrow stromal cells (MSCs) for 7 days. Surface topography differed depending on processing method; HIP created micro‐/nano‐ridge like structures and GB + AE created micro‐pits and nano‐scale texture. Micro‐CT showed decreases in closed pore number and closed porosity after HIP treatment in the third build parameter constructs. Compressive moduli were similar for all constructs. All constructs exhibited ability to differentiate MSCs into osteoblasts. MSCs responded best to micro−/nano‐structures created by final post‐processing by GB + AE, increasing OCN, OPG, VEGFA, latent TGFβ1, IL4, and IL10. Collectively these data demonstrate that M3D‐printed constructs can be readily manufactured with distinct architectures based on the print parameters and post‐build modifications. MSCs are sensitive to discrete surface topographical differences that may not show up in qualitative assessments of surface properties and respond by altering local factor production. These factors are vital for osseointegration after implant insertion, especially in patients with compromised bone qualities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bone marrow stromal cells are sensitive to discrete surface alterations in build and post‐build modifications of bioinspired Ti6Al4V 3D‐printed in vitro testing constructs

Berger

Cohen

Snyder³

et al. 2022

J Biomed Mater Res

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show abstract

“…One limitation of these Ti-based implants was the mismatch in mechanical modulus between titanium and the native bone tissue leading to stress shielding and increasing the potential for subsidence, or vertebral spacing loss. These implants lacked discrete, specific surface properties engineered to direct cellular response, possessing instead a less sophisticated topography [ 5 , 8 ].…”

Section: Spine Fusion Devices As a Subset Of Bone-facing Implantsmentioning

confidence: 99%

A Review of Biomimetic Topographies and Their Role in Promoting Bone Formation and Osseointegration: Implications for Clinical Use

et al. 2022

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The use of metallic and polymeric materials for implants has been increasing over the past decade. This trend can be attributed to a variety of factors including a significant increase in basic science research focused on implant material characteristics and how various surface modifications may stimulate osseointegration and, ultimately, fusion. There are many interbody fusion devices and dental implants commercially available; however, detailed information about their surface properties, and the effects that various materials and surface modifications may have on osteogenesis, is lacking in the literature. While the concept of bone-implant osseointegration is a relatively recent addition to the spine fusion literature, there is a comparatively large body of literature related to dental implants. The purpose of this article is to summarize the science of surface modified bone-facing implants, focusing on biomimetic material chemistry and topography of titanium implants, to promote a better understanding of how these characteristics may impact bone formation and osseointegration. This manuscript has the following aspects: highlights the role of titanium and its alloys as potent osteoconductive bioactive materials; explores the importance of biomimetic surface topography at the macro-, micro- and nano-scale; summarizes how material surface design can influence osteogenesis and immune responses in vitro; focuses on the kinds of surface modifications that play a role in the process. Biomimetic surface modifications can be varied across many clinically available biomaterials, and the literature supports the hypothesis that those biomaterial surfaces that exhibit physical properties of bone resorption pits, such as roughness and complex hierarchical structures at the submicron and nanoscale, are more effective in supporting osteoblast differentiation in vitro and osteogenesis in vivo.

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Internal surface modification of additively manufactured macroporous TiAl6V4 biomimetic implants via a calciothermic reaction‐based process and osteogenic in vivo responses

Berger,

Cohen,

Deng

et al. 2023

J Biomed Mater Res

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Three‐dimensional macroporous titanium–aluminum–vanadium (TiAl6V4) implants produced by additive manufacturing (AM) can be grit blasted (GB) to yield microtextured exterior surfaces, with additional micro/nano‐scale surface features provided by subsequent acid etching (AE). However, the line‐of‐sight nature of GB causes the topography of exterior GB + AE‐modified surfaces to differ from internal GB‐inaccessible surfaces. Previous in vitro studies using dense TiAl6V4 substrates indicated that a nonline‐of‐sight, calciothermic‐reaction (CaR)‐based process provided homogeneous osteogenic nanotextures on GB + AE surfaces, suggesting it could be used to achieve a homogeneous nanotopography on external and internal surfaces of macroporous AM constructs. Macroporous TiAl6V4 (3D) constructs were produced by direct laser melting and modified by GB + AE, with the CaR process then applied to 50% of constructs (3DCaR). The CaR process yielded nanoporous/nanorough internal surfaces throughout the macroporous constructs. Skeletally mature, male Sprague–Dawley rats were implanted with these constructs using a cranial on‐lay model. Prior to implantation, a Cu++‐free click hydrogel was applied to half of the constructs (3D + H, 3DCaR + H) to act as a challenge to osseointegration. Osseointegration was compared between the four implant groups (3D, 3DCaR, 3D + H, 3DCaR + H) at 4w. 3D + H implants exhibited lower bone volume (BV) and percent bone ingrowth (%BI) than the 3D implants. In contrast, osseointegrated 3DCaR + H implants had similar BV and %BI as the 3DCaR implants. Implant pull‐off forces correlated with these results. In vitro analyses indicated that human bone marrow stromal cells (MSCs) exhibited enhanced production of osteoblast differentiation markers and factors associated with osteogenesis when grown on CaR‐modified 3D substrates relative to control (TCPS) substrates. This work confirms that the CaR process provides osteogenic nanotextures on internal surfaces of macroporous 3D implants, and suggests that CaR‐modified surfaces can promote osseointegration in cases where osteogenesis is impaired.

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Cervical Intervertebral Cages: Past, Present, Innovations, and Future Trends with Review of the Literature.

Cited by 4 publications

References 83 publications

Bone marrow stromal cells are sensitive to discrete surface alterations in build and post‐build modifications of bioinspired Ti6Al4V 3D‐printed in vitro testing constructs

Bone marrow stromal cells are sensitive to discrete surface alterations in build and post‐build modifications of bioinspired Ti6Al4V 3D‐printed in vitro testing constructs

A Review of Biomimetic Topographies and Their Role in Promoting Bone Formation and Osseointegration: Implications for Clinical Use

Internal surface modification of additively manufactured macroporous TiAl6V4 biomimetic implants via a calciothermic reaction‐based process and osteogenic in vivo responses

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