Choice of Spinal Interbody Fusion Cage Material and Design Influences Subsidence and Osseointegration Performance

Fogel, Guy R.; Martin, Nicholas; Williams, Gerald D.; Unger, Jesse; Yee-Yanagishita, Christian; Pelletier, Matthew H.; Walsh, William R.; Peng, Yun; Jekir, Michael

doi:10.1016/j.wneu.2022.03.087

Cited by 15 publications

(5 citation statements)

References 39 publications

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“…However, the PEEK surface is not osteoconductive, and bone integration is compromised compared to titanium. 4,8 In a study by Fogel et al using titanium and PEEK devices with the same design shape, the cages had significantly different outcomes during in vitro tests 25 . For this study, we reverse-engineered all the commercial cages and printed them using the same 'Rigid' resin used for the PS cages, standardizing the material for cage comparison.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Subsidence Between Patient-Specific and Non-Patient-Specific Lumbar Interbody Fusion Cages

Fernandes

Gee

Kanawati

et al. 2022

Global Spine Journal

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Study Design Biomechanical study. Objectives Several strategies to improve the surface of contact between an interbody device and the endplate have been employed to attenuate the risk of cage subsidence. 3D-printed patient-specific cages have been presented as a promising alternative to help mitigate that risk, but there is a lack of biomechanical evidence supporting their use. We aim to evaluate the biomechanical performance of 3D printed patient-specific lumbar interbody fusion cages in relation to commercial cages in preventing subsidence. Methods A cadaveric model is used to investigate the possible advantage of 3D printed patient-specific cages matching the endplate contour using CT-scan imaging in preventing subsidence in relation to commercially available cages (Medtronic Fuse and Capstone). Peak failure force and stiffness were analyzed outcomes for both comparison groups. Results PS cages resulted in significantly higher construct stiffness when compared to both commercial cages tested (>59%). PS cage peak failure force was 64% higher when compared to Fuse cage ( P < .001) and 18% higher when compared to Capstone cage ( P = .086). Conclusions Patient-specific cages required higher compression forces to produce failure and increased the cage-endplate construct' stiffness, decreasing subsidence risk.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Subsidence Between Patient-Specific and Non-Patient-Specific Lumbar Interbody Fusion Cages

Fernandes

Gee

Kanawati

et al. 2022

Global Spine Journal

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“…A thorough discectomy, performed carefully so as not to violate the subchondral bone of the endplates [ 1 , 2 , 29 , 31 ], included release of the contralateral anulus using a Cobb elevator and placing the widest possible implant that spanned the lateral margins of the apophyseal ring bilaterally to maximize endplate support [ 1 , 2 , 29 , 32 , 33 , 34 ]. We used porous titanium LLIF cages (CoRoent XL Titanium, NuVasive, Inc.) [ 35 ] with a 10° lordotic angle for 25 patients who underwent the transpsoas LLIF surgery and polyether ether ketone (PEEK) cages (Clydesdale; Medtronic Inc., Minneapolis, MN, USA) with a 6° lordotic angle for 4 patients who underwent LLIF with the prepsoas approach [ 36 ]. In both cases, the cage was packed with porous hydroxyapatite/collagen composite (Refit ® ; HOYA Technosurgical Co., Tokyo, Japan) [ 37 , 38 ] after soaking it in autogenous iliac bone marrow aspirate.…”

Section: Methodsmentioning

confidence: 99%

Can We Rely on Prophylactic Two-Level Vertebral Cement Augmentation in Long-Segment Adult Spinal Deformity Surgery to Reduce the Incidence of Proximal Junctional Complications?

Tani,

Naka,

Ono

et al. 2024

Medicina

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Background and Objectives: Proximal junctional kyphosis (PJK) and failure (PJF), the most prevalent complications following long-segment thoracolumbar fusions for adult spinal deformity (ASD), remain lacking in defined preventive measures. We studied whether one of the previously reported strategies with successful results—a prophylactic augmentation of the uppermost instrumented vertebra (UIV) and supra-adjacent vertebra to the UIV (UIV + 1) with polymethylmethacrylate (PMMA)—could also serve as a preventive measure of PJK/PJF in minimally invasive surgery (MIS). Materials and Methods: The study included 29 ASD patients who underwent a combination of minimally invasive lateral lumbar interbody fusion (MIS-LLIF) at L1-2 through L4-5, all-pedicle-screw instrumentation from the lower thoracic spine to the sacrum, S2-alar-iliac fixation, and two-level balloon-assisted PMMA vertebroplasty at the UIV and UIV + 1. Results: With a minimum 3-year follow-up, non-PJK/PJF group accounted for fifteen patients (52%), PJK for eight patients (28%), and PJF requiring surgical revision for six patients (21%). We had a total of seven patients with proximal junctional fracture, even though no patients showed implant/bone interface failure with screw pullout, probably through the effect of PMMA. In contrast to the PJK cohort, six PJF patients all had varying degrees of neurologic deficits from modified Frankel grade C to D3, which recovered to grades D3 and to grade D2 in three patients each, after a revision operation of proximal extension of instrumented fusion with or without neural decompression. None of the possible demographic and radiologic risk factors showed statistical differences between the non-PJK/PJF, PJK, and PJF groups. Conclusions: Compared with the traditional open surgical approach used in the previous studies with a positive result for the prophylactic two-level cement augmentation, the MIS procedures with substantial benefits to patients in terms of less access-related morbidity and less blood loss also provide a greater segmental stability, which, however, may have a negative effect on the development of PJK/PJF.

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“…Another validation technique could involve the wettability test, where the roughened surface will increase the contact angle of the water droplet, as mentioned in many works (Ha et al, 1997;Tsougeni et al, 2009;Kubiak et al, 2011;Akkan et al, 2014;Ourahmoune et al, 2014). Previous studies (Gittens et al, 2014;Fogel et al, 2022;Kia et al, 2022;Jia et al, 2023) have developed various surface engineering techniques, specifically for spinal fusion applications, that had the same hypothesis and objective in addressing the osteointegration issue of PEEK material. However, a limited number of works discuss the effect of PEEK surface treatments on the attachment of microorganisms mimicking the human body environment.…”

Section: Frontiers In Mechanical Engineeringmentioning

confidence: 99%

“…Therefore, PEEK-based biomaterial has emerged and been developed as an alternative. Despite those advantages compared to the metals, PEEK suffers from hydrophobicity, bioactivity, and osseointegration performance (Najeeb et al, 2016;Fogel et al, 2022). The biologically inert behavior of PEEK material creates a constraint to integrating with its host bone when implanted, causing the implant to loosen (Gu et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Optimizing PEEK implant surfaces for improved stability and biocompatibility through sandblasting and the platinum coating approach

Faadhila,

Taufiqurrakhman,

Katili

et al. 2024

Front. Mech. Eng.

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Polyether–ether–ketone (PEEK) is a commonly employed biomaterial for spinal, cranial, and dental implant applications due to its mechanical properties, bio-stability, and radiolucency, especially when compared to metal alloys. However, its biologically inert behavior poses a substantial challenge in osseointegration between host bone and PEEK implants, resulting in implant loosening. Previous studies identified PEEK surface modification methods that prove beneficial in enhancing implant stability and supporting cell growth, but simultaneously, those modifications have the potential to promote bacterial attachment. In this study, sandblasting and sputter coating are performed to address the aforementioned issues as preclinical work. The aim is to investigate the effects of surface roughness through alumina sandblasting and a platinum (Pt) sputtered coating on the surface friction, cell viability, and bacterial adhesion rates of PEEK material. This study reveals that a higher average surface roughness of the PEEK sample (the highest was 1.2 μm obtained after sandblasting) increases the coefficient of friction, which was 0.25 compared to the untreated PEEK of 0.14, indicating better stability performance but also increased bacterial adhesion. A novelty of this study is that the method of Pt coating after alumina sandblasting is seen to significantly reduce the bacterial adhesion by 67% when compared to the sandblasted PEEK sample after 24 h immersion, implying better biocompatibility without changing the cell viability performance.

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Choice of Spinal Interbody Fusion Cage Material and Design Influences Subsidence and Osseointegration Performance

Cited by 15 publications

References 39 publications

Biomechanical Comparison of Subsidence Between Patient-Specific and Non-Patient-Specific Lumbar Interbody Fusion Cages

Biomechanical Comparison of Subsidence Between Patient-Specific and Non-Patient-Specific Lumbar Interbody Fusion Cages

Can We Rely on Prophylactic Two-Level Vertebral Cement Augmentation in Long-Segment Adult Spinal Deformity Surgery to Reduce the Incidence of Proximal Junctional Complications?

Optimizing PEEK implant surfaces for improved stability and biocompatibility through sandblasting and the platinum coating approach

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