Comparison of anterior cervical fusion by titanium mesh cage versus nano-hydroxyapatite/polyamide cage following single-level corpectomy

Abstract

Purpose The titanium mesh cage (TMC) is a typical metal cage device which has been widely used in cervical reconstruction for decades. Nano-hydroxyapatite/polyamide-66 (n-HA/PA66) cage is a novel biomimetic non-metal cage device growing in popularity in many medical centres in recent years. There has been no comparison of the efficacy between these two anterior reconstructing cages. The purpose of this study was to compare the radiographic and clinical outcomes of these two different devices. Methods Sixty-seven eligible patients with single-level ACCF using TMC or n-HA/PA66 cage for cervical degenerative diseases, with four-year minimum follow-up, were included in this prospective non-randomised comparative study. Their radiographic (cage subsidence, fusion status, segmental sagittal alignment [SSA]) and clinical (VAS and JOA scales) data before surgery and at each follow-up was recorded completely. Results The fusion rate of the n-HA/PA66 group was higher than TMC at one year after surgery (94 % vs. 84 %) though their finial fusion rates were similar (97 % vs. 94 %). Finial n-HA/PA66 cage subsidence was 1.5 mm with 6 % of severe subsidence over three millimetres, which was significantly lower than the respective 2.9 mm and 22 % of TMC (P <0.0001). Lastly, SSA, VAS and JOA in TMC group were worse than in the n-HA/PA66 group (P =0.235, 0.034 and 0.007, respectively). ConclusionsThe n-HA/PA66 cage is associated with earlier radiographic fusion, less subsidence and better clinical results than TMC within four years after one-level ACCF. With the added benefit of radiolucency, the n-HA/PA66 cage may be superior to TMC in anterior cervical construction.

Long-term results of anterior cervical corpectomy and fusion with nano-hydroxyapatite/polyamide 66 strut for cervical spondylotic myelopathy

“…However, the elastic modulus of the n-HA/PA66 cage was founded to be 4.0 GPa, which is substantially lower than that of a bone graft. Theoretically, the n-HA/PA66 strut can avoid the stress shield caused by some metallic implants and promote bony fusion1516. Previous studies reported satisfactory clinical and radiographic outcomes of ACCF with the n-HA/PA66 strut in short- and mid-term follow-up.…”

“…Nano-hydroxyapatite/polyamide66 (n-HA/PA66) is a biomimetic composite synthesized from nano-scale HA and the polar polymer PA66 and has been approved for clinical application in recent years. The n-HA/PA66 struts have been used for anterior cervical reconstruction for several years, and satisfactory clinical outcomes have been reported in previous studies141516. However, studies evaluating the long-term results of the n-HA/PA66 strut for ACCF are relatively scarce.…”

In vitro and in vivo biocompatibility and osteogenesis of graphene-reinforced nanohydroxyapatite polyamide66 ternary biocomposite as orthopedic implant material

“…A previous study showed that four years after implantation, nHA/PA66 implants directly connected with bone tissue without the immunological rejection and trabecular bone resorption caused by the stress-shielding effect. 18 The successful application of nHA/PA66 composites in the abovementioned area encouraged us to explore a broader range of their possible applications. Although the nHA/ PA66 composites have improved mechanical properties compared to PLA, our previous studies revealed that the mechanical strength of nHA/PA66 composites is still insufficient.…”

Bone plate composed of a ternary nano-hydroxyapatite/polyamide 66/glass fiber composite: biomechanical properties and biocompatibility

“…n-HA/PA66 composites have good biocompatibility and desirable mechanical properties, and have been used successfully as scaffolds in orthopedics. 13,14,19,22,23 However, n-HA/PA66 composites cannot provide adequate mechanical strength as bone plates for fixation of fractures. In the present study, to enhance the strength of these composites, we added 30 wt% glass fibers to n-HA/PA66 when fabricating the bone plate.…”