First Results of a New Vacuum Plasma Sprayed (VPS) Titanium-Coated Carbon/PEEK Composite Cage for Lumbar Interbody Fusion

Hoppe, Sven; Albers, Christoph E.; El-Fiky, Tarek; Deml, Moritz C.; Milavec, Helena; Bigdon, Sebastian F.; Benneker, Lorin Michael

doi:10.3390/jfb9010023

Cited by 30 publications

(15 citation statements)

References 35 publications

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“…A significant degree of clinical improvement was achieved, in addition to radiological unions in all patients with a mean 24-month follow-up. However, the fusion was evaluated only by plain radiographs [23].…”

Section: Discussionmentioning

confidence: 99%

Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion

et al. 2020

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Study Design: A retrospective radiographic analysis.Purpose: The aim of the current study is to assess endplate changes after the use of polyetheretherketone (PEEK) cages in posterior lumbar interbody fusion (PLIF).Overview of Literature: A few recent reports had revealed endplate abnormalities due to PEEK cages, which may lead to nonunions.Methods: A retrospective computed tomography (CT)-based analysis of the endplate cavities and fusion status following PLIFs with PEEK cages was conducted by two independent observers. The term “cavity” was used to describe the endplate changes. The vertebral endplate cavities were assessed according to the size, multiplicity, location, and presence or absence of sclerosis.Results: There were 86 fixed levels in 65 consecutive patients, with a mean age of 35.44±19.60 years. The mean follow-up was 16.5±10.1 months (range, 6–57 months). Definite fusion was seen in 56 levels (65.12%) by observer 1 versus 44 levels (51.16) by observer 2. The strength of agreement was moderate. Endplate cavities were observed in 42 levels (48.84%) by observer 1 versus 47 levels (54.65%) by observer 2, with fair agreement. The strengths of agreement for the locations, multiplicity, and size were moderate, fair, and poor, respectively. Neither age, sex, etiology, levels, nor follow-up period was significantly associated with the presence of cavities. With regard to fusions, the nonunions detected by observer 1 were significantly associated with the presence of cavities (p<0.0001). However, those detected by observer 2 were nearly significant (p=0.05).Conclusions: There was a high rate of unfavorable radiographic findings in the form of endplate cavities in PLIF cases with PEEK cages. A more comprehensive classification for the assessment of fusions and endplate cavities should be formulated. We strongly recommend further CT-based studies with larger sample size and longer follow-up periods.

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Section: Discussionmentioning

confidence: 99%

Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion

et al. 2020

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“…Vacuum plasma‐sprayed TiO 2 coatings have demonstrated some success in clinical testing when applied to CFR‐PEEK lumbar interbody cages. High clinical fusion rates were observed in a small clinical study where 42 patients underwent transforaminal lumbar interbody fusion surgery to fuse one or two spinal segments . After 24 months, no radiolucent zones devoid of bone were detected around the coated PEEK cages, and 90.4% of patients felt no pain.…”

Section: Strategies For Improving Osseointegrationmentioning

confidence: 99%

Surface Modification Strategies to Improve the Osseointegration of Poly(etheretherketone) and Its Composites

Buck

Cerruti

2019

Macromolecular Bioscience

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In the last 5 years, a wide variety of surface modification strategies are explored to improve the integration of poly(etheretherketone) (PEEK) implants with bone. Since PEEK does not support bone on‐growth, its surface properties need to be tailored to promote osteogenesis at the bone‐implant interface. Surface modifications applied to achieve this response range from simple surface morphology changes to the deposition of osteoconductive coatings. Of the many methods, titanium and/or hydroxyapatite coatings, extrusion to create surface pores, and an accelerated neutral atom beam treatment have been approved by the U.S. Food and Drug Administration to improve the integration of PEEK spinal cages. The success of these surface modifications brings hope for the clinical translation of other techniques in the future, but there are several limitations that may be preventing other treatments from reaching the clinic. This review describes numerous strategies that have been applied to PEEK‐based implants for improving their osseointegration and enhancing their antibacterial properties. The review concludes with a discussion about future directions for the field and provides suggestions for advancing clinical translation of surface‐modified PEEK implants to improve the lives of patients in need of these implants.

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“…Hoppe et al used vacuum plasma spray to apply a titanium coating to PEEK cages; they performed a retrospective review on 42 patients who underwent a transforaminal lumbar interbody fusion (TLIF) using Ti-coated PEEK implants and had no patients with evidence of pseudarthrosis or radiolucency around the cage. At 24-month follow-up, they found 93.6% of patients had a G1 fusion rate (per Bridwell classification), and 90.4% of patients were pain-free with high satisfaction at final follow-up [45]. Lastly, Makino et al evaluated 24 patients who underwent 1-or 2-level posterior lumbar interbody fusion (PLIF) surgery using Ti-coated PEEK cages.…”

Section: Peek Coatingmentioning

confidence: 99%

Optimizing the Spinal Interbody Implant: Current Advances in Material Modification and Surface Treatment Technologies

Park

Lehman

2020

Curr Rev Musculoskelet Med

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Purpose of Review Interbody implants allow for fusion of the anterior column of the spine between vertebral body endplates. As rates of spinal fusion surgery have increased over the past several years, significant research has been devoted to optimizing both the mechanical and biologic properties of the interbody implant in order to promote bony fusion. The first interbody implants used decades ago were fashioned from cortical autograft. Currently, titanium alloy and polyetheretherketone (PEEK) are the most widely used and studied materials for this purpose. This review focuses on recent innovations in material modification and surface treatment techniques for both titanium and PEEK implants to maximize fusion rates in spinal surgery. Recent Findings Titanium has an elastic modulus much higher than native bone and however has better osseointegrative properties than PEEK. PEEK, however, has an elastic modulus closer to that of bone without any of the advantageous biologic properties that titanium has. Increasing porosity and surface roughness of titanium implants have been shown to improve the mechanical properties of titanium implants, while the biologic properties of PEEK have been enhanced using surface coating technology, either with titanium or with hydroxyapatite (HA). Summary Techniques such as increasing porosity, surface roughening, and surface coating are just some of the recent innovations aimed at optimizing both mechanical and biologic properties of interbody implants to promote spinal fusion. The future of interbody implant design will rely on continued improvements of PEEK and titanium implants as well as exploring new implant materials altogether.

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First Results of a New Vacuum Plasma Sprayed (VPS) Titanium-Coated Carbon/PEEK Composite Cage for Lumbar Interbody Fusion

Cited by 30 publications

References 35 publications

Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion

Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion

Surface Modification Strategies to Improve the Osseointegration of Poly(etheretherketone) and Its Composites

Optimizing the Spinal Interbody Implant: Current Advances in Material Modification and Surface Treatment Technologies

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