<i>In vitro</i> and <i>in vivo</i> degradation of bioabsorbable PLLA spinal fusion cages

Dijk, Martijn van; Tunc, Deger C.; Smit, Theo H.; Higham, Paul; Burgér, E.H.; Wuisman, P.

doi:10.1002/jbm.10466

Cited by 76 publications

(40 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…23,24,28 It was shown that degradation of the resorbable material occurred in a time-dependent and controlled way, resulting in high fusion rates. 23,24,26,29 Similar results were reported for a resorbable PLDLA device packed with autograft or rhBMP-2 in a sheep model. 30 Although the number of animals was small, the results were promising.…”

Section: Discussionsupporting

confidence: 53%

Lumbar body fusion with a bioresorbable cage in a goat model is delayed by the use of a carboxymethylcellulose‐stabilized collagenous rhOP‐1 device

Mullender

Krijnen

Helder

et al. 2006

Journal Orthopaedic Research

View full text Add to dashboard Cite

The purpose of this study was to evaluate the efficacy of recombinant human osteogenic protein-1 (rhOP-1) with a carboxymethylcellulose-stabilized collagenous carrier as a bone graft substitute for instrumented lumbar spinal fusion in an established goat model. Twenty goats received a resorbable poly-L-lactic acid (PLLA) interbody cage packed with either rhOP-1 and its carrier or autologous bone graft. The carrier material was bovine collagen type-1 stabilized with carboxymethylcellulose. The fusion segments were retrieved at 3 or 6 months postimplantation and evaluated by radiographic and histologic analyses. The rhOP-1 graft substitute, used in combination with the resorbable PLLA cage, showed inferior results as compared to autologous bone graft in the goat lumbar fusion model. Whereas four out of five segments from the autograft group were fused after 6 months, none of the four segments receiving the rhOP-1 graft substitute were fused at this time point. Bone ingrowth into the cage was delayed or absent in the experimental group, whereas all autograft specimens showed advanced bone ingrowth (3 months) or fusion (6 months). We suggest that the fusion process was inhibited, because cells were unable to penetrate the rhOP-1 graft material. This led to delayed bone formation and in some cases inadequate tissue formation. ß

show abstract

Section: Discussionsupporting

confidence: 53%

Lumbar body fusion with a bioresorbable cage in a goat model is delayed by the use of a carboxymethylcellulose‐stabilized collagenous rhOP‐1 device

Mullender

Krijnen

Helder

et al. 2006

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…Lateral radiographs of the sectioned specimens were used to estimate interbody fusion within the cage devices according to a validated threepoint radiographic score, 36 as follows: radiographic Score 0, no ingrowth of bone into the cage; radiographic Score 1, ingrowth of bone with the cage securely fixed to vertebral bone above and below, but with a radiolucent discontinuity in the fusion mass; and radiographic Score 2, spondylosyndesis with solid bone bridging the fusion area. Similarly, the interbody fusion stage was determined on MR images, according to the same scoring range, but now expressed as MR Scores 0, 1, and 2.…”

Section: Analysis Of Fusionmentioning

confidence: 99%

“…2,6,8,9,23 Second, connective tissues need mechanical deformation to transport nutrients and waste products to and from the cells through the extracellular matrix, 16,21,24 and probably also to proliferate and differentiate; stiff implants relieve the load on living tissues and thus may retard or even inhibit interbody fusion (stress shielding). 14,28,[34][35][36]40 Therefore, the design and material of the spinal instrumentation largely determine clinical success.…”

mentioning

confidence: 99%

“…First, the metal cages were much stiffer than the surrounding tissues, thus retarding or even inhibiting interbody fusion. 28,[34][35][36]40 Second, the metal cages obscured the intervertebral space on neuroimaging examination; it beNeurosurg Focus 16 (3): Article 3, 2004, Click here to return to Object. Interbody fusion is a gradual process of graft resorption and tissue formation, ideally resulting in a bone bridge between two adjacent vertebral bodies.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The use of high-resolution magnetic resonance imaging for monitoring interbody fusion and bioabsorbable cages: an ex vivo pilot study

Krijnen¹,

Smit²,

Strijkers³

et al. 2004

FOC

View full text Add to dashboard Cite

Object Interbody fusion is a gradual process of graft resorption and tissue formation, ideally resulting in a bone bridge between two adjacent vertebral bodies. Initially, fibrous tissue and cartilage are formed, which subsequently are replaced by bone through the process of endochondral ossification. When cages and/or their contents are made of resorbable polymers like lactic or glycolic acids, there is a simultaneous process of implant degradation, which is eventually accompanied by reactions in the surrounding tissues. The purpose of this study was to explore the use of high-resolution magnetic resonance (MR) imaging for monitoring tissue differentiation, spinal fusion, cage degradation, and eventually tissue reactions as a function of time. Methods Lumbar vertebral segments obtained in 14 goats with 3, 6, and 12 months of follow up (three, four, and seven animals, respectively) were available from a study of the feasibility of poly(L,D-lactic acid) cages for spinal fusion. Plain x-ray films, MR images, and histological sections were used to evaluate spinal fusion and cage resorption. The first follow-up tests revealed that MR imaging noninvasively provided three-dimensional information on cage placement, cage degradation and bone formation, and that it has potential to differentiate between the various soft tissues. Conclusions Although the magnetic field strength and thus the resolution used were higher than normal in clinical practice, MR imaging appears to be a promising modality for the noninvasive clinical follow up of patients who undergo fusion with resorbable cages. Tissue reactions were not encountered in this study, and thus could not be evaluated.

show abstract

“…Bone formation rate and bone remodelling are elevated at 12 months, probably because of disintegration of the PLDLLA cages. Thereafter, PLDLLA cages were replaced with trabecular bone and dispersed fibrous tissue progressively [11,12].…”

Section: Discussionmentioning

confidence: 99%

Osteolysis following resorbable poly-l-lactide-co-d, l-lactide PLIF cage use: a review of cases

et al. 2011

View full text Add to dashboard Cite

Study design Report of case seriesObjective To report a problem with bioabsorbable poly-Llactide-co-D, L-lactide, PLDLLA, posterior lumbar instrumented fusion (PLIF) cage implants. Summary of background data Synthetic bioabsorbable implants have recently been introduced to spinal surgery and their indications and applications are still being explored. There is evidence that the use of bioabsorbable cages may be of benefit in interbody spinal fusion. Methods We present a case series of nine patients who have undergone PLIF with bioabsorbable cages in the lumbar spine. Results At follow-up over at least 1 year, four of these patients were found to have osteolysis around the implant on CT scanning. One of these patients underwent an operation to remove the cage and histology sent during surgery suggested that the implant had caused the bone loss and there was no evidence of infection. Another patient had ongoing pain in relation to the lysis, while the other two patients with lysis remained asymptomatic. Conclusions PLDLLA cage, which has high osteolytic nature, is considered not suitable as a fusion cage.

show abstract

In vitro and in vivo degradation of bioabsorbable PLLA spinal fusion cages

Cited by 76 publications

References 43 publications

Lumbar body fusion with a bioresorbable cage in a goat model is delayed by the use of a carboxymethylcellulose‐stabilized collagenous rhOP‐1 device

Lumbar body fusion with a bioresorbable cage in a goat model is delayed by the use of a carboxymethylcellulose‐stabilized collagenous rhOP‐1 device

The use of high-resolution magnetic resonance imaging for monitoring interbody fusion and bioabsorbable cages: an ex vivo pilot study

Osteolysis following resorbable poly-l-lactide-co-d, l-lactide PLIF cage use: a review of cases

Contact Info

Product

Resources

About