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

Abstract

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.

Bioabsorbable self-retaining PLA/nano-sized β-TCP cervical spine interbody fusion cage in goat models: an in vivo study

“…The previous in vitro study revealed that a BCFC provides better initial biomechanical stability than two types of PEEK traditional cages. 8 The novel BCFC may be a promising alternative to the current PEEK cages and anterior plate devices.…”

“…Studies on PLA cages have been conducted to explore the effect on interbody fusion, the degradation of the cages, and the tissue response to the cages. 8 However, issues regarding low primary stability with the development of cracks and some foreign body reactions with inflammatory signs have been noted, which has led to widespread skepticism about the value of bioabsorbable implants and their limited use in clinical practice. Previous studies have indicated that the incorporation of β-TCP into PLA materials can both enhance osteoconductivity and buffer acid products to reduce the inflammation around the implants.…”

Short-Term Experience With a New Absorbable Composite Cage (β-Tricalcium Phosphate–Polylactic Acid) in Patients After Stand-Alone Anterior Cervical Discectomy and Fusion

“…Results of the histological investigation indicated the presence of an aseptic infl ammatory response. 16 At least from a biomechanical and histological perspective, superior results could be found with the use of a polymercalciumphosphate composite cage. 7 , 17 Those cages showed better biomechanical properties at 12 weeks after implantation mainly as a result of progressed interbody bone matrix formation and limited degree of foreign body reactions.…”

Biomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized β-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models

“…Although it can also be designed as an interbody fusion cage, PLA acidic degradation products can cause asepsis inflammation, which will damage the microenvironment of bone formation. Kandziora et al 12 and Frost et al 13 have reported osteolysis around lumber and cervical fusion cages made of PLA. Previous studies have indicated that the incorporation of β-tricalcium phosphate (β-TCP) into PLA materials can both enhance its osteoconductivity and buffer acid products.…”