Early bone ingrowth and segmental stability of a trussed titanium cage versus a polyether ether ketone cage in an ovine lumbar interbody fusion model

被引:11
作者
Loenen, Arjan C. Y. [1 ,2 ]
Peters, Marloes J. M. [1 ]
Bevers, Raymond T. J. [1 ]
Schaffrath, Claus [3 ]
van Haver, Els [4 ]
Cuijpers, Vincent M. J., I [5 ]
Rademakers, Timo [6 ]
van Rietbergen, Bert [1 ,2 ]
Willems, Paul C. [1 ]
Arts, Jacobus J. [1 ,2 ]
机构
[1] Maastricht Univ, CAPHRI, Med Ctr, Dept Orthoped Surg,Lab Expt Orthoped, POB 5800, NL-6202 AZ Maastricht, Netherlands
[2] Eindhoven Univ Technol, Dept Biomed Engn, Orthoped Biomech, Eindhoven, Netherlands
[3] 4WEB EU, Assendelft, Netherlands
[4] Medanex Clin, Diest, Belgium
[5] Radboud Univ Nijmegen, Med Ctr, Dept Biomat, Nijmegen, Netherlands
[6] MERLN Inst Technol Inspired Regenerat Med, Dept Cell Biol Inspired Tissue Engn, Maastricht, Netherlands
关键词
Ovine model; Spine; Interbody cage; Bone ingrowth; Early segmental stability; Polyether ether ketone; Trussed titanium; Interbody fusion; IMPLANTS; RHBMP-2; OUTCOMES; CONSISTENT; ALLOGRAFT; STRAINS; RATES; DISC;
D O I
10.1016/j.spinee.2021.07.011
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND CONTEXT: Lumbar interbody fusion is an effective treatment for unstable spinal segments. However, the time needed to establish a solid bony interbody fusion between the two vertebrae may be longer than twelve months after surgery. During this time window, the instrumented spinal segment is assumed to be at increased risk for instability related complications such as cage migration or subsidence. It is hypothesized that the design of new interbody cages that enable direct osseointegration of the cage at the vertebral endplates, without requiring full bony fusion between the two vertebral endplates, might shorten the time window that the instrumented spinal segment is susceptible to failure. PURPOSE: To quantify the bone ingrowth and resulting segmental stability during consolidation of lumbar interbody fusion using two different cage types. STUDY DESIGN: Preclinical ovine model. METHODS: Seven skeletally mature sheep underwent bi-segmental lumbar interbody fusion surgery with one conventional polyether ether ketone (PEEK) cage, and one newly developed trussed titanium (TT) cage. After a postoperative time period of 13 weeks, non-destructive range of motion testing, and histologic analysis was performed. Additionally, sample specific finite element (FE) analysis was performed to predict the stability of the interbody fusion region alone. RESULTS: Physiological movement of complete spinal motion segments did not reveal significant differences between the segments operated with PEEK and TT cages. The onset of creeping substitution within the cage seemed to be sooner for PEEK cages, which led to significantly higher bone volume over total volume (BV/TV) compared with the TT cages. TT cages showed significantly more direct bone to implant contact (BIC). Although the mean stability of the interbody fusion region alone was not statistically different between the PEEK and TT cages, the variation within the cage types illustrated an all-or-nothing response for the PEEK cages while a more gradual increase in stability was found for the TT cages. CONCLUSIONS: Spinal segments operated with conventional PEEK cages were not different from those operated with newly developed TT cages in terms of segmental stability but did show a different mechanism of bone ingrowth and attachment. Based on the differences in development of bony fusion, we hypothesize that TT cages might facilitate increased early segmental stability by direct osseointegration of the cage at the vertebral endplates without requiring complete bony bridging through the cage. CLINICAL SIGNIFICANCE: Interbody cage type affects the consolidation process of spinal interbody fusion. Whether different consolidation processes of spinal interbody fusion result in clinically significant differences requires further investigation. (C) 2021 The Author(s). Published by Elsevier Inc.
引用
收藏
页码:174 / 182
页数:9
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