Abstract
Vertebral body replacement is well-established to stabilize vertebral injuries due to trauma or cancer. Spinal implants are mainly manufactured by metallic alloys; which leads to artifacts in radiological diagnostics; as well as in radiotherapy. The purpose of this study was to evaluate the biomechanical data of a novel carbon fiber reinforced polyetheretherketone (CF/PEEK) vertebral body replacement (VBR). Six thoracolumbar specimens were tested in a six degrees of freedom spine tester. In all tested specimens CF/PEEK pedicle screws were used. Two different rods (CF/PEEK versus titanium) with/without cross connectors and two different VBRs (CF/PEEK prototype versus titanium) were tested. In lateral bending and flexion/extension; range of motion (ROM) was significantly reduced in all instrumented states. In axial rotation; the CF/PEEK combination (rods and VBR) resulted in the highest ROM; whereas titanium rods with titanium VBR resulted in the lowest ROM. Two cross connectors reduced ROM in axial rotation for all instrumentations independently of VBR or rod material. All instrumented states in all planes of motion showed a significantly reduced ROM. No significant differences were detected between the VBR materials in all planes of motion. Less rigid CF/PEEK rods in combination with the CF/PEEK VBR without cross connectors showed the smallest reduction in ROM. Independently of VBR and rod material; two cross connectors significantly reduced ROM in axial rotation. Compared to titanium rods; the use of CF/PEEK rods results in higher ROM. The stiffness of rod material has more influence on the ROM than the stiffness of VBR material.
Highlights
Less rigid carbon fiber reinforced polyetheretherketone (CF/PEEK) rods in combination with the CF/PEEK Vertebral body replacement (VBR) without cross connectors showed the smallest reduction in range of motion (ROM)
Less rigid CF/PEEK rods combined with CF/PEEK VBR
No significant differences in ROM were measured for the different VBR material (CF/PEEK versus titanium), posterior rod material (CF/PEEK versus titanium) or additional cross connectors
Summary
Vertebral body replacement (VBR) combined with dorsal instrumentation is the preferred treatment option to achieve decompression and restore stability of the spinal column either in patients with a traumatic fracture (>AO Spine A3) [1,2,3,4,5,6] or major pathological instability due to infection [7,8,9,10], spinal metastases [11,12,13] or primary malignancy [7,8,11,12,13]. The incidence of clinically apparent metastatic disease in the spine has increased since advances in tumor treatment generally have improved the life expectancy of cancer patients [10,15]. Patients with prolonged life expectancy (>12 months) are recommended to be treated with a 360◦ instrumentation [15,17,18,19,20]
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