Abstract
BackgroundBioabsorbable implants are not widely used in spine surgery. This study investigated the clinical and radiological findings after anterior cervical discectomy and fusion (ACDF) in an ovine animal model with an experimental bioabsorbable cage consisting of magnesium and polymer (poly-ϵ-caprolactone, PCL) in comparison to a tricortical bone graft as the gold standard procedure.Materials and Methods24 full-grown sheep had ACDF of C3/4 and C5/6 with an experimental bioabsorbable implant (magnesium and PCL) in one level and an autologous tricortical bone graft in the second level. The sheep were divided into 4 groups (6 sheep each). After 3, 6, 12, or 24 weeks postoperatively, the cervical spines were harvested and conventional x-rays of each operated segment were conducted. The progress of interbody fusion was classified according to a three-point scoring system.ResultsThere were no operation related complications except for one intraoperative fracture of the anterior superior iliac spine and two cases of screw loosening and sinking, respectively. In particular, no vascular, neurologic, wound healing or infectious problems were observed. According to the time of follow-up, both interbody fusion devices showed similar behaviour with increasing intervertebral osseointegration and complete arthrodesis in 10 of 12 (83.3%) motion segments after 24 weeks.ConclusionsThe bioabsorbable magnesium-PCL cage used in this experimental animal study showed clinically no signs of incompatibility such as infectious or wound healing problems. The radiographic results regarding the osseointegration are comparable between the cage and the bone graft group.
Highlights
Bioabsorbable implants are not widely used in spine surgery
The bioabsorbable magnesium-PCL cage used in this experimental animal study showed clinically no signs of incompatibility such as infectious or wound healing problems
Anterior cervical discectomy and fusion (ACDF) is a standard procedure performed in patients with degenerative disc disease, disc prolapse and spinal canal stenosis
Summary
Bioabsorbable implants are not widely used in spine surgery. This study investigated the clinical and radiological findings after anterior cervical discectomy and fusion (ACDF) in an ovine animal model with an experimental bioabsorbable cage consisting of magnesium and polymer (poly-ε-caprolactone, PCL) in comparison to a tricortical bone graft as the gold standard procedure. One further relevant disadvantage of these metallic implants is the fact, that they lead to artifacts during computed tomography (CT) and magnetic resonance imaging (MRI), complicating early detection of a metastatic recurrence and the evaluation of interbody fusion (Schulte et al 2000). Because of their high axial compression stiffness, metallic cages may lead to stress shielding of the cancellous bone grafts inside the cage, resulting in a decreased interbody bone matrix formation or non-union (Epari et al 2005, Kandziora et al 2001a, 2002, Kanayama et al 2000, van Dijk et al 2002b). Subsidence in cages which consist of PEEK with consecutive segmental kyphosis had been observed in several clinical studies (Cabraja et al 2012, Chen et al 2013, Kast et al 2009, Lemcke et al 2011)
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