Resistance of coated polyetheretherketone lumbar interbody fusion cages against abrasion under simulated impaction into the disc space

Abstract

In order to improve osseointegration, polyetheretherketone (PEEK) interbody fusion cages are frequently surface coated. The bonding strength of the coatings is mostly investigated under unrealistic loading conditions. To close this gap, in this study, uncoated and coated cages were loaded in a clinical setup in order to investigate their real resistance against abrasion. Six uncoated, six calcium phosphate (CaP) nanocoated, and six titanium (Ti) nanocoated PEEK cages were tested in this study. The experimental setup was designed to mimic cage impaction into the intervertebral disc space using polyurethane (PU) foam blocks as vertebral body substitutes. The cage surface was inspected before and after impaction, and their weight was measured. Impaction resulted in abrasion at the tip of the ridges on the implant surface. The mean weight loss was 0.39 mg for the uncoated cages, 0.57 mg for the CaP nanocoated cages, and 0.75 mg for the Ti nanocoated cages. These differences were statistically significant. In conclusion, differences between the three cage types were found concerning the amount of abrasion. However, all three cages lost less weight than a comparative Ti plasma spray coated cage, which showed a mean weight loss of 2.02 mg. This may be because the plasma spray coating is significantly thicker than the two nanocoatings. If compared with the permitted amount of weight loss derived from an FDA guidance document, which is approximately 1.7 mg, the wear of the Ti plasma spray coated cage is above this limit, whereas the wear for all other cage types is below.