Abstract
BACKGROUND CONTEXTThe interface and interactions between an interbody cage, graft material, and host bone can all participate in the fusion. Shortcomings of Poly(aryl-ether-ether-ketone) interbody cages have been addressed with novel titanium surfaces. Titanium surfaces paired with macroscale topography features on the endplates and within the aperture may provide additional benefits. PURPOSETo evaluate the influence of cage design parameters on interbody fusion in a large animal preclinical model. STUDY DESIGN/SETTINGA comparative preclinical large animal model was performed to evaluate how macroscale topography features of an interbody cage can facilitate early integration between the host bone, graft material, and interbody cage and these effects on biomechanical stability and fusion. METHODSForty single level interbody fusions (L4–L5) using iliac crest autograft and bilateral pedicle screw fixation were performed in adult sheep to evaluate the effect of undercut macrostructure topography features of an interbody cage on the endplates and within the aperture. Fusions were evaluated at 6 and 12 weeks (n=10 per group) using radiography, microcomputed tomography, biomechanical integrity, and histology endpoints. RESULTSThe presence of the undercut macrostructures present on the endplates and within the aperture statistically improved biomechanical integrity at 6 and 12 weeks compared with controls. Microcomputed tomography and histology demonstrated bony interdigitation within the endplate and aperture features contributing to the improvement in properties. CONCLUSIONSThe present study demonstrates that Poly(aryl-ether-ether-ketone) implants with titanium surfaces can be augmented by undercut macrostructures present on the endplates and within the aperture to provide opportunities for a series of anchoring points that, with new bone formation and remodelling, result in earlier and improved biomechanical integrity of the treated level. CLINICAL SIGNIFICANCEThis preclinical study showed that bone interdigitation with the undercut macrostructures present on the endplates and within the aperture resulted in improved fusion and biomechanical stability in a clinically relevant spinal fusion model. Future clinical study is warranted to evaluate such implants’ performance in humans.
Highlights
Fusion using interbody cages has become a routine procedure to treat instability and degenerative spinal pathologies
Interbody cages and graft materials ideally should work in concert with the surgical preparation, immediate postoperative correction, and local biology to facilitate fusion as quickly as possible considering the devastating effects of a slow fusion or non-union to the patient and healthcare system
The cages were not visible considering the radiolucent nature of PEEK even with the thin layer of titanium [8]
Summary
Fusion using interbody cages has become a routine procedure to treat instability and degenerative spinal pathologies. Surgical, and biomechanical requirements drive technological developments with the aim of improving patient care and quality of life. This is clearly seen in interbody fusion as new materials, surfaces, and technologies are developed, often in other musculoskeletal fields, and applied to spinal fusion [1]. Interbody cages and graft materials ideally should work in concert with the surgical preparation, immediate postoperative correction, and local biology to facilitate fusion as quickly as possible considering the devastating effects of a slow fusion or non-union to the patient and healthcare system
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
