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Biological cages
M E Janssen1, C Nguyen, R Beckham
1Center for Spinal Disorders, Denver, CO 80229, USA.
Summary
Femoral ring allografts and posterior lumbar interbody fusion spacers offer biological solutions for anterior column reconstruction. These bone graft cages demonstrate high strength and resistance to expulsion, with no adverse events reported in clinical use.
Area of Science:
- Spine surgery
- Orthopedic biomechanics
- Biomaterials
Background:
- Restoring anterior column stability is crucial for normal spinal biomechanics.
- Mechanical spacers have limitations in assessing bone incorporation.
- Existing spacers often lack biological integration assessment.
Purpose of the Study:
- To introduce and evaluate the femoral ring allograft (FRA) and posterior lumbar interbody fusion (PLIF) spacers as biological cages for anterior column reconstruction.
- To assess the biomechanical properties and clinical outcomes of these biological cages.
Main Methods:
- Biomechanical testing of FRA and PLIF spacers for compressive strength and resistance to expulsion.
- Clinical evaluation of FRA and PLIF spacers in patients undergoing spinal fusion.
- Radiographic monitoring of bone incorporation and graft integration.
Main Results:
- FRA and PLIF spacers exhibit compressive strength exceeding 25,000 N.
- Implant design features enhance resistance to expulsion under physiological loads.
- Clinical studies (90 FRA, 10 PLIF) reported no graft migration, infection, or subsidence.
Conclusions:
- FRA and PLIF biological cages effectively restore the anterior column with good biomechanical properties.
- These biological cages offer a viable alternative to mechanical spacers, allowing radiographic monitoring of bone incorporation.
- Minimally invasive or open procedures for insertion preserve end-plates and demonstrate favorable clinical outcomes.
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