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Bioabsorbable interbody cages in a sheep cervical spine fusion model
Frank Kandziora1, Robert Pflugmacher, Matti Scholz
1Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Charité der Humboldt-Universität Berlin, Campus Virchow-Klinikum, Germany. frank.kandziora@charite.de
Spine
|November 10, 2004
Summary
The polymer-calciumphosphate composite cage demonstrated superior fusion and biomechanical stability in a sheep cervical spine model but showed cracking. The poly(l-lactide-co-d,l-lactide) cage showed foreign body reactions and osteolysis, suggesting limited value.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Spine Fusion Research
Background:
- Bioabsorbable cages offer advantages over metallic implants for interbody fusion.
- Currently, no ideal bioabsorbable interbody fusion cage is commercially available.
Purpose of the Study:
- To compare the efficacy of an autologous tricortical iliac crest bone graft with two types of bioabsorbable cages for cervical spine interbody fusion.
- To evaluate differences in preserving postoperative distraction, biomechanical stability, and histological bone matrix formation among the three techniques.
Main Methods:
- An experimental study utilizing a sheep cervical spine (C3/C4) interbody fusion model.
- Three groups (n=8 each) were compared: iliac crest bone graft, poly(l-lactide-co-d,l-lactide) cage with cancellous bone, and polymer-calciumphosphate composite cage with cancellous bone.
- Evaluations included serial radiography, quantitative CT, biomechanical testing (flexion, extension, axial rotation, lateral bending), and histomorphological analysis over 12 weeks.
Main Results:
- The polymer-calciumphosphate composite cage group maintained disc space height significantly better and exhibited higher biomechanical stiffness with reduced range of motion.
- Histologically, the polymer-calciumphosphate composite cage group showed the highest bone volume and fusion rate.
- However, six of the eight polymer-calciumphosphate composite cages developed cracks, and the poly(l-lactide-co-d,l-lactide) cage group showed significant foreign body reactions and osteolysis.
Conclusions:
- The polymer-calciumphosphate composite cage demonstrated promising results in terms of fusion and stability but exhibited structural failure (cracking).
- The poly(l-lactide-co-d,l-lactide) cage showed concerning foreign body reactions and osteolysis, questioning its clinical utility.
- Further investigation is needed to address the long-term fate of cage-related issues and optimize bioabsorbable cage design for spinal fusion.