Ceramics in total disc replacements: A scoping review

The field of spinal arthroplasty faces challenges related to implant wear, imaging compatibility, and long-term stability. Traditional Total Disc Replacements (TDRs) often struggle with wear resistance and postoperative imaging limitations. While ceramics have been explored for their durability and biocompatibility, concerns about brittleness have persisted. Prior research has shown that ceramics can offer MRI and CT compatibility, which is a significant advantage over non-ceramic alternatives. However, the extent to which ceramics can improve clinical outcomes in TDRs remains unclear. This gap motivated a comprehensive review of current evidence on ceramic use in TDRs. No prior work had resolved the comparative safety and effectiveness of ceramic TDRs versus other approaches. The need to evaluate ceramic TDRs in terms of wear resistance, osseointegration, and clinical outcomes is evident. This paper contributes by synthesizing existing clinical and experimental evidence on ceramic TDRs. The review approach focuses on addressing uncertainties about ceramic TDR performance in real-world applications.

The study aims to evaluate the clinical and biomechanical evidence supporting the use of ceramics in Total Disc Replacements. It addresses the uncertainty surrounding whether ceramic TDRs can overcome the limitations of non-ceramic devices. The motivation stems from the need to compare ceramic TDRs with spinal fusion and other TDR types in terms of safety and effectiveness. The specific problem involves assessing whether ceramics can provide durable and imaging-compatible alternatives to traditional implants. The review also seeks to determine if ceramics can promote osseointegration and restore segmental motion effectively. By analyzing clinical and experimental data, the study aims to clarify the role of ceramics in spinal arthroplasty. The goal is to determine whether ceramics are a viable material for TDRs based on current evidence. This approach helps guide future clinical decisions and material development in spinal surgery.

The researchers conducted a scoping review to evaluate the use of ceramics in Total Disc Replacements. They searched Scopus, Web of Science, and PubMed for relevant studies. The review included clinical, ex vivo, and nonhuman in vivo studies, as well as tribological and mechanical analyses. The inclusion criteria focused on studies that examined ceramic materials in TDR applications. The researchers synthesized findings from 36 studies, including case reports and experimental data. They assessed safety, effectiveness, and performance of ceramic TDRs compared to alternatives. The analysis covered cervical TDRs specifically, with follow-up periods up to 10 and 3.3 years. The review approach allowed for a comprehensive evaluation of clinical and biomechanical outcomes.

Clinical studies showed that ceramic TDRs restore segmental motion and provide non-inferior outcomes to spinal fusion. Follow-up periods reached up to 10 years for articulation and 3.3 years for osseointegration applications. In vivo studies demonstrated osseointegration comparable to non-ceramic devices. Tribological studies suggested appropriate wear properties for ceramic materials. No systematic issues with ceramic TDRs were identified in the reviewed literature. The findings suggest that ceramics perform similarly to non-ceramic TDRs in terms of safety and effectiveness. Clinical evidence supports the use of ceramics in cervical TDRs for both articulation and osseointegration. The results indicate that ceramics are suitable materials for Total Disc Replacements based on current evidence.

The authors propose that ceramics are suitable materials for Total Disc Replacements based on current clinical and experimental evidence. They suggest that ceramic TDRs restore segmental motion and provide outcomes comparable to spinal fusion. The findings indicate that ceramics promote osseointegration and exhibit appropriate wear properties. The review suggests that ceramics are viable alternatives to non-ceramic TDRs in terms of safety and effectiveness. No systematic problems with ceramic TDRs were identified in the reviewed studies. The authors propose that ceramics address key limitations of non-ceramic TDRs, such as wear and imaging compatibility. The synthesis of evidence supports the use of ceramics in cervical TDRs for both articulation and osseointegration. The implications suggest that ceramics are a promising material for future Total Disc Replacements.