Bioresorbable polymers: heading for a new generation of spinal cages

Wuisman, P.; Smit, Theo H.

doi:10.1007/s00586-005-1003-6

Cited by 102 publications

(75 citation statements)

References 110 publications

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“…Most of the studies on bioabsorbable cages focus on PLA and its copolymer, [11][12][13][14][15][16][17] which have ~30 years of clinical application, including for sutures, plates, and screws in different orthopedic surgeries. 18,19 Although cervical fusion cages that are made of PLA generally work very well, 15,17,20,21 the acidic degradation products of PLA can cause asepsis inflammation and osteolysis, [22][23][24] which will deteriorate the microenvironment of bone healing.…”

Section: Discussionmentioning

confidence: 99%

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Bioabsorbable self-retaining PLA/nano-sized β-TCP cervical spine interbody fusion cage in goat models: an in vivo study

Cao¹,

Chen²,

Jiang³

et al. 2017

IJN

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Study design This is an experimental animal study. Objective The objective of this study was to compare an anterior cervical discectomy and interbody fusion of a novel polylactide/nano-sized β-tricalcium phosphate (PLA/nβ-TCP) bioabsorbable self-retaining cervical fusion cage (BCFC) with an autologous bone graft and polyetheretherketone (PEEK) cages. Background Although PLA cervical cages have potential advantages compared with traditional materials, they are not currently routinely used in spine surgery because of undesirable effects such as the lack of osteoconductivity and osteolysis around the implant. This study involved the manufacturing of a bioabsorbable cage from PLA/nβ-TCP that was then used as a device for anterior cervical discectomy and fusion (ACDF) on a goat cervical spine fusion model. Materials and methods Eighteen goats underwent C3/C4 discectomy and were randomly divided into three groups based on the following methods: Group A (n=6), an autologous bone graft; Group B (n=6), PEEK cage filled with an autologous graft; and Group C (n=6), BCFC filled with an autologous iliac bone. Radiography was performed preoperatively and postoperatively and at 1, 4, 8, and 12 weeks after the operation. Disc space height (DSH) was measured at the same time. After 12 weeks, the fused segments were harvested and evaluated with functional radiographic views, biomechanical testing, and histological analyses. Results Over a 12-week period, the BCFC and PEEK cage groups exhibited significantly higher DSH values than the bone graft group. Additionally, the BCFC group yielded a significantly lower range of motion in axial rotation than both the autologous bone graft and PEEK cage groups. A histologic evaluation revealed an increased intervertebral bone volume/total volume ratio and better interbody fusion in the BCFC group than in the other groups. Conclusion The BCFC device exhibited better results than the autologous bone graft and PEEK cages in single-level ACDF models in vivo. This device may be a potential alternative to the current PEEK cages.

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Section: Discussionmentioning

confidence: 99%

“…18,19 Although cervical fusion cages that are made of PLA generally work very well, 15,17,20,21 the acidic degradation products of PLA can cause asepsis inflammation and osteolysis, [22][23][24] which will deteriorate the microenvironment of bone healing. In addition, PLA cannot offer the capacity to osteoconduct.…”

Section: Discussionmentioning

confidence: 99%

Bioabsorbable self-retaining PLA/nano-sized β-TCP cervical spine interbody fusion cage in goat models: an in vivo study

Cao¹,

Chen²,

Jiang³

et al. 2017

IJN

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“…11,49,133,241 These polymers have been FDA-approved and utilized in a wide variety of clinical applications such as sutures, systemic drug delivery, spinal fusion cages, coronary stents, fixation screws, and nerve conduits. 233,[242][243][244][245] PLA is the cyclic dimer of lactic acid, which exists as two isomers: D-and L-Poly(lactic aid) (PLLA) is $37% crystalline with a melting temperature of 60-65 C, and a degradation time of up to several years. 246,247 Both PGA and PLA scaffolds has been investigated as a slowdelivery carrier for growth factors in several in vitro and in vivo studies, and demonstrated the ability to promote healing and osseointegration compared with control scaffolds.…”

Section: Mechanisms Of Polymer Biodegradationmentioning

confidence: 99%

Bone tissue engineering: A review in bone biomimetics and drug delivery strategies

Porter

Ruckh

Popat

2009

Biotechnology Progress

671

499

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Critical‐sized defects in bone, whether induced by primary tumor resection, trauma, or selective surgery have in many cases presented insurmountable challenges to the current gold standard treatment for bone repair. The primary purpose of a tissue‐engineered scaffold is to use engineering principles to incite and promote the natural healing process of bone which does not occur in critical‐sized defects. A synthetic bone scaffold must be biocompatible, biodegradable to allow native tissue integration, and mimic the multidimensional hierarchical structure of native bone. In addition to being physically and chemically biomimetic, an ideal scaffold is capable of eluting bioactive molecules (e.g., BMPs, TGF‐βs, etc., to accelerate extracellular matrix production and tissue integration) or drugs (e.g., antibiotics, cisplatin, etc., to prevent undesired biological response such as sepsis or cancer recurrence) in a temporally and spatially controlled manner. Various biomaterials including ceramics, metals, polymers, and composites have been investigated for their potential as bone scaffold materials. However, due to their tunable physiochemical properties, biocompatibility, and controllable biodegradability, polymers have emerged as the principal material in bone tissue engineering. This article briefly reviews the physiological and anatomical characteristics of native bone, describes key technologies in mimicking the physical and chemical environment of bone using synthetic materials, and provides an overview of local drug delivery as it pertains to bone tissue engineering is included. © 2009 American Institute of Chemical Engineers Biotechnol. Prog., 2009

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“…21 For example, bone healing time varies from days to weeks to months, depending on the nature of bone defects. 22,23 Extensive efforts have been focused on reducing the initial burst release of drug carriers by controlling formulation parameters of the carriers such as molecular weight, hydrophilicity, as well as drug loading amount. 21 Recently, our laboratory has developed a biodegradable hydrogel of PEG sebacic acid diacrylate (PEGSDA), based on PEG and sebacic acid macromer terminated with acrylate groups.…”

Section: Introductionmentioning

confidence: 99%

Potential of Hydrogels Based on Poly(Ethylene Glycol) and Sebacic Acid as Orthopedic Tissue Engineering Scaffolds

Kim

Hefferan

Yaszemski

et al. 2009

Tissue Engineering Part A

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In this study, the bioactive effects of poly(ethylene glycol) (PEG) sebacic acid diacrylate (PEGSDA) hydrogels with or without RGD peptide modification on osteogenic differentiation and mineralization of marrow stromal cells (MSCs) were examined. In a separate experiment, the ability of PEGSDA hydrogel to serve as a delivery vehicle for bone morphogenetic protein 2 (BMP-2) was also investigated. As a scaffold, the attachment and proliferation of MSCs on PEGSDA hydrogel scaffolds with and without RGD peptide modification was similar to the control, tissue culture polystyrene. In contrast, cells were barely seen on unmodified PEG diacrylate (PEGDA) hydrogel throughout the culture period for up to 21 days. Osteogenic phenotypic expression such as alkaline phosphatase (ALP) of MSCs as well as mineralized calcium content were significantly higher on PEGSDA-based hydrogels than those on the control or PEGDA hydrogels. Potential use of PEGSDA scaffold as a delivery vehicle of osteogenic molecules such as BMP-2 was also evaluated. Initial burst release of BMP-2 from PEGSDA hydrogel scaffold (14.7%) was significantly reduced compared to PEGDA hydrogel scaffold (84.2%) during the first 3 days of a 21-day release period. ALP activity of an osteoblast was significantly higher in the presence of BMP-2 released from PEGSDA hydrogel scaffolds compared to that in the presence of BMP-2 released from PEGDA scaffolds, especially after 6 days of release. Overall, PEGSDA hydrogel scaffolds without further modification may be useful as orthopedic tissue engineering scaffolds as well as local drug carriers for prolonged sustained release of osteoinductive molecules.

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Bioresorbable polymers: heading for a new generation of spinal cages

Cited by 102 publications

References 110 publications

Bioabsorbable self-retaining PLA/nano-sized β-TCP cervical spine interbody fusion cage in goat models: an in vivo study

Bioabsorbable self-retaining PLA/nano-sized β-TCP cervical spine interbody fusion cage in goat models: an in vivo study

Bone tissue engineering: A review in bone biomimetics and drug delivery strategies

Potential of Hydrogels Based on Poly(Ethylene Glycol) and Sebacic Acid as Orthopedic Tissue Engineering Scaffolds

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Bioresorbable polymers: heading for a new generation of spinal cages

Cited by 102 publications

References 110 publications

Bioabsorbable self-retaining PLA/nano-sized &beta;-TCP cervical spine interbody fusion cage in goat models: an in vivo study

Bioabsorbable self-retaining PLA/nano-sized &beta;-TCP cervical spine interbody fusion cage in goat models: an in vivo study

Bone tissue engineering: A review in bone biomimetics and drug delivery strategies

Potential of Hydrogels Based on Poly(Ethylene Glycol) and Sebacic Acid as Orthopedic Tissue Engineering Scaffolds

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Bioabsorbable self-retaining PLA/nano-sized β-TCP cervical spine interbody fusion cage in goat models: an in vivo study

Bioabsorbable self-retaining PLA/nano-sized β-TCP cervical spine interbody fusion cage in goat models: an in vivo study