Novel Titanium Cages for Minimally Invasive Lateral Lumbar Interbody Fusion: First Assessment of Subsidence

Krafft, Paul R.; Osburn, Brooks; Vivas, Andrew C.; Rao, Gautam; Alikhani, Puya

doi:10.22603/ssrr.2019-0089

Cited by 36 publications

(25 citation statements)

References 21 publications

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“…Importantly, a study by Lim et al showed that subsidence likelihood for a non-porous intervertebral fusion cage was 2.33 times higher in flexion motion than for a porous cage, 1.16 times higher in extension motion, 1.9 times higher in axial rotation motion and 1.81 times higher in lateral bending motion [ 27 ]. Moreover, Krafft et al demonstrated that porous structure led to maximized bone-implant contact area and minimized stress-shielding effect [ 28 ]. Results obtained by Chatham et al proved also that a larger implant-to-bone contact interface provided more even stress distribution, which lowered the risk of subsidence [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

Mesh Ti6Al4V Material Manufactured by Selective Laser Melting (SLM) as a Promising Intervertebral Fusion Cage

Przekora

Kazimierczak

Wójcik

et al. 2022

IJMS

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Intervertebral cages made of Ti6Al4V alloy show excellent osteoconductivity, but also higher stiffness, compared to commonly used polyether-ether-ketone (PEEK) materials, that may lead to a stress-shielding effect and implant subsidence. In this study, a metallic intervertebral fusion cage, with improved mechanical behavior, was manufactured by the introduction of a three-dimensional (3D) mesh structure to Ti6Al4V material, using an additive manufacturing method. Then, the mechanical and biological properties of the following were compared: (1) PEEK, with a solid structure, (2) 3D-printed Ti6Al4V, with a solid structure, and (3) 3D-printed Ti6Al4V, with a mesh structure. A load-induced subsidence test demonstrated that the 3D-printed mesh Ti6Al4V cage had significantly lower tendency (by 15%) to subside compared to the PEEK implant. Biological assessment of the samples proved that all tested materials were biocompatible. However, both titanium samples (solid and mesh) were characterized by significantly higher bioactivity, osteoconductivity, and mineralization ability, compared to PEEK. Moreover, osteoblasts revealed stronger adhesion to the surface of the Ti6Al4V samples compared to PEEK material. Thus, it was clearly shown that the 3D-printed mesh Ti6Al4V cage possesses all the features for optimal spinal implant, since it carries low risk of implant subsidence and provides good osseointegration at the bone-implant interface.

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Section: Resultsmentioning

confidence: 99%

Mesh Ti6Al4V Material Manufactured by Selective Laser Melting (SLM) as a Promising Intervertebral Fusion Cage

Przekora

Kazimierczak

Wójcik

et al. 2022

IJMS

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“…Arts et al found that the fusion rate of porous Ti was similar to that of autologous bone–filled PEEK at 12 months during a prospective study of single-segment anterior cervical discectomy and fusion (ACDF) patients using 3D-printed porous Ti neck implants ( Arts et al, 2020 ). Through a clinical comparison, Krafft et al found that the sinking rate of 3D-printed porous Ti interbody fusion cages was significantly lower than that of PEEK interbody fusion cages ( Krafft et al, 2020 ). 3D-printed lamellar Ti cages filled with SiCaP bone grafts can also achieve promising fusion rates in adult degenerative diseases by providing more consistent bone growth and biological fixation ( McGilvray et al, 2018 ; Mokawem et al, 2019 ).…”

Section: Interbody Fusion Cage Materialsmentioning

confidence: 99%

Biomaterials for Interbody Fusion in Bone Tissue Engineering

Zhang

Wang

et al. 2022

Front. Bioeng. Biotechnol.

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In recent years, interbody fusion cages have played an important role in interbody fusion surgery for treating diseases like disc protrusion and spondylolisthesis. However, traditional cages cannot achieve satisfactory results due to their unreasonable design, poor material biocompatibility, and induced osteogenesis ability, limiting their application. There are currently 3 ways to improve the fusion effect, as follows. First, the interbody fusion cage is designed to facilitate bone ingrowth through the preliminary design. Second, choose interbody fusion cages made of different materials to meet the variable needs of interbody fusion. Finally, complete post-processing steps, such as coating the designed cage, to achieve a suitable osseointegration microstructure, and add other bioactive materials to achieve the most suitable biological microenvironment of bone tissue and improve the fusion effect. The focus of this review is on the design methods of interbody fusion cages, a comparison of the advantages and disadvantages of various materials, the influence of post-processing techniques and additional materials on interbody fusion, and the prospects for the future development of interbody fusion cages.

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“…Metal 3D printing has facilitated the fabrication of porous cellular scaffolds for orthopedic implants, which have been shown to have the potential to reduce stress shielding and thus reduce bone loss 12–14 . Porous metal implants have also been shown to exhibit excellent osseointegration, 15–17 demonstrated in vivo by porous 3D‐printed titanium interbody fusion cages in animal models 18 and initial patient trials 19,20 . The feasibility of using MRI to monitor bone apposition and implant fixation into the porous coating of a 3D‐printed acetabular shell was also recently demonstrated 21 …”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14] Porous metal implants have also been shown to exhibit excellent osseointegration, [15][16][17] demonstrated in vivo by porous 3D-printed titanium interbody fusion cages in animal models 18 and initial patient trials. 19,20 The feasibility of using MRI to monitor bone apposition and implant fixation into the porous coating of a 3D-printed acetabular shell was also recently demonstrated. 21 An important feature of 3D-printed porous metal structures is their lower density-and hence lower magnetic susceptibility-compared to that of solid metal implants.…”

Section: Introductionmentioning

confidence: 99%

Effective magnetic susceptibility of 3D‐printed porous metal scaffolds

Hong

Liu

Cobos

et al. 2022

Magnetic Resonance in Med

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Purpose: 3D-printed porous metal scaffolds are a promising emerging technology in orthopedic implant design. Compared to solid metal implants, porous metal implants have lower magnetic susceptibility values, which have a direct impact on imaging time and image quality. The purpose of this study is to determine the relationship between porosity and effective susceptibility through quantitative estimates informed by comparing coregistered scanned and simulated field maps.Methods: Five porous scaffold cylinders were designed and 3D-printed in titanium alloy (Ti-6Al-4V) with nominal porosities ranging from 60% to 90% using a cellular sheet-based gyroid design. The effective susceptibility of each cylinder was estimated by comparing acquired B 0 field maps against simulations of a solid cylinder of varying assigned magnetic susceptibility, where the orientation and volume of interest of the simulations was informed by a custom alignment phantom.Results: Magnitude images and field maps showed obvious decreases in artifact size and field inhomogeneity with increasing porosity. The effective susceptibility was found to be linearly correlated with porosity (R 2 = 0.9993). The extrapolated 100% porous (no metal) magnetic susceptibility was −9.9 ppm, closely matching the expected value of pure water (−9 ppm), indicating a reliable estimation of susceptibility. Conclusion:Effective susceptibility of porous metal scaffolds is linearly correlated with porosity. Highly porous implants have sufficiently low effective susceptibilities to be more amenable to routine imaging with MRI.

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Novel Titanium Cages for Minimally Invasive Lateral Lumbar Interbody Fusion: First Assessment of Subsidence

Abstract: Author contributions: PRK, BO, GR collected and analyzed patient data including radiographic studies. ACV and PA designed the study and supervised data collection and analysis. All authors contributed in the preparation of the manuscript.

Cited by 36 publications

References 21 publications

Mesh Ti6Al4V Material Manufactured by Selective Laser Melting (SLM) as a Promising Intervertebral Fusion Cage

Mesh Ti6Al4V Material Manufactured by Selective Laser Melting (SLM) as a Promising Intervertebral Fusion Cage

Biomaterials for Interbody Fusion in Bone Tissue Engineering

Effective magnetic susceptibility of 3D‐printed porous metal scaffolds

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