Polyetheretherketone as a biomaterial for spinal applications

Toth, Jeffrey M.; Wang, Mei; Estes, Bradley T.; Scifert, Jeffrey L.; Seim, Howard B.; Turner, A. Simon

doi:10.1016/j.biomaterials.2005.07.011

Cited by 494 publications

(357 citation statements)

References 35 publications

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“…However, this model can be challenging and studies have produced inconsistent success rates using autograft bone. Ovine single-level interbody fusions utilizing different radiolucent polymers with autograft augmentation, including 70/30 poly (L-lactide-co-D,L-lactide) and PEEK rings, have produced fusion rates of 50 and 71%, respectively [27,28]. Other lumbar interbody fusion cages have also been investigated in sheep, including Bagby and Kuslich (BAK) cages (SpineTech, Minneapolis, MN) which yielded only a 20% rate of fusion at 6 months when supplemented with autograft [35].…”

Section: Discussionmentioning

confidence: 99%

“…A retroperitoneal lateral approach enabled discectomy, distraction of the vertebral bodies, preparation of the endplates, and placement of the interbody device. In order to optimize visualization and provide a more rigorous model for lumbar fusion, PEEK rings were utilized rather than titanium, and instrumentation was not used [27]. The PEEK rings were ''D'' shaped devices, 8 mm thick with a major circumference of 18 mm, 4 mm thick walls, and an internal volume of 0.4 cm 3 .…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model

et al. 2010

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A prospective, randomized study was performed in an ovine model to compare the efficacy of an anorganic bovine-derived hydroxyapatite matrix combined with a synthetic 15 amino acid residue (ABM/P-15) in facilitating lumbar interbody fusion when compared with autogenous bone harvested from the iliac crest. P-15 is a biomimetic to the cell-binding site of Type-I collagen for bone-forming cells. When combined with ABM, it creates the necessary scaffold to initiate cell invasion, binding, and subsequent osteogenesis. In this study, six adult ewes underwent anterior-lateral interbody fusion at L3/L4 and L4/L5 using PEEK interbody rings filled with autogenous bone at one level and ABM/P-15 at the other level and no additional instrumentation. Clinical CT scans were obtained at 3 and 6 months; micro-CT scans and histomorphometry analyses were performed after euthanization at 6 months. Clinical CT scan analysis showed that all autograft and ABM/P-15 treated levels had radiographically fused outside of the rings at the 3-month study time point. Although the clinical CT scans of the autograft treatment group showed significantly better fusion within the PEEK rings than ABM/P-15 at 3 months, micro-CT scans, clinical CT scans, and histomorphometric analyses showed there were no statistical differences between the two treatment groups at 6 months. Thus, ABM/P-15 was as successful as autogenous bone graft in producing lumbar spinal fusion in an ovine model, and it should be further evaluated in clinical studies.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model

et al. 2010

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“…Polyetheretherketone (PEEK) is a polymer widely used in orthopaedic and spinal applications such as soft tissue repair and spinal fusion devices as a result of its high strength, fatigue resistance, radiolucency, and favorable biocompatibility in osseous environments [25,38,45,47,50]. However, attributable in part to PEEK's relatively inert and hydrophobic surface, recent evidence has demonstrated that smooth PEEK can exhibit poor osseointegration [9,25] and fibrous capsule formation around the implant [23,34].…”

Section: Introductionmentioning

confidence: 99%

Do Surface Porosity and Pore Size Influence Mechanical Properties and Cellular Response to PEEK?

Torstrick

Evans

Stevens

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Despite its widespread use in orthopaedic implants such as soft tissue fasteners and spinal intervertebral implants, polyetheretherketone (PEEK) often suffers from poor osseointegration. Introducing porosity can overcome this limitation by encouraging bone ingrowth; however, the corresponding decrease in implant strength can potentially reduce the implant's ability to bear physiologic loads. We have previously shown, using a single pore size, that limiting porosity to the surface of PEEK implants preserves strength while supporting in vivo osseointegration. However, additional work is needed to investigate the effect of pore size on both the mechanical properties and cellular response to PEEK. Questions/purposes (1) Can surface porous PEEK (PEEK-SP) microstructure be reliably controlled? (2) What is the effect of pore size on the mechanical properties of PEEK-SP? (3) Do surface porosity and pore size influence the cellular response to PEEK? Methods PEEK-SP was created by extruding PEEK through NaCl crystals of three controlled ranges: 200 to 312, 312 to 425, and 425 to 508 lm. Micro-CT was used to characterize the microstructure of PEEK-SP. Tensile, fatigue, and interfacial shear tests were performed to compare the mechanical properties of PEEK-SP with injectionmolded PEEK (PEEK-IM). The cellular response to PEEK-SP, assessed by proliferation, alkaline phosphatase activity, vascular endothelial growth factor production, and calcium content of osteoblast, mesenchymal stem cell, and preosteoblast (MC3T3-E1) cultures, was compared with that of machined smooth PEEK and Ti6Al4V. Results Micro-CT analysis showed that PEEK-SP layers possessed pores that were 284 ± 35 lm, 341 ± 49 lm, and 416 ± 54 lm for each pore size group. Porosity and

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“…It is a high-temperature semi crystalline thermoplastic polymer from the group of polyaryletherketone (PAEK) consisting of an aromatic backbone molecular chain, interconnected by ketone and ether functional groups [5] with the density of 1.3 -1.5 g/cm 3 . Its favorable biocompatible and mechanical properties [5][6], as well as a high melting point (about 343°C), good dimensional stability at high temperatures and chemical stability to nearly all-organic and inorganic chemicals makes it an interesting material for metal-free prosthodontics. One major drawback of PEEK is the greyish and opaque color and the requirement of veneering composites to achieve acceptable esthetics.…”

Section: Introductionmentioning

confidence: 99%

Influence of plasma pretreatment on shear bond strength of self-adhesive resin cements to polyetheretherketone

et al. 2013

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OBJECTIVES: The aim of this study is to evaluate the adhesion between PEEK and two selfadhesive resin cements after plasma treatment. METHODS: Eight hundred sixty-four polyetheretherketone (PEEK) disks were cut and polished to silicon carbide (SIC) P4000. One half of the specimens were randomly selected and pretreated with plasma, whereas the remaining 432 specimens remained untreated. Subsequently, specimens were randomly allocated to four groups (n = 108/group): Visio.link (Bredent), Signum PEEK Bond (Heraeus Kulzer), Ambarino P60 (Creamed), and a control group without additional treatment. Half of the specimens of each group (n = 54) were then cemented with either RelyX Unicem Automix 2 (3 M ESPE) or with Clearfil SA (Kuraray). All specimens were stored in water for 24 h (37°C ). Afterwards, specimens were divided into three groups (n = 18) for different aging levels: (1) no aging (baseline measurement), (2) thermal aging for 5,000 cycles (5/55°C), and (3) thermal aging for 10,000 cycles (5/55°C). Thereafter, shear bond strengths (SBS) were measured, and failure types (adhesive, mixed, and cohesive) were assessed. Data were analyzed using descriptive statistics, four-and one-way ANOVA followed by a post hoc Scheffé test (p < 0.05). RESULTS: No adhesion could be established without adhesive pretreatment, irrespectively, whether plasma was applied or not. Also, no bond strength was measured when Ambarino P60 was applied. In contrast, adhesive pretreatment resulted in SBS ranging between 8 and 15 MPa. No significant differences were found between the resin cements used. In general, no cohesive failures were observed. Groups without plasma treatment combined with Visio.link or Signum PEEK Bond showed predominantly mixed failure types. Control groups, plasma treated, or treated using Ambarino P60 groups fractured predominantly adhesively. CONCLUSION: The use of methyl methacrylate (MMA)-based adhesives allows bonding between PEEK and self-adhesive resin cements. Plasma treatment has no impact on bond to resin cements. CLINICAL SIGNIFICANCE: PEEK reconstructions can be cemented using self-adhesive resin cements combined with pretreatment with MMA-based adhesives. Methods: Eight-hundred-and-sixty-four PEEK disks were cut and polished to silicon carbide (SIC) P4000. One half of the specimens was randomly selected and pre-treated with plasma, whereas the remaining 432 specimens remained untreated. Subsequently, specimens were randomly allocated to four groups (n=108/group): Visio.link (Bredent), Signum PEEK Bond (Heraeus Kulzer), Ambarino P60 (Creamed) and a control group without additional treatment. Half of the specimens of each group (n=54) were then cemented with either RelyX Unicem Automix 2 (3M ESPE) or with Clearfil SA (Kuraray).All specimens were storage in water for 24 h (37°C). Afterwards, specimens were divided into three groups (n=18) for different aging levels: i. no aging (baseline measurement), ii.thermal aging for 5000 cycles (5/55°C) and iii. thermal aging for 10000 cycles (5/55°C).Thereafte...

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Polyetheretherketone as a biomaterial for spinal applications

Cited by 494 publications

References 35 publications

Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model

Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model

Do Surface Porosity and Pore Size Influence Mechanical Properties and Cellular Response to PEEK?

Influence of plasma pretreatment on shear bond strength of self-adhesive resin cements to polyetheretherketone

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