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Jowdy PK, Soliman MAR, Quiceno E, Azmy S, Popoola DO, Aguirre AO, Khan A, Slosar PJ, Pollina J, Mullin JP. Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusions Using a Titanium Cage with a Biomimetic Surface. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38395054 DOI: 10.1055/a-2275-0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND We analyzed clinical and radiographic outcomes in patients undergoing anterior lumbar interbody fusions (ALIFs) using a new biomimetic titanium fusion cage (Titan nanoLOCK interbody, Medtronic, Minneapolis, Minnesota, United States). This specialized cage employs precise nanotechnology to stimulate inherent biochemical and cellular osteogenic reactions to the implant, aiming to amplify the rate of fusion. To our knowledge, this is the only study to assess early clinical and radiographic results in ALIFs. METHODS We conducted a retrospective review of data for patients who underwent single or multilevel ALIF using this implant between October 2016 and April 2021. Indications for treatment were spondylolisthesis, postlaminectomy syndrome, or spinal deformity. Clinical and radiographic outcome data for these patients were collected and assessed. RESULTS A total of 84 patients were included. The mean clinical follow-up was 36.6 ± 14 months. At 6 months, solid fusion was seen in 97.6% of patients. At 12 months, solid fusion was seen in 98.8% of patients. Significant improvements were seen in patient-reported outcome measures (PROMs; visual analog scale and Oswestry Disability Index) at 6 and 12 months compared with the preoperative scores (p < 0.001). One patient required reoperation for broken pedicle screws 2 days after the ALIF. None of the patients required readmission within 90 days of surgery. No patients experienced an infection. CONCLUSIONS ALIF using a new titanium interbody fusion implant with a biomimetic surface technology demonstrated high fusion rates (97.6%) as early as 6 months. There was significant improvement in PROMs at 6 and 12 months.
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Affiliation(s)
- Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Shady Azmy
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Daniel O Popoola
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Paul J Slosar
- Peninsula Orthopedic Associates, Daly City, California, United States
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
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Berger MB, Cohen DJ, Bosh KB, Kapitanov M, Slosar PJ, Levit MM, Gallagher M, Rawlinson JJ, Schwartz Z, Boyan BD. Bone marrow stromal cells generate an osteoinductive microenvironment when cultured on titanium-aluminum-vanadium substrates with biomimetic multiscale surface roughness. Biomed Mater 2023; 18. [PMID: 36827708 PMCID: PMC9993812 DOI: 10.1088/1748-605x/acbf15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/24/2023] [Indexed: 02/26/2023]
Abstract
Osseointegration of titanium-based implants possessing complex macroscale/microscale/mesoscale/nanoscale (multiscale) topographies support a direct and functional connection with native bone tissue by promoting recruitment, attachment and osteoblastic differentiation of bone marrow stromal cells (MSCs). Recent studies show that the MSCs on these surfaces produce factors, including bone morphogenetic protein 2 (BMP2) that can cause MSCs not on the surface to undergo osteoblast differentiation, suggesting they may produce an osteogenic environmentin vivo. This study examined if soluble factors produced by MSCs in contact with titanium-aluminum-vanadium (Ti6Al4V) implants possessing a complex multiscale biomimetic topography are able to induce osteogenesis ectopically. Ti6Al4V disks were grit-blasted and acid-etched to create surfaces possessing macroscale and microscale roughness (MM), micro/meso/nanoscale topography (MN), and macro/micro/meso/nanoscale topography (MMNTM). Polyether-ether-ketone (PEEK) disks were also fabricated by machining to medical-grade specifications. Surface properties were assessed by scanning electron microscopy, contact angle, optical profilometry, and x-ray photoelectron spectroscopy. MSCs were cultured in growth media (GM). Proteins and local factors in their conditioned media (CM) were measured on days 4, 8, 10 and 14: osteocalcin, osteopontin, osteoprotegerin, BMP2, BMP4, and cytokines interleukins 6, 4 and 10 (IL6, IL4, and IL10). CM was collected from D14 MSCs on MMNTMand tissue culture polystyrene (TCPS) and lyophilized. Gel capsules containing active demineralized bone matrix (DBM), heat-inactivated DBM (iDBM), and iDBM + MMN-GM were implanted bilaterally in the gastrocnemius of athymic nude mice (N= 8 capsules/group). Controls included iDBM + GM; iDBM + TCPS-CM from D5 to D10 MSCs; iDBM + MMN-CM from D5 to D10; and iDBM + rhBMP2 (R&D Systems) at a concentration similar to D5-D10 production of MSCs on MMNTMsurfaces. Legs were harvested at 35D. Bone formation was assessed by micro computed tomography and histomorphometry (hematoxylin and eosin staining) with the histology scored according to ASTM 2529-13. DNA was greatest on PEEK at all time points; DNA was lowest on MN at early time points, but increased with time. Cells on PEEK exhibited small changes in differentiation with reduced production of BMP2. Osteoblast differentiation was greatest on the MN and MMNTM, reflecting increased production of BMP2 and BMP4. Pro-regenerative cytokines IL4 and IL10 were increased on Ti-based surfaces; IL6 was reduced compared to PEEK. None of the media from TCPS cultures was osteoinductive. However, MMN-CM exhibited increased bone formation compared to iDBM and iDBM + rhBMP2. Furthermore, exogenous rhBMP2 alone, at the concentration found in MMN-CM collected from D5 to D10 cultures, failed to induce new bone, indicating that other factors in the CM play a critical role in that osteoinductive microenvironment. MSCs cultured on MMNTMTi6Al4V surfaces differentiate and produce an increase in local factors, including BMP2, and the CM from these cultures can induce ectopic bone formation compared to control groups, indicating that the increased bone formation arises from the local response by MSCs to a biomimetic, multiscale surface topography.
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Affiliation(s)
- Michael B Berger
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 W. Main Street, Richmond, VA 23284, United States of America
| | - D Joshua Cohen
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 W. Main Street, Richmond, VA 23284, United States of America
| | - Kyla B Bosh
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 W. Main Street, Richmond, VA 23284, United States of America
| | - Marina Kapitanov
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 W. Main Street, Richmond, VA 23284, United States of America
| | - Paul J Slosar
- SpineCare Medical Group, 455 Hickey Blvd., Suite 310, Daly City, CA 94015, United States of America
| | - Michael M Levit
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 W. Main Street, Richmond, VA 23284, United States of America
| | - Michelle Gallagher
- Medtronic, Applied Research-Spine, Minneapolis, MN, United States of America
| | - Jeremy J Rawlinson
- Medtronic, Applied Research-Spine, Minneapolis, MN, United States of America
| | - Zvi Schwartz
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 W. Main Street, Richmond, VA 23284, United States of America.,Department of Periodontology, University of Texas Health Science Center at San Antonio, 7703, Floyd Curl Drive, San Antonio, TX 78229, United States of America
| | - Barbara D Boyan
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 W. Main Street, Richmond, VA 23284, United States of America.,Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, GA 30332, United States of America
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Stich T, Alagboso F, Křenek T, Kovářík T, Alt V, Docheva D. Implant-bone-interface: Reviewing the impact of titanium surface modifications on osteogenic processes in vitro and in vivo. Bioeng Transl Med 2022; 7:e10239. [PMID: 35079626 PMCID: PMC8780039 DOI: 10.1002/btm2.10239] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022] Open
Abstract
Titanium is commonly and successfully used in dental and orthopedic implants. However, patients still have to face the risk of implant failure due to various reasons, such as implant loosening or infection. The risk of implant loosening can be countered by optimizing the osteointegration capacity of implant materials. Implant surface modifications for structuring, roughening and biological activation in favor for osteogenic differentiation have been vastly studied. A key factor for a successful stable long-term integration is the initial cellular response to the implant material. Hence, cell-material interactions, which are dependent on the surface parameters, need to be considered in the implant design. Therefore, this review starts with an introduction to the basics of cell-material interactions as well as common surface modification techniques. Afterwards, recent research on the impact of osteogenic processes in vitro and vivo provoked by various surface modifications is reviewed and discussed, in order to give an update on currently applied and developing implant modification techniques for enhancing osteointegration.
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Affiliation(s)
- Theresia Stich
- Experimental Trauma Surgery, Department of Trauma SurgeryUniversity Regensburg Medical CentreRegensburgGermany
| | - Francisca Alagboso
- Experimental Trauma Surgery, Department of Trauma SurgeryUniversity Regensburg Medical CentreRegensburgGermany
| | - Tomáš Křenek
- New Technologies Research CentreUniversity of West BohemiaPilsenCzech Republic
| | - Tomáš Kovářík
- New Technologies Research CentreUniversity of West BohemiaPilsenCzech Republic
| | - Volker Alt
- Experimental Trauma Surgery, Department of Trauma SurgeryUniversity Regensburg Medical CentreRegensburgGermany
- Clinic and Polyclinic for Trauma Surgery, University Regensburg Medical CentreRegensburgGermany
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma SurgeryUniversity Regensburg Medical CentreRegensburgGermany
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Banik BL, Riley TR, Platt CJ, Brown JL. Human Mesenchymal Stem Cell Morphology and Migration on Microtextured Titanium. Front Bioeng Biotechnol 2016; 4:41. [PMID: 27243001 PMCID: PMC4862254 DOI: 10.3389/fbioe.2016.00041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/25/2016] [Indexed: 12/23/2022] Open
Abstract
The implant used in spinal fusion procedures is an essential component to achieving successful arthrodesis. At the cellular level, the implant impacts healing and fusion through a series of steps: first, mesenchymal stem cells (MSCs) need to adhere and proliferate to cover the implant; second, the MSCs must differentiate into osteoblasts; third, the osteoid matrix produced by the osteoblasts needs to generate new bone tissue, thoroughly integrating the implant with the vertebrate above and below. Previous research has demonstrated that microtextured titanium is advantageous over smooth titanium and PEEK implants for both promoting osteogenic differentiation and integrating with host bone tissue; however, no investigation to date has examined the early morphology and migration of MSCs on these surfaces. This study details cell spreading and morphology changes over 24 h, rate and directionality of migration 6–18 h post-seeding, differentiation markers at 10 days, and the long-term morphology of MSCs at 7 days, on microtextured, acid-etched titanium (endoskeleton), smooth titanium, and smooth PEEK surfaces. The results demonstrate that in all metrics, the two titanium surfaces outperformed the PEEK surface. Furthermore, the rough acid-etched titanium surface presented the most favorable overall results, demonstrating the random migration needed to efficiently cover a surface in addition to morphologies consistent with osteoblasts and preosteoblasts.
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Affiliation(s)
- Brittany L Banik
- Musculoskeletal Regenerative Engineering Laboratory, Department of Biomedical Engineering, The Pennsylvania State University , University Park, PA , USA
| | - Thomas R Riley
- Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Christina J Platt
- Department of Electrical Engineering, The Pennsylvania State University , University Park, PA , USA
| | - Justin L Brown
- Musculoskeletal Regenerative Engineering Laboratory, Department of Biomedical Engineering, The Pennsylvania State University , University Park, PA , USA
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