Advancing spinal fusion: Interbody stabilization by in situ foaming of a chemically modified polycaprolactone

Innovative Developments in Lumbar Interbody Cage Materials and Design: A Comprehensive Narrative Review

This review comprehensively examines the evolution and current state of interbody cage technology for lumbar interbody fusion (LIF). This review highlights the biomechanical and clinical implications of the transition from traditional static cage designs to advanced expandable variants for spinal surgery. The review begins by exploring the early developments in cage materials, highlighting the roles of titanium and polyetheretherketone in the advancement of LIF techniques. This review also discusses the strengths and limitations of these materials, leading to innovations in surface modifications and the introduction of novel materials, such as tantalum, as alternative materials. Advancements in three-dimensional printing and surface modification technologies form a significant part of this review, emphasizing the role of these technologies in enhancing the biomechanical compatibility and osseointegration of interbody cages. In addition, this review explores the increase in biodegradable and composite materials such as polylactic acid and polycaprolactone, addressing their potential to mitigate long-term implant-related complications. A critical evaluation of static and expandable cages is presented, including their respective clinical and radiological outcomes. While static cages have been a mainstay of LIF, expandable cages are noted for their adaptability to the patient's anatomy, reducing complications such as cage subsidence. However, this review highlights the ongoing debate and the lack of conclusive evidence regarding the superiority of either cage type in terms of clinical outcomes. Finally, this review proposes future directions for cage technology, focusing on the integration of bioactive substances and multifunctional coatings and the development of patient-specific implants. These advancements aim to further enhance the efficacy, safety, and personalized approach of spinal fusion surgeries. Moreover, this review offers a nuanced understanding of the evolving landscape of cage technology in LIF and provides insights into current practices and future possibilities in spinal surgery.

Forefront Research of Foaming Strategies on Biodegradable Polymers and Their Composites by Thermal or Melt-Based Processing Technologies: Advances and Perspectives

The last few decades have witnessed significant advances in the development of polymeric-based foam materials. These materials find several practical applications in our daily lives due to their characteristic properties such as low density, thermal insulation, and porosity, which are important in packaging, in building construction, and in biomedical applications, respectively. The first foams with practical applications used polymeric materials of petrochemical origin. However, due to growing environmental concerns, considerable efforts have been made to replace some of these materials with biodegradable polymers. Foam processing has evolved greatly in recent years due to improvements in existing techniques, such as the use of supercritical fluids in extrusion foaming and foam injection moulding, as well as the advent or adaptation of existing techniques to produce foams, as in the case of the combination between additive manufacturing and foam technology. The use of supercritical CO2 is especially advantageous in the production of porous structures for biomedical applications, as CO2 is chemically inert and non-toxic; in addition, it allows for an easy tailoring of the pore structure through processing conditions. Biodegradable polymeric materials, despite their enormous advantages over petroleum-based materials, present some difficulties regarding their potential use in foaming, such as poor melt strength, slow crystallization rate, poor processability, low service temperature, low toughness, and high brittleness, which limits their field of application. Several strategies were developed to improve the melt strength, including the change in monomer composition and the use of chemical modifiers and chain extenders to extend the chain length or create a branched molecular structure, to increase the molecular weight and the viscosity of the polymer. The use of additives or fillers is also commonly used, as fillers can improve crystallization kinetics by acting as crystal-nucleating agents. Alternatively, biodegradable polymers can be blended with other biodegradable polymers to combine certain properties and to counteract certain limitations. This work therefore aims to provide the latest advances regarding the foaming of biodegradable polymers. It covers the main foaming techniques and their advances and reviews the uses of biodegradable polymers in foaming, focusing on the chemical changes of polymers that improve their foaming ability. Finally, the challenges as well as the main opportunities presented reinforce the market potential of the biodegradable polymer foam materials.

Adhesive Tissue Engineered Scaffolds: Mechanisms and Applications

A variety of suture and bioglue techniques are conventionally used to secure engineered scaffold systems onto the target tissues. These techniques, however, confront several obstacles including secondary damages, cytotoxicity, insufficient adhesion strength, improper degradation rate, and possible allergic reactions. Adhesive tissue engineering scaffolds (ATESs) can circumvent these limitations by introducing their intrinsic tissue adhesion ability. This article highlights the significance of ATESs, reviews their key characteristics and requirements, and explores various mechanisms of action to secure the scaffold onto the tissue. We discuss the current applications of advanced ATES products in various fields of tissue engineering, together with some of the key challenges for each specific field. Strategies for qualitative and quantitative assessment of adhesive properties of scaffolds are presented. Furthermore, we highlight the future prospective in the development of advanced ATES systems for regenerative medicine therapies.

The Surface Characterisation of Polyetheretherketone (PEEK) Modified via the Direct Sputter Deposition of Calcium Phosphate Thin Films

Polyetheretherketone (PEEK) has emerged as the material of choice for spinal fusion devices, replacing conventional materials such as titanium and its alloys due to its ability to easily overcome a lot of the limitations of traditional metallic biomaterials. However, one of the major drawbacks of this material is that it is not osteoinductive, nor osteoconductive, preventing direct bone apposition. One way to overcome this is through the modification of the PEEK with bioactive calcium phosphate (CaP) materials, such as hydroxyapatite (HA–Ca10(PO4)6(OH)2). RF magnetron sputtering has been shown to be a particularly useful technique for the deposition of CaP coatings due to the ability of the technique to provide greater control of the coating’s properties. The work undertaken here involved the deposition of HA directly onto PEEK via RF magnetron at a range of deposition times between 10–600 min to provide more bioactive surfaces. The surfaces produced have been extensively characterised using X-Ray Photoelectron Spectroscopy (XPS), Scanning Electron Microscopy (SEM), stylus profilometry, and Time of Flight Secondary Ion Mass Spectrometry (ToFSIMS). XPS results indicated that both Ca and P had successfully deposited onto the surface, albeit with low Ca/P ratios of around 0.85. ToFSIMS analysis indicated that Ca and P had been homogeneously deposited across all the surfaces. The SEM results showed that the CaP surfaces produced were a porous micro-/nano-structured lattice network and that the deposition rate influenced the pore area, pore diameter and number of pores. Depth profiling, using ToFSIMS, highlighted that Ca and P were embedded into the PEEK matrix up to a depth of around 1.21 µm and that the interface between the CaP surface and PEEK substrate was an intermixed layer. In summary, the results highlighted that RF magnetron sputtering can deliver homogenous CaP lattice-like surfaces onto PEEK in a direct, one-step process, without the need for any interlayers, and provides a basis for enhancing the potential bioactivity of PEEK.