1
|
Xu X, Wang L, Wang J, Yu X, Huang W. Retrieval analysis of PEEK rods pedicle screw system: three cases analysis. BMC Musculoskelet Disord 2024; 25:488. [PMID: 38909212 PMCID: PMC11193296 DOI: 10.1186/s12891-024-07600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/13/2024] [Indexed: 06/24/2024] Open
Abstract
PURPOSE To analyze the characteristics of PEEK rods retrieved in vivo, specifically their wear and deformation, biodegradability, histocompatibility, and mechanical properties. METHOD Six PEEK rods were retrieved from revision surgeries along with periprosthetic tissue. The retrieved PEEK rods were evaluated for surface damage and internal changes using Micro-CT, while light and electron microscopy were utilized to determine any histological changes in periprosthetic tissues. Patient history was gathered from medical records. Two intact and retrieved PEEK rods were used for fatigue testing analysis by sinusoidal load to the spinal construct. RESULTS All implants showed evidence of plastic deformation around the screw-rod interface, while the inner structure of PEEK rods appeared unchanged with no visible voids or cracks. Examining images captured through light and electron microscopy indicated that phagocytosis of macrophages around PEEK rods was less severe in comparison to the screw-rod interface. The results of an energy spectrum analysis suggested that the distribution of tissue elements around PEEK rods did not differ significantly from normal tissue. During fatigue testing, it was found that the retrieved PEEK rods cracked after 1.36 million tests, whereas the intact PEEK rods completed 5 million fatigue tests without any failure. CONCLUSION PEEK rods demonstrate satisfactory biocompatibility, corrosion resistance, chemical stability, and mechanical properties. Nevertheless, it is observed that the indentation at the junction between the nut and the rod exhibits relatively weak strength, making it susceptible to breakage. As a precautionary measure, it is recommended to secure the nut with a counter wrench, applying the preset torque to prevent overtightening.
Collapse
Affiliation(s)
- Xiaoduo Xu
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, China
| | - Lei Wang
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, China
| | - Jingming Wang
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, China
| | - Xiuchun Yu
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, China.
| | - Weimin Huang
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, China.
| |
Collapse
|
2
|
Vanaclocha-Saiz A, Vanaclocha V, Atienza C, Jorda-Gomez P, Primo-Capella V, Barrios C, Vanaclocha L. Bionate Biocompatibility: In Vivo Study in Rabbits. ACS OMEGA 2022; 7:29647-29654. [PMID: 36061708 PMCID: PMC9435029 DOI: 10.1021/acsomega.2c01690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Response to foreign materials includes local tissue reaction, osteolysis, implant loosening, and migration to lymph nodes and organs. Bionate 80A human explants show minor wear and slight local tissue reaction, but we do not know the response at the spinal cord, nerve roots, lymph nodes, or distant organs. This study aims to figure out reactions against Bionate 80A when implanted at the spinal epidural space of 24 20-week-old New Zealand white rabbits. In one group of 12 rabbits, we implanted Bionate 80A on the spinal epidural space, and another group of 12 rabbits was used as the control group. We studied tissues, organs, and tissue damage markers on blood biochemistry, urine tests, and necropsy. The animals' clinical parameters and weight showed no statistically significant differences. At 3 months, the basophils increased slightly in the implant group, platelets decreased in all, and at 6 months, implanted animals showed slight eosinophilia, but none of these changes was statistically significant. External, organ, and spinal tissue examination showed neither toxic reaction, inflammatory changes, or noticeable differences between groups or survival periods. Under microscopic examination, the Bionate 80A particles induced a chronic granulomatous response always outside the dura mater, with giant multinucleated cells holding phagocytized particles and no particle migration to lymph nodes or organs. Thus, it was concluded that Bionate particles, when implanted in the rabbit lumbar epidural space, do not generate a significant reaction limited to the surrounding soft tissues with giant multinucleated cells. In addition, the particles did not cross the dura mater or migrate to lymph nodes or organs.
Collapse
Affiliation(s)
- Amparo Vanaclocha-Saiz
- Instituto de Biomecánica (IBV), Universitat Politècnica de Valencia, Valencia 46022, Spain
| | | | - Carlos Atienza
- Instituto de Biomecánica (IBV), Universitat Politècnica de Valencia, Valencia 46022, Spain
| | - Pablo Jorda-Gomez
- Hospital General Universitario de Castellón, Castellón de la Plana 12004, Spain
| | - Víctor Primo-Capella
- Instituto de Biomecánica (IBV), Universitat Politècnica de Valencia, Valencia 46022, Spain
| | - Carlos Barrios
- Catholic University of Valencia, Saint Vincent Martyr, Valencia 46001, Spain
| | - Leyre Vanaclocha
- Medius Klinik, Ostfildern-Ruit Klinik für Urologie, Hedelfinger Strasse 166, 73760 Ostfildern, Germany
| |
Collapse
|
3
|
Dorrepaal RM, Lawless BM, Burton HE, Espino DM, Shepherd DE, Gowen AA. Hyperspectral chemical imaging reveals spatially varied degradation of polycarbonate urethane (PCU) biomaterials. Acta Biomater 2018; 73:81-89. [PMID: 29626697 DOI: 10.1016/j.actbio.2018.03.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/12/2018] [Accepted: 03/28/2018] [Indexed: 11/26/2022]
Abstract
Hyperspectral chemical imaging (HCI) is an emerging technique which combines spectroscopy with imaging. Unlike traditional point spectroscopy, which is used in the majority of polymer biomaterial degradation studies, HCI enables the acquisition of spatially localised spectra across the surface of a material in an objective manner. Here, we demonstrate that attenuated total reflectance Fourier transform infra-red (ATR-FTIR) HCI reveals spatial variation in the degradation of implantable polycarbonate urethane (PCU) biomaterials. It is also shown that HCI can detect possible defects in biomaterial formulation or specimen production; these spatially resolved images reveal regional or scattered spatial heterogeneity. Further, we demonstrate a map sampling method, which can be used in time-sensitive scenarios, allowing for the investigation of degradation across a larger component or component area. Unlike imaging, mapping does not produce a contiguous image, yet grants an insight into the spatial heterogeneity of the biomaterial across a larger area. These novel applications of HCI demonstrate its ability to assist in the detection of defective manufacturing components and lead to a deeper understanding of how a biomaterial's chemical structure changes due to implantation. STATEMENT OF SIGNIFICANCE The human body is an aggressive environment for implantable devices and their biomaterial components. Polycarbonate urethane (PCU) biomaterials in particular were investigated in this study. Traditionally one or a few points on the PCU surface are analysed using ATR-FTIR spectroscopy. However the selection of acquisition points is susceptible to operator bias and critical information can be lost. This study utilises hyperspectral chemical imaging (HCI) to demonstrate that the degradation of a biomaterial varies spatially. Further, HCI revealed spatial variations of biomaterials that were not subjected to oxidative degradation leading to the possibility of HCI being used in the assessment of biomaterial formulation and/or component production.
Collapse
|
4
|
Lawless BM, Espino DM, Shepherd DET. In vitro oxidative degradation of a spinal posterior dynamic stabilization device. J Biomed Mater Res B Appl Biomater 2017; 106:1237-1244. [PMID: 28580771 DOI: 10.1002/jbm.b.33913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/27/2017] [Accepted: 04/22/2017] [Indexed: 11/10/2022]
Abstract
This study quantified the changes of the frequency-dependant viscoelastic properties of the BDyn (S14 Implants, Pessac, France) spinal posterior dynamic stabilization (PDS) device due to in vitro oxidation. Six polycarbonate urethane (PCU) rings and six silicone cushions were degraded using a 20% hydrogen peroxide/0.1 M cobalt (II) chloride hexahydrate, at 37°C, for 24 days. The viscoelastic properties of the individual components and the components assembled into the BDyn PDS device were determined using Dynamic Mechanical Analysis at frequencies from 0.01 to 30 Hz. Attenuated Total Reflectance Fourier Transform Infra-Red spectra demonstrated chemical structure changes, of the PCU, associated with oxidation while Scanning Electron Microscope images revealed surface pitting. No chemical structure or surface morphology changes were observed for the silicone cushion. The BDyn device storage and loss stiffness ranged between 84.46 N/mm to 99.36 N/mm and 8.13 N/mm to 21.99 N/mm, respectively. The storage and loss stiffness for the components and BDyn device increased logarithmically with respect to frequency. Viscoelastic properties, between normal and degraded components, were significantly different for specific frequencies only. This study demonstrates the importance of analyzing changes of viscoelastic properties of degraded biomaterials and medical devices into which they are incorporated, using a frequency sweep. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1237-1244, 2018.
Collapse
Affiliation(s)
- Bernard M Lawless
- Department of Mechanical Engineering, School of Engineering, University of Birmingham, Birmingham, UK
| | - Daniel M Espino
- Department of Mechanical Engineering, School of Engineering, University of Birmingham, Birmingham, UK
| | - Duncan E T Shepherd
- Department of Mechanical Engineering, School of Engineering, University of Birmingham, Birmingham, UK
| |
Collapse
|
5
|
Mazurek-Budzyńska M, Razzaq MY, Tomczyk K, Rokicki G, Behl M, Lendlein A. Poly(carbonate-urea-urethane) networks exhibiting high-strain shape-memory effect. POLYM ADVAN TECHNOL 2016. [DOI: 10.1002/pat.3948] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Magdalena Mazurek-Budzyńska
- Institute of Biomaterial Science; Helmholtz-Zentrum Geesthacht; Kantstr. 55 14513 Teltow Germany
- Warsaw University of Technology; Department of Chemistry; ul. Noakowskiego 3 00-664 Warsaw Poland
| | - Muhammad Yasar Razzaq
- Institute of Biomaterial Science; Helmholtz-Zentrum Geesthacht; Kantstr. 55 14513 Teltow Germany
| | - Karolina Tomczyk
- Warsaw University of Technology; Department of Chemistry; ul. Noakowskiego 3 00-664 Warsaw Poland
| | - Gabriel Rokicki
- Warsaw University of Technology; Department of Chemistry; ul. Noakowskiego 3 00-664 Warsaw Poland
| | - Marc Behl
- Institute of Biomaterial Science; Helmholtz-Zentrum Geesthacht; Kantstr. 55 14513 Teltow Germany
| | - Andreas Lendlein
- Institute of Biomaterial Science; Helmholtz-Zentrum Geesthacht; Kantstr. 55 14513 Teltow Germany
| |
Collapse
|
6
|
Bisschop A, van Tulder MW. Market approval processes for new types of spinal devices: challenges and recommendations for improvement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2993-3003. [PMID: 27235154 DOI: 10.1007/s00586-016-4606-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spinal pathology and related symptoms are among the most common health problems and are associated with high health care costs and productivity losses. Due to the aging population, these costs are further increasing every year. Another important reason for the increasing costs is the market approval of new technologies, such as spinal devices that are usually more expensive than the existing technologies. Previous cases of medical device failure led to concern about possible deficiencies in the market approval process. OBJECTIVE The objective is to provide an overview of U.S. Food and Drug Administration (FDA) regulation regarding spinal implants to delineate the challenges and opportunities that spine surgery currently faces. METHODS In this paper, two cases of market entries of spinal devices are presented and evaluated to illustrate these deficiencies. RESULTS Spinal implant regulation is facing several challenges. New spinal devices should increase patient outcomes and safety at reasonable societal costs. The main challenge is to have a rigorous evaluation before dissemination, while still leaving room for innovative behavior that thrusts the healthcare practice forward. CONCLUSION We have provided recommendations to enhance spinal implant regulation and improve and ensure the patient's safety and the future of spine surgery.
Collapse
Affiliation(s)
- Arno Bisschop
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| |
Collapse
|
7
|
In vivo compatibility of Dynesys® spinal implants: a case series of five retrieved periprosthetic tissue samples and corresponding implants. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:1074-84. [DOI: 10.1007/s00586-014-3705-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 12/28/2022]
|
8
|
The use of polyurethane materials in the surgery of the spine: a review. Spine J 2014; 14:3038-47. [PMID: 25151132 DOI: 10.1016/j.spinee.2014.08.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/26/2014] [Accepted: 08/13/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The spine contains intervertebral discs and the interspinous and longitudinal ligaments. These structures are elastomeric or viscoelastic in their mechanical properties and serve to allow and control the movement of the bony elements of the spine. The use of metallic or hard polymeric devices to replace the intervertebral discs and the creation of fusion masses to replace discs and/or vertebral bodies changes the load transfer characteristics of the spine and the range of motion of segments of the spine. PURPOSE The purpose of the study was to survey the literature, regulatory information available on the Web, and industry-reported device development found on the Web to ascertain the usage and outcomes of the use of polyurethane polymers in the design and clinical use of devices for spine surgery. STUDY DESIGN/SETTING A systematic review of the available information from all sources concerning the subject materials' usage in spinal devices was conducted. METHODS A search of the peer-reviewed literature combining spinal surgery with polyurethane or specific types and trade names of medical polyurethanes was performed. Additionally, information available on the Food and Drug Administration Web site and for corporate Web sites was reviewed in an attempt to identify pertinent information. RESULTS The review captured devices that are in testing or have entered clinical practice that use elastomeric polyurethane polymers as disc replacements, dynamic stabilization of spinal movement, or motion limitation to relieve nerve root compression and pain and as complete a listing as possible of such devices that have been designed or tested but appear to no longer be pursued. This review summarizes the available information about the uses to which polyurethanes have been tested or are being used in spinal surgery. CONCLUSIONS The use of polyurethanes in medicine has expanded as modifications to the stability of the polymers in the physiological environment have been improved. The potential for the use of elastomeric materials to more closely match the mechanical properties of the structures being replaced and to maintain motion between spinal segments appears to hold promise. The published results from the use of the devices that are discussed show early success with these applications of elastomeric materials.
Collapse
|
9
|
Chamoli U, Diwan AD, Tsafnat N. Pedicle screw-based posterior dynamic stabilizers for degenerative spine:In vitrobiomechanical testing and clinical outcomes. J Biomed Mater Res A 2013; 102:3324-40. [DOI: 10.1002/jbm.a.34986] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/25/2013] [Accepted: 09/30/2013] [Indexed: 01/28/2023]
Affiliation(s)
- Uphar Chamoli
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Clinical School; University of New South Wales; Kogarah Sydney NSW 2217 Australia
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Kensington Campus Sydney NSW 2052 Australia
| | - Ashish D. Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Clinical School; University of New South Wales; Kogarah Sydney NSW 2217 Australia
| | - Naomi Tsafnat
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Kensington Campus Sydney NSW 2052 Australia
| |
Collapse
|
10
|
Cipriani E, Bracco P, Kurtz SM, Costa L, Zanetti M. In-vivo degradation of poly(carbonate-urethane) based spine implants. Polym Degrad Stab 2013; 98:1225-1235. [PMID: 24043907 DOI: 10.1016/j.polymdegradstab.2013.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Fourteen explanted Dynesys® spinal devices were analyzed for biostability and compared with a reference, never implanted, control. Both poly(carbonate-urethane) (PCU) spacers and polyethylene-terephthalate (PET) cords were analyzed. The effect of implantation was evaluated through the observation of physical alterations of the device surfaces, evaluation of the chemical degradation and fluids absorption on the devices and examination of the morphological and mechanical features. PCU spacers exhibited a variety of surface damage mechanisms, the most significant being abrasion and localized, microscopic surface cracks. Evidence of oxidation and chain scission were detected on PCU spacers ATR-FTIR. ATR-FTIR, DSC and hardness measurements also showed a slight heterogeneity in the composition of PCU. The extraction carried out on the PCU spacers revealed the presence of extractable polycarbonate segments. One spacer and all PET cords visually exhibited the presence of adherent biological material (proteins), confirmed by the ATR-FTIR results. GC/MS analyses of the extracts from PET cords revealed the presence of biological fluids residues, mainly cholesterol derivatives and fatty acids, probably trapped into the fiber network. No further chemical alterations were observed on the PET cords. Although the observed physical and chemical damage can be considered superficial, greater attention must be paid to the chemical degradation mechanisms of PCU and to the effect of byproducts on the body.
Collapse
Affiliation(s)
- E Cipriani
- Dipartimento di Chimica and NIS Centre of Excellence, University of Torino, Via Pietro Giuria 7, 10125 Torino, Italy
| | | | | | | | | |
Collapse
|
11
|
Sequestrectomy with additional transpedicular dynamic stabilization for the treatment of lumbar disc herniation: no clinical benefit after 10 years follow-up. Spine (Phila Pa 1976) 2013; 38:887-95. [PMID: 23232214 DOI: 10.1097/brs.0b013e31828150a6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Single-center prospective study. OBJECTIVE Clinical and radiological long-term evaluation of the effects of transpedicular dynamic stabilization after sequestrectomy. SUMMARY OF BACKGROUND DATA Short- and mid-term investigations have shown that additional dynamic stabilization is appropriate to prevent progression of initial segment degeneration after sequestrectomy and associated with superior clinical outcome compared with sequestrectomy alone. Long-term data are missing. METHODS Eighty-four patients with symptomatic disc herniation and initial osteochondrosis (Modic = I°) of the lumbar spine underwent sequestrectomy. Additional dynamic stabilization was performed in 35 subjects (group D); the remaining 49 subjects were treated with sequestrectomy alone (group S). Clinical (Oswestry Low Back Pain Disability Questionnaire, Version 2.0; visual analogue scale) and radiological (plain and extension-flexion radiographs and magnetic resonance images) parameters were collected preoperatively, at 3 months postoperatively, as well as at a mean follow-up of 2.8 and 10.2 years. RESULTS Twenty-nine of 35 (83%, group D) and 38 of 49 (78%, group S) patients were available at the final follow-up. Reoperation rate in group D was 34% (10/29) due to implant failures or progression of degeneration at the index or the adjacent segments. In group S, 5 of 38 (13%) underwent further operation because of a reprolapse or progression of degeneration of the index level. In the remaining patients, clinical scores (Oswestry Low Back Pain Disability Questionnaire, Version 2.0; and visual analogue scale) improved significantly, with similar results in both groups at the final follow-up. The rate of progression of disc degeneration was lower when the patients were also dynamically stabilized than sequestrectomy alone, but the rate of adjacent segment degeneration superior to the operated segment was significantly higher in group D. CONCLUSION Additional dynamic stabilization does not lead to a clinical benefit in patients with symptomatic disc herniation and initial segment degeneration compared with sequestrectomy alone after a long-term follow-up. Because of this and the high rate of necessary reoperations, we do not recommend this surgical strategy for this indication. LEVEL OF EVIDENCE 4.
Collapse
|
12
|
Yang J, Gao Y, Li J, Ding M, Chen F, Tan H, Fu Q. Synthesis and microphase separated structures of polydimethylsiloxane/polycarbonate-based polyurethanes. RSC Adv 2013. [DOI: 10.1039/c3ra40515j] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
13
|
Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318256e7f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|