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Wang L, Huang H, Yuan H, Yao Y, Park JH, Liu J, Geng X, Zhang K, Hollister SJ, Fan Y. In vitro fatigue behavior and in vivo osseointegration of the auxetic porous bone screw. Acta Biomater 2023; 170:185-201. [PMID: 37634835 DOI: 10.1016/j.actbio.2023.08.040] [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: 03/27/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
The incidence of screw loosening, migration, and pullout caused by the insufficient screw-bone fixation stability is relatively high in clinical practice. To solve this issue, the auxetic unit-based porous bone screw (AS) has been put forward in our previous work. Its favorable auxetic effect can improve the primary screw-bone fixation stability after implantation. However, porous structure affected the fatigue behavior and in vivo longevity of bone screw. In this study, in vitro fatigue behaviors and in vivo osseointegration performance of the re-entrant unit-based titanium auxetic bone screw were studied. The tensile-tensile fatigue behaviors of AS and nonauxetic bone screw (NS) with the same porosity (51%) were compared via fatigue experiments, fracture analysis, and numerical simulation. The in vivo osseointegration of AS and NS were compared via animal experiment and biomechanical analysis. Additionally, the effects of in vivo dynamic tensile loading on the osseointegration of AS and NS were investigated and analyzed. The fatigue strength of AS was approximately 43% lower while its osseointegration performance was better than NS. Under in vivo dynamic tensile loading, the osseointegration of AS and NS both improved significantly, with the maximum increase of approximately 15%. Preferrable osseointegration of AS might compensate for the shortage of fatigue resistance, ensuring its long-term stability in vivo. Adequate auxetic effect and long-term stability of the AS was supposed to provide enough screw-bone fixation stability to overcome the shortages of the solid bone screw, developing the success of surgery and showing significant clinical application prospects in orthopedic surgery. STATEMENT OF SIGNIFICANCE: This research investigated the high-cycle fatigue behavior of re-entrant unit-based auxetic bone screw under tensile-tensile cyclic loading and its osseointegration performance, which has not been focused on in existing studies. The fatigue strength of auxetic bone screw was lower while the osseointegration was better than non-auxetic bone screw, especially under in vivo tensile loading. Favorable osseointegration of auxetic bone screw might compensate for the shortage of fatigue resistance, ensuring its long-term stability and longevity in vivo. This suggested that with adequate auxetic effect and long-term stability, the auxetic bone screw had significant application prospects in orthopedic surgery. Findings of this study will provide a theoretical guidance for design optimization and clinical application of the auxetic bone screw.
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Affiliation(s)
- Lizhen Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Huiwen Huang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Hao Yuan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Yan Yao
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Jeong Hun Park
- Wallace H. Coulter Department of Biomedical Engineering and Center for 3D Medical Fabrication, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, GA 30332, USA
| | - Jinglong Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Xuezheng Geng
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Kuo Zhang
- Laboratory Animal Science Center, Peking University Health Science Center, Beijing 100083, China
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering and Center for 3D Medical Fabrication, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, GA 30332, USA
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China.
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Muhayudin NA, Basaruddin KS, Ijaz MF, Daud R. Finite Element Modelling of a Synthetic Paediatric Spine for Biomechanical Investigation. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4514. [PMID: 37444827 DOI: 10.3390/ma16134514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/31/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023]
Abstract
Studies on paediatric spines commonly use human adult or immature porcine spines as specimens, because it is difficult to obtain actual paediatric specimens. There are quite obvious differences, such as geometry, size, bone morphology, and orientation of facet joint for these specimens, compared to paediatric spine. Hence, development of synthetic models that can behave similarly to actual paediatric spines, particularly in term of range of motion (ROM), could provide a significant contribution for paediatric spine research. This study aims to develop a synthetic paediatric spine using finite element modelling and evaluate the reliability of the model by comparing it with the experimental data under certain load conditions. The ROM of the paediatric spine was measured using a validated FE model at ±0.5 Nm moment in order to determine the moment required by the synthetic spine to achieve the same ROM. The results showed that the synthetic spine required two moments, ±2 Nm for lateral-bending and axial rotation, and ±3 Nm for flexion-extension, to obtain the paediatric ROM. The synthetic spine was shown to be stiffer in flexion-extension but more flexible in lateral bending than the paediatric FE model, possibly as a result of the intervertebral disc's simplified shape and the disc's weak bonding with the vertebrae. Nevertheless, the synthetic paediatric spine has promising potential in the future as an alternative paediatric spine model for biomechanical investigation of paediatric cases.
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Affiliation(s)
- Nor Amalina Muhayudin
- Faculty of Mechanical Engineering Technology, Universiti Malaysia Perlis, Pauh Putra Campus, Arau 02600, Malaysia
| | - Khairul Salleh Basaruddin
- Faculty of Mechanical Engineering Technology, Universiti Malaysia Perlis, Pauh Putra Campus, Arau 02600, Malaysia
- Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Malaysia
| | - Muhammad Farzik Ijaz
- Mechanical Engineering Department, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia
- King Salman Center for Disability Research, Riyadh 11614, Saudi Arabia
| | - Ruslizam Daud
- Faculty of Mechanical Engineering Technology, Universiti Malaysia Perlis, Pauh Putra Campus, Arau 02600, Malaysia
- Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Malaysia
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Matsumoto Y, Mutsuzaki H, Hara Y, Nagashima K, Okano E, Yanagisawa Y, Noguchi H, Sankai T, Yamazaki M. Safety and Osteointegration of Titanium Screws Coated with a Fibroblast Growth Factor-2-Calcium Phosphate Composite Layer in Non-Human Primates: A Pilot Study. J Funct Biomater 2023; 14:jfb14050261. [PMID: 37233371 DOI: 10.3390/jfb14050261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Spinal instrumentation surgery for older patients with osteoporosis is increasing. Implant loosening may occur due to inappropriate fixation in osteoporotic bone. Developing implants that achieve stable surgical results, even in osteoporotic bone, can reduce re-operation, lower medical costs, and maintain the physical status of older patients. Fibroblast growth factor-2 (FGF-2) promotes bone formation; thus, coating pedicle screws with an FGF-2-calcium phosphate (FGF-CP) composite layer is hypothesized to enhance osteointegration in spinal implants. We designed a long-term implantation pilot study that estimated the safety and bone-forming efficacy of pedicle screws coated with an FGF-CP composite layer in cynomolgus monkeys. Titanium alloy screws, either uncoated (controls) or aseptically coated with an FGF-CP composite layer, were implanted in the vertebral bodies of six female adult cynomolgus monkeys (three monkeys per group) for 85 days. Physiological, histological, and radiographic investigations were performed. There were no serious adverse events, and no radiolucent areas were observed around the screws in either group. The bone apposition rate in the intraosseous region was significantly higher in the FGF-CP group than in the controls. Moreover, as analyzed by Weibull plots, the bone formation rate of the FGF-CP group exhibited a significantly higher regression line slope than the control group. These results demonstrated that there was significantly less risk of impaired osteointegration in the FGF-CP group. Our pilot study suggests that FGF-CP-coated implants could promote osteointegration, be safe, and reduce the probability of screw loosening.
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Affiliation(s)
- Yukei Matsumoto
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Katsuya Nagashima
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Eriko Okano
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yohei Yanagisawa
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Tadashi Sankai
- Tsukuba Primate Research Center, National Institutes of Biomedical Innovation, Health and Nutrition, 1-1 Hachimandai, Tsukuba 305-0843, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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Analysis of the Osseointegration Process of Dental Implants by Electron Paramagnetic Resonance: An In Vivo Study. Dent J (Basel) 2022; 10:dj10020028. [PMID: 35200253 PMCID: PMC8871022 DOI: 10.3390/dj10020028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 12/04/2022] Open
Abstract
This research work presents an analysis of the process of an implant’s osseointegration to the jawbone tissue. The purpose of this work was to describe the processes of assimilation and the biochemical dynamics which occur during dental implantation using implants with different macro-microstructure surfaces at the level of stable free radicals using the electron paramagnetic resonance (EPR) method. The experimental investigation was conducted on seven Vietnamese minipigs over twelve months old and weighing up to 30 kg using implants with various macro-microstructure surfaces (SLA, RBM, and HSTTM) and implantation systems, namely the Adin, Sunran, Biomed, and Osstem systems. The integration of the implant into the bone triggered biochemical processes with the formation of stable free radicals. The EPR method was used to identify the formed paramagnetic species and to study the dynamics of the interaction between the surface of the implant and the bone after one and two months. The concentration of carbonate surface centers increased with the time that the implant was connected to the hard tissue. The “Sunran” and “HSTTM” were established as the most suitable implantation system and surface type, respectively, thanks to the highest rate of osseointegration (assimilation) with the bone (hard) tissue. Thus, the EPR method provides the opportunity to study implantation processes.
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Experimental Analysis of Fabricated Synthetic Midthoracic Paediatric Spine as Compared to the Porcine Spine Based on Range of Motion (ROM). Appl Bionics Biomech 2021; 2021:2799415. [PMID: 34608402 PMCID: PMC8487360 DOI: 10.1155/2021/2799415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
The present study is aimed at investigating the mechanical behaviour of fabricated synthetic midthoracic paediatric spine based on range of motion (ROM) as compared to porcine spine as the biological specimen. The main interest was to ensure that the fabricated synthetic model could mimic the biological specimen behaviour. The synthetic paediatric spine was designed as a 200% scaled-up model to fit into the Bionix Servohydraulic spine simulator. Biomechanical tests were conducted to measure the ROM and nonlinearity of sigmoidal curves at six degrees of freedom (DOF) with moments at ±4 Nm before the specimens failed. Results were compared with the porcine spine (biological specimen). The differences found between the lateral bending and axial rotation of synthetic paediatric spine as compared to the porcine spine were 18% and 3%, respectively, but was still within the range. Flexion extension of the synthetic spine is a bit stiff in comparison of porcine spine with 45% different. The ROM curves of the synthetic paediatric spine exhibited nonlinearities for all motions as the measurements of neutral zone (NZ) and elastic zone (EZ) stiffness were below “1.” Therefore, it showed that the proposed synthetic paediatric spine behaved similarly to the biological specimen, particularly on ROM.
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Chiba T, Inami S, Moridaira H, Takeuchi D, Sorimachi T, Ueda H, Ohe M, Aoki H, Iimura T, Nohara Y, Taneichi H. Growing rod technique with prior foundation surgery and sublaminar taping for early-onset scoliosis. J Neurosurg Spine 2020; 33:607-612. [PMID: 32590351 DOI: 10.3171/2020.4.spine2036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to show the surgical results of growing rod (GR) surgery with prior foundation surgery (PFS) and sublaminar taping at an apex vertebra. METHODS Twenty-two early-onset scoliosis (EOS) patients underwent dual GR surgery with PFS and sublaminar taping. PFS was performed prior to rod placement, including exposure of distal and proximal anchor areas and anchor instrumentation filled with a local bone graft. After a period of 3-5 months for the anchors to become solid, dual rods were placed for distraction. The apex vertebra was exposed and fastened to the concave side of the rods using sublaminar tape. Preoperative, post-GR placement, and final follow-up radiographic parameters were measured. Complications during the treatment period were evaluated using the patients' clinical records. RESULTS The median age at the initial surgery was 55.5 months (range 28-99 months), and the median follow-up duration was 69.5 months (range 25-98 months). The median scoliotic curves were 81.5° (range 39°-126°) preoperatively, 30.5° (range 11°-71°) after GR placement, and 33.5° (range 12°-87°) at the final follow-up. The median thoracic kyphotic curves were 45.5° (range 7°-136°) preoperatively, 32.5° (range 15°-99°) after GR placement, and 42° (range 11°-93°) at the final follow-up. The median T1-S1 lengths were 240.5 mm (range 188-305 mm) preoperatively, 286.5 mm (range 232-340 mm) after GR placement, and 337.5 mm (range 206-423 mm) at the final follow-up. Complications occurred in 6 patients (27%). Three patients had implant-related complications, 2 patients had alignment-related complications, and 1 patient had a wound-related complication. CONCLUSIONS A dual GR technique with PFS and sublaminar taping showed effective correction of scoliotic curves and a lower complication rate than previous reports when a conventional dual GR technique was used.
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Affiliation(s)
- Takafumi Chiba
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Satoshi Inami
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | | | - Daisaku Takeuchi
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | | | - Haruki Ueda
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Makoto Ohe
- 3Department of Orthopaedic Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Hiromichi Aoki
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Takuya Iimura
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Yutaka Nohara
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Hiroshi Taneichi
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
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Posterior vertebral column resection with short-segment fusion for the patients with congenital kyphoscoliosis. J Pediatr Orthop B 2020; 29:572-579. [PMID: 32956282 DOI: 10.1097/bpb.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to assess the surgical outcomes of posterior vertebral column resection (PVCR) with short-segment fusion for pediatric patients with congenital kyphoscoliosis (CKS). The medical records of 12 consecutive pediatric patients with CKS due to hemivertebrae located in thoracolumbar and lumbar area that had undergone PVCR and presented for follow-up at a minimum of 2 years were retrospectively reviewed. The mean follow-up period was 56.2 months, and the mean age at the surgery was 9.2 years. We evaluated radiographic parameters using plain radiographs, and evaluated segmental correction using computed tomography imaging. The mean values of the preoperative Cobb angle (cranial curve, main curve, and caudal curve) were 16.0°, 41.3°, and 25.0°, respectively. The main curve was reduced 5.4° after surgery and was maintained at 6.3° at the time of the most recent follow-up. The overall correction rate of main curve was 86.6%. Spontaneous correction rate in the cranial curve and caudal curve were calculated as 55.9 and 80.8%, respectively. The mean segmental scoliosis in the osteotomized segments and fused segments at preoperative/postoperative/final follow-up (FFU) were 40.8°/7.8°/9.2° and 34.3°/3.9°/5.1°, respectively. The mean segmental kyphosis in the osteotomized segments and fused segments at the preoperative/postoperative/FFU were 36.0°/3.8°/4.0° and 27.5°/-1.3°/0.7°, respectively. Our data indicate that PVCR with short-segment fusion for CKS can provide good correction in the main curve and spontaneous correction in the compensatory curves after a minimum 2-year follow-up. Further investigation over the long term is mandatory for pediatric patients.
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Lam TN, Trinh MG, Huang CC, Kung PC, Huang WC, Chang W, Amalia L, Chin HH, Tsou NT, Shih SJ, Chen SY, Wang CC, Tsai PI, Wu MH, Huang EW. Investigation of Bone Growth in Additive-Manufactured Pedicle Screw Implant by Using Ti-6Al-4V and Bioactive Glass Powder Composite. Int J Mol Sci 2020; 21:ijms21207438. [PMID: 33050160 PMCID: PMC7587946 DOI: 10.3390/ijms21207438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 01/25/2023] Open
Abstract
In this study, we optimized the geometry and composition of additive-manufactured pedicle screws. Metal powders of titanium-aluminum-vanadium (Ti-6Al-4V) were mixed with reactive glass-ceramic biomaterials of bioactive glass (BG) powders. To optimize the geometry of pedicle screws, we applied a novel numerical approach to proposing the optimal shape of the healing chamber to promote biological healing. We examined the geometry and composition effects of pedicle screw implants on the interfacial autologous bone attachment and bone graft incorporation through in vivo studies. The addition of an optimal amount of BG to Ti-6Al-4V leads to a lower elastic modulus of the ceramic-metal composite material, effectively reducing the stress-shielding effects. Pedicle screw implants with optimal shape design and made of the composite material of Ti-6Al-4V doped with BG fabricated through additive manufacturing exhibit greater osseointegration and a more rapid bone volume fraction during the fracture healing process 120 days after implantation, per in vivo studies.
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Affiliation(s)
- Tu-Ngoc Lam
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
- Department of Physics, College of Education, Can Tho University, Can Tho City 900000, Vietnam
| | - Minh-Giam Trinh
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan;
- Department of Trauma-Orthopaedics, College of Medicine, Pham Ngoc Thach Medical University, No. 02, Duong Quang Trung St, 10th District, Ho Chi Minh City 700000, Vietnam
| | - Chih-Chieh Huang
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
| | - Pei-Ching Kung
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
| | - Wei-Chin Huang
- Laser and Additive Manufacturing Technology Center, Industrial Technology Research Institute, Hsinchu 31040, Taiwan;
| | - Wei Chang
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
| | - Lia Amalia
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
| | - Hsu-Hsuan Chin
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
| | - Nien-Ti Tsou
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
| | - Shao-Ju Shih
- Department of Materials Science and Engineering, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Road, Taipei 10607, Taiwan;
| | - San-Yuan Chen
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
| | - Chun-Chieh Wang
- National Synchrotron Radiation Research Center, Hsinchu 30076, Taiwan;
| | - Pei-I Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31040, Taiwan;
| | - Meng-Huang Wu
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
- Department of Orthopedics, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi District, Taipei 11031, Taiwan
- Correspondence: (M.-H.W.); (E.-W.H.)
| | - E-Wen Huang
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu 30010, Taiwan; (T.-N.L.); (C.-C.H.); (P.-C.K.); (W.C.); (L.A.); (H.-H.C.); (N.-T.T.); (S.-Y.C.)
- Correspondence: (M.-H.W.); (E.-W.H.)
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Ono Y, Miyakoshi N, Hongo M, Kasukawa Y, Misawa A, Ishikawa Y, Kudo D, Shimada Y. Growing Rod Surgery for Early-Onset Scoliosis in an Osteogenesis Imperfecta Patient. World Neurosurg 2020; 144:178-183. [PMID: 32889193 DOI: 10.1016/j.wneu.2020.08.165] [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: 05/27/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is characterized by bone fragility and is often accompanied by spinal deformity. Surgical treatment for early-onset scoliosis in patients with OI is hazardous and difficult due to the bone fragility and rigidity of the deformity. A case of early-onset scoliosis with OI that was treated using growing-rod surgery is presented. CASE DESCRIPTION The patient was an 11-year-old girl with type 4 OI. At the age of 4 years, she was noted to have scoliosis. Preoperative radiographs showed that the Cobb angle, thoracic kyphosis angle, and T1-S1 height were 94°, 77°, and 258 mm, respectively. One year before the operation, she underwent cyclic intravenous pamidronate disodium treatment. Three months after the pedicle screws were inserted, the growing rods were placed with pedicle screws and sublaminar polyethylene tape. The patient had intraoperative traction for correction. At 13 years and 11 months, the patients underwent posterior instrumentation and spinal fusion. Postoperative radiographs showed that the Cobb angle, thoracic kyphosis angle, and T1-S1 height were 29°, 29°, and 405 mm, respectively. Three months after the operation, she was well, and there have been no spine-related problems. CONCLUSIONS This case demonstrates the successful use of the growing rod for early-onset scoliosis in patients with OI. The treatment strategy, which included pedicle screw insertion as anchors to create the foundations in advance, sublaminar tape, intraoperative traction, and preoperative bisphosphonate administration, might have led to the good outcome.
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Affiliation(s)
- Yuichi Ono
- Department of Orthopedic Surgery, Akita Red Cross Hospital, Akita, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiko Misawa
- Department of Orthopedic Surgery, Akita Prefectural Center on Development and Disability, Akita, Japan
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Ohe M, Moridaira H, Inami S, Takeuchi D, Nohara Y, Taneichi H. Pedicle screws with a thin hydroxyapatite coating for improving fixation at the bone-implant interface in the osteoporotic spine: experimental study in a porcine model. J Neurosurg Spine 2018; 28:679-687. [DOI: 10.3171/2017.10.spine17702] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEInstrumentation failure caused by the loosening of pedicle screws (PSs) in patients with osteoporosis is a serious problem after spinal surgery. The addition of a thin hydroxyapatite (HA) surface coating applied by using a sputtering process was reported recently to be a promising method for providing bone conduction around an implant without a significant risk of coating-layer breakage. In this study, the authors evaluated the biomechanical and histological features of the bone-implant interface (BII) of PSs with a thin HA coating in an in vivo porcine osteoporotic spine model.METHODSThree types of PSs (untreated/standard [STPS], sandblasted [BLPS], and HA-coated [HAPS] PSs) were implanted into the thoracic and lumbar spine (T9–L6) of 8 mature Clawn miniature pigs (6 ovariectomized [osteoporosis group] and 2 sham-operated [control group] pigs). The spines were harvested from the osteoporosis group at 0, 2, 4, 8, 12, or 24 weeks after PS placement and from the control group at 0 or 24 weeks. Their bone mineral density (BMD) was measured by peripheral quantitative CT. Histological evaluation of the BIIs was conducted by performing bone volume/tissue volume and bone surface/implant surface measurements. The strength of the BII was evaluated with extraction torque testing.RESULTSThe BMD decreased significantly in the osteoporosis group (p < 0.01). HAPSs exhibited the greatest mean extraction peak torque at 8 weeks, and HAPSs and BLPSs exhibited significantly greater mean torque than the STPSs at 12 weeks (p < 0.05). The bone surface/implant surface ratio was significantly higher for HAPSs than for STPSs after 2 weeks (p < 0.05), and bonding between bone and the implant surface was maintained until 24 weeks with no detachment of the coating layer. In contrast, the bone volume/tissue volume ratio was significantly higher for HAPSs than for BLPSs or STPSs only at 4 weeks.CONCLUSIONSUsing PSs with a thin HA coating applied using a sputtering process strengthens bonding at the BII, which might improve early implant fixation after spinal surgery for osteoporosis. However, the absence of increased bone mass around the screw remains a concern; prescribing osteoporosis treatment to improve bone quality might be necessary to prevent fractures around the screws.
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