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
|
Chang SY, Kang DH, Cho SK. Innovative Developments in Lumbar Interbody Cage Materials and Design: A Comprehensive Narrative Review. Asian Spine J 2024; 18:444-457. [PMID: 38146053 PMCID: PMC11222887 DOI: 10.31616/asj.2023.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Sam Yeol Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul,
Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
| | - Dong-Ho Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Seoul,
Korea
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| |
Collapse
|
3
|
Yang H, Zhang F, Xu H, Wang J, Li H, Li L, Shao M, Wang H, Pei J, Niu J, Yuan G, Lyu F. Anatomical Brushite-Coated Mg-Nd-Zn-Zr Alloy Cage Promotes Cervical Fusion: One-Year Results in Goats. ACS Biomater Sci Eng 2024; 10:1753-1764. [PMID: 38351646 DOI: 10.1021/acsbiomaterials.3c01364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
In this study, an anatomical brushite-coated Mg-Nd-Zn-Zr alloy cage was fabricated for cervical fusion in goats. The purpose of this study was to investigate the cervical fusion effect and degradation characteristics of this cage in goats. The Mg-Nd-Zn-Zr alloy cage was fabricated based on anatomical studies, and brushite coating was prepared. Forty-five goats were divided into three groups, 15 in each group, and subjected to C2/3 anterior cervical decompression and fusion with tricortical bone graft, Mg-Nd-Zn-Zr alloy cage, or brushite-coated Mg-Nd-Zn-Zr alloy cage, respectively. Cervical radiographs and computed tomography (CT) were performed 3, 6, and 12 months postoperatively. Blood was collected for biocompatibility analysis and Mg2+ concentration tests. The cervical spine specimens were obtained at 3, 6, and 12 months postoperatively for biomechanical, micro-CT, scanning electron microscopy coupled with energy dispersive spectroscopy, laser ablation-inductively coupled plasma-time-of-flight mass spectrometry, and histological analysis. The liver and kidney tissues were obtained for hematoxylin and eosin staining 12 months after surgery for biosafety analysis. Imaging and histological analysis showed a gradual improvement in interbody fusion over time; the fusion effect of the brushite-coated Mg-Nd-Zn-Zr alloy cage was comparable to that of the tricortical bone graft, and both were superior to that of the Mg-Nd-Zn-Zr alloy cage. Biomechanical testing showed that the brushite-coated Mg-Nd-Zn-Zr alloy cage achieved better stability than the tricortical bone graft at 12 months postoperatively. Micro-CT showed that the brushite coating significantly decreases the corrosion rate of the Mg-Nd-Zn-Zr alloy cage. In vivo degradation analysis showed higher Ca and P deposition in the degradation products of the brushite-coated Mg-Nd-Zn-Zr alloy cage, and no hyperconcentration of Mg was detected. Biocompatibility analysis showed that both cages were safe for cervical fusion surgery in goats. To conclude, the anatomical brushite-coated Mg-Nd-Zn-Zr alloy cage can promote cervical fusion in goats, and the brushite-coated Mg-Nd-Zn-Zr alloy is a potential material for developing absorbable fusion cages.
Collapse
Affiliation(s)
- Haiyuan Yang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Fan Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Haocheng Xu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jin Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Hailong Li
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Linli Li
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Minghao Shao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jia Pei
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jialin Niu
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| |
Collapse
|
4
|
Li Q, Gao Q, Wang L, Liu L, Yang H, Song Y. Comparison of Long-term Follow-Up of n-HA PA66 Cage and PEEK Cage of Lumbar Interbody Fusion in Multi-level Degenerative Lumbar Diseases: A Stepwise Propensity Score Matching Analysis. Orthop Surg 2024; 16:17-28. [PMID: 37953456 PMCID: PMC10782257 DOI: 10.1111/os.13929] [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: 05/20/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE Previous studies have confirmed that the nanohydroxyapatite/polyamide-66 (n-HA/PA66) cage is an ideal alternative material for degenerative lumbar disease (DLD) comparable to the polyether ether ketone (PEEK) cage due to its similar radiographic fusion, subsidence rate, and clinical results. However, these studies were restricted to one-level surgery. The aim of this study was to analyze the long-term clinical and radiologic outcomes between n-HA PA66 cage and PEEK cage for patients with multi-level degenerative lumbar diseases (DLDs). METHODS We retrospectively reviewed all patients who underwent multi-level transforaminal lumbar interbody fusion (TLIF) from June 2010 to December 2016 with a minimum 6-year follow-up. Matched-pair analysis was performed using a 1-to-1 closest neighbor approach to match patients who received an n-HA PA66 cage with those who received a PEEK cage. Clinical outcomes and radiographic evaluations were compared between the two groups. The independent student's t-test and χ2 -test were applied to compare the differences between groups. RESULTS At the end of the propensity score matching (PSM) analysis, 48 patients from n-HA/PA66 group were matched to 48 patients in the PEEK group. No significant difference was observed in cage subsidence and bony fusion except for adjacent segment degeneration (ASD). The occurrence of ASD was 14.58% (7/48) in the n-HA/PA 66 group, which was significantly less than that in the PEEK group (33.33% [16/48]) (p = 0.031). Although the intervertebral space height (IH), segmental angle (SA) and lumbar lordosis (LL) significantly increased after surgery in both groups, there was no significant difference at any time point after surgery (p > 0.05). The visual analogue scale (VAS) and Oswestry disability index (ODI) scores significantly improved in both groups at 3m postoperative, 1y postoperative and at final follow-up. However, there were no significant differences in the VAS and ODI score at any time point (p > 0.05). The total complications and re-admission rate were not different between the two groups. CONCLUSION Overall, our data suggest that the outcomes of n-HA/PA66 cage group are comparable to those of the PEEK cage group, with a similar high fusion rate and low cage subsidence rate as PEEK cages, except its lower rate of ASD occurrence.
Collapse
Affiliation(s)
- Qiujiang Li
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Qingyang Gao
- Department of Burn and Plastic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Lei Wang
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Limin Liu
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Huiliang Yang
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| |
Collapse
|
5
|
Shih CM, Lee CH, Chen KH, Pan CC, Yen YC, Wang CH, Su KC. Optimizing Spinal Fusion Cage Design to Improve Bone Substitute Filling on Varying Disc Heights: A 3D Printing Study. Bioengineering (Basel) 2023; 10:1250. [PMID: 38002375 PMCID: PMC10669701 DOI: 10.3390/bioengineering10111250] [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: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
The success of spinal fusion surgery relies on the precise placement of bone grafts and minimizing scatter. This study aims to optimize cage design and bone substitute filling methods to enhance surgical outcomes. A 3D printed lumbar spine model was utilized to implant 3D printed cages of different heights (8 mm, 10 mm, 12 mm, and 14 mm) filled with BICERA® Bone Graft Substitute mixed with saline. Two filling methods, SG cage (side hole for grafting group, a specially designed innovative cage with side hole, post-implantation filling) and FP cage (finger-packing group, pre-implantation finger packing, traditional cage), were compared based on the weight of the implanted bone substitute. The results showed a significantly higher amount of bone substitute implanted in the SG cage group compared to the FP cage group. The quantity of bone substitute filled in the SG cage group increased with the height of the cage. However, in the FP cage group, no significant difference was observed between the 12 mm and 14 mm subgroups. Utilizing oblique lumbar interbody fusion cages with side holes for bone substitute filling after implantation offers several advantages. It reduces scatter and increases the amount of implanted bone substitute. Additionally, it effectively addresses the challenge of insufficient fusion surface area caused by gaps between the cage and endplates. The use of cages with side holes facilitates greater bone substitute implantation, ultimately enhancing the success of fusion. This study provides valuable insights for future advancements in oblique lumbar interbody fusion cage design, highlighting the effectiveness of using cages with side holes for bone substitute filling after implantation.
Collapse
Affiliation(s)
- Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-M.S.); (C.-H.L.); (K.-H.C.); (C.-C.P.)
- Department of Physical Therapy, Hungkuang University, Taichung 433, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-M.S.); (C.-H.L.); (K.-H.C.); (C.-C.P.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-M.S.); (C.-H.L.); (K.-H.C.); (C.-C.P.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-M.S.); (C.-H.L.); (K.-H.C.); (C.-C.P.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
| | - Yu-Chun Yen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan; (Y.-C.Y.); (C.-H.W.)
| | - Chun-Hsiang Wang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan; (Y.-C.Y.); (C.-H.W.)
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan; (Y.-C.Y.); (C.-H.W.)
- Department of Biomedical Engineering, HungKuang University, Taichung 433, Taiwan
- Department of Chemical and Materials Engineering, Tunghai University, Taichung 407, Taiwan
| |
Collapse
|
6
|
Derman PB, Yusufbekov R, Braaksma B. Device profile of the FlareHawk interbody fusion system, an endplate-conforming multi-planar expandable lumbar interbody fusion cage. Expert Rev Med Devices 2023; 20:357-364. [PMID: 37051651 DOI: 10.1080/17434440.2023.2198123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
INTRODUCTION The FlareHawk Interbody Fusion System is a family of lumbar interbody fusion devices (IBFDs) that include FlareHawk7, FlareHawk9, FlareHawk11, TiHawk7, TiHawk9, and TiHawk11. These IBFDs offer a new line of multi-planar expandable interbody devices designed to provide mechanical stability, promote arthrodesis, and allow for restoration of disc height and lordosis through a minimal insertion profile during standard open and minimally invasive posterior lumbar fusion procedures. The two-piece interbody cage design consists of a PEEK outer shell that expands in width, height, and lordosis with the insertion of a titanium shim. Once expanded, the open architecture design allows for ample graft delivery into the disc space. AREAS COVERED The design and unique features of the FlareHawk family of expandable fusion cages are described. The indications for their use are discussed. Early clinical and radiographic outcome studies using the FlareHawk Interbody Fusion System are reviewed, and properties of competitor products are outlined. EXPERT OPINION The FlareHawk multi-planar expandable interbody fusion cage is unique amongst the many lumbar fusion cages currently on the market. The multi-planar expansion, open architecture, and adaptive geometry set it apart from its competitors.
Collapse
Affiliation(s)
- Peter B Derman
- Orthopedic Spine Surgery, Texas Back Institute, Plano, TX, Unites States
| | - Rachelle Yusufbekov
- Clinical Research, Accelus, Palm Beach Gardens, FL, United States
- Johns Hopkins Whiting School of Engineering, Biomedical Engineering
| | - Brian Braaksma
- Orthopedic Spine Surgery, Texas Back Institute, Plano, TX, Unites States
| |
Collapse
|
7
|
Schömig F, Becker L, Schönnagel L, Völker A, Disch AC, Schnake KJ, Pumberger M. Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review. Global Spine J 2023; 13:52S-58S. [PMID: 37084355 PMCID: PMC10177307 DOI: 10.1177/21925682231159066] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES With an aging population, the prevalence of osteoporosis is continuously rising. As osseous integrity is crucial for bony fusion and implant stability, previous studies have shown osteoporosis to be associated with an increased risk for implant failure and higher reoperation rates after spine surgery. Thus, our review's purpose was to provide an update of evidence-based solutions in the surgical treatment of osteoporosis patients. METHODS We summarize the existing literature regarding changes associated with decreased bone mineral density (BMD) and resulting biomechanical implications for the spine as well as multidisciplinary treatment strategies to avoid implant failures in osteoporotic patients. RESULTS Osteoporosis is caused by an uncoupling of the bone remodeling cycle based on an unbalancing of bone resorption and formation and resulting reduced BMD. The reduction in trabecular structure, increased porosity of cancellous bone and decreased cross-linking between trabeculae cause a higher risk of complications after spinal implant-based surgeries. Thus, patients with osteoporosis require special planning considerations, including adequate preoperative evaluation and optimization. Surgical strategies aim towards maximizing screw pull-out strength, toggle resistance, as well as primary and secondary construct stability. CONCLUSIONS As osteoporosis plays a crucial role in the fate of patients undergoing spine surgery, surgeons need to be aware of the specific implications of low BMD. While there still is no consensus on the best course of treatment, multidisciplinary preoperative assessment and adherence to specific surgical principles help reduce the rate of implant-related complications.
Collapse
Affiliation(s)
- Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luis Becker
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas Schönnagel
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Völker
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Alexander C Disch
- University Comprehensive Spine Center, University Center for Orthopedics, Traumatology and Plastic Surgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St Marien gGmbH, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
8
|
Ma H, Han H, Zhao X, Ma J, Qu X, Lou X, Suonan A, Lei B, Zhang Y. Engineering Multifunctional Polyether Ether Ketone Implant: Mechanics-Adaptability, Biominerialization, Immunoregulation, Anti-Infection, Osteointegration, and Osteogenesis. Adv Healthc Mater 2023; 12:e2202799. [PMID: 36808883 DOI: 10.1002/adhm.202202799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/23/2022] [Indexed: 02/19/2023]
Abstract
Polyether ether ketone (PEEK) has become one of the most promising polymer implants in bone orthopedics, due to the biocompatibility, good processability, and radiation resistance. However, the poor mechanics-adaptability/osteointegration/osteogenesis/antiinfection limits the long-term in vivo applications of PEEK implants. Herein, a multifunctional PEEK implant (PEEK-PDA-BGNs) is constructed through in situ surface deposition of polydopamine-bioactive glass nanoparticles (PDA-BGNs). PEEK-PDA-BGNs exhibit good performance on osteointegration and osteogenesis in vitro and in vivo, due to their multifunctional properties including mechanics-adaptability, biominerialization, immunoregulation, anti-infection, and osteoinductive activity. PEEK-PDA-BGNs can show the bone tissue-adaptable mechanic surface and induce the rapid biomineralization (apatite formation) under a simulated body solution. Additionally, PEEK-PDA-BGNs can induce the M2 phenotype polarization of macrophages, reduce the expression of inflammatory factors, promote the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), and improve the osseointegration and osteogenesis ability of the PEEK implant. PEEK-PDA-BGNs also show good photothermal antibacterial activity and can kill 99% of Escherichia coli (E. coli) and Methicillin-resistant Staphylococcus aureus (MRSA), suggesting their potential antiinfection ability. This work suggests that PDA-BGNs coating is probably a facile strategy to construct multifunctional (biomineralization, antibacterial, immunoregulation) implants for bone tissue replacement.
Collapse
Affiliation(s)
- Hongyun Ma
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710000, P. R. China.,Department of Orthopedics, Qinghai Provincial People's Hospital, Qinghai, 810007, P. R. China
| | - Hao Han
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710000, P. R. China
| | - Xiaoming Zhao
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710000, P. R. China
| | - Junping Ma
- Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710000, P. R. China
| | - Xiaoyan Qu
- Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710000, P. R. China
| | - Xiaoxiao Lou
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Angxiu Suonan
- Department of Orthopedics, Qinghai Provincial People's Hospital, Qinghai, 810007, P. R. China
| | - Bo Lei
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710000, P. R. China
| | - Yingang Zhang
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| |
Collapse
|
9
|
Ding Z, Ren Y, Cao H, Li J. Top 100 most cited articles on anterior cervical discectomy and fusion. Front Surg 2022; 9:1000360. [PMID: 36147696 PMCID: PMC9485582 DOI: 10.3389/fsurg.2022.1000360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Study Design Bibliometric analysis. Objective Anterior cervical discectomy and fusion (ACDF) is a typical surgical method in spine surgery and has progressed significantly in the last several decades. The purpose of this study is to determine how the 100 most-cited original articles on ACDF have been the most influential in this field by identifying and analyzing them. Methods The articles on ACDF were identified by searching the Thomson ISI Web of Science database on 30 May 2022. The 100 most-cited articles were selected according to specific criteria. The data extracted from the articles included title, publication date, total citations, journal name, first author, institutions, and keywords. Results The total number of citations was 13,181, with a mean number of 131.81 ± 100.18. The publication dates ranged from 1994 to 2018. Most of these articles originated in the United States (68%) and were published in the 2000s (32%) and 2010s (48%). Spine published most of the articles (30%), followed by the Journal of Neurosurgery-Spine (16%), Spine Journal (14%), and European Spine Journal (13%). The most prolific author was Dr. Todd J Albert (n = 7), with 1,312 citations. The Texas Back Institute was the most productive institution (n = 10). The keywords ACDF, cervical spine, cervical spine, and fusion showed the highest degree of centrality. Conclusion One hundred top-cited articles on ACDF were identified and analyzed in this study. We demonstrate that ACDF is a growing and popular area of research, with the focus of research varying through timeline trends. This will provide a comprehensive and detailed basis for spine surgeons to make clinical decisions and assimilate the research focus of cervical spine surgery.
Collapse
Affiliation(s)
- Zhiyu Ding
- Department of Orthopaedics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yijun Ren
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongqing Cao
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinsong Li
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jinsong Li
| |
Collapse
|
10
|
Early Osteogenic Marker Expression in hMSCs Cultured onto Acid Etching-Derived Micro- and Nanotopography 3D-Printed Titanium Surfaces. Int J Mol Sci 2022; 23:ijms23137070. [PMID: 35806083 PMCID: PMC9266831 DOI: 10.3390/ijms23137070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 12/13/2022] Open
Abstract
Polyetheretherketone (PEEK) titanium composite (PTC) is a novel interbody fusion device that combines a PEEK core with titanium alloy (Ti6Al4V) endplates. The present study aimed to investigate the in vitro biological reactivity of human bone-marrow-derived mesenchymal stem cells (hBM-MSCs) to micro- and nanotopographies produced by an acid-etching process on the surface of 3D-printed PTC endplates. Optical profilometer and scanning electron microscopy were used to assess the surface roughness and identify the nano-features of etched or unetched PTC endplates, respectively. The viability, morphology and the expression of specific osteogenic markers were examined after 7 days of culture in the seeded cells. Haralick texture analysis was carried out on the unseeded endplates to correlate surface texture features to the biological data. The acid-etching process modified the surface roughness of the 3D-printed PTC endplates, creating micro- and nano-scale structures that significantly contributed to sustaining the viability of hBM-MSCs and triggering the expression of early osteogenic markers, such as alkaline phosphatase activity and bone-ECM protein production. Finally, the topography of 3D-printed PTC endplates influenced Haralick’s features, which in turn correlated with the expression of two osteogenic markers, osteopontin and osteocalcin. Overall, these data demonstrate that the acid-etching process of PTC endplates created a favourable environment for osteogenic differentiation of hBM-MSCs and may potentially have clinical benefit.
Collapse
|