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Jiang JH, Zhao CM, Zhang J, Xu RM, Chen L. Biomechanical effects of posterior lumbar interbody fusion with vertical placement of pedicle screws compared to traditional placement. World J Clin Cases 2024; 12:4108-4120. [PMID: 39015896 PMCID: PMC11235545 DOI: 10.12998/wjcc.v12.i20.4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/24/2024] [Accepted: 05/31/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The pedicle screw technique is widely employed for vertebral body fixation in the treatment of spinal disorders. However, traditional screw placement methods require the dissection of paraspinal muscles and the insertion of pedicle screws at specific transverse section angles (TSA). Larger TSA angles require more force to pull the muscle tissue, which can increase the risk of surgical trauma and ischemic injury to the lumbar muscles. AIM To study the feasibility of zero-degree TSA vertical pedicle screw technique in the lumbosacral segment. METHODS Finite element models of vertebral bodies and pedicle screw-rod systems were established for the L4-S1 spinal segments. A standard axial load of 500 N and a rotational torque of 10 N/m were applied. Simulated screw pull-out experiment was conducted to observe pedicle screw resistance to pull-out, maximum stress, load-displacement ratio, maximum stress in vertebral bodies, load-displacement ratio in vertebral bodies, and the stress distribution in pedicle screws and vertebral bodies. Differences between the 0-degree and 17-degree TSA were compared. RESULTS At 0-degree TSA, the screw pull-out force decreased by 11.35% compared to that at 17-degree TSA (P < 0.05). At 0-degree and 17-degree TSA, the stress range in the screw-rod system was 335.1-657.5 MPa and 242.8-648.5 MPa, separately, which were below the fracture threshold for the screw-rod system (924 MPa). At 0-degree and 17-degree TSA, the stress range in the vertebral bodies was 68.45-78.91 MPa and 39.08-72.73 MPa, separately, which were below the typical bone yield stress range for vertebral bodies (110-125 MPa). At 0-degree TSA, the load-displacement ratio for the vertebral bodies and pedicle screws was slightly lower compared to that at 17-degree TSA, indicating slightly lower stability (P < 0.05). CONCLUSION The safety and stability of 0-degree TSA are slightly lower, but the risks of screw-rod system fracture, vertebral body fracture, and rupture are within acceptable limits.
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Affiliation(s)
- Ji-Hong Jiang
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Chang-Ming Zhao
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Jun Zhang
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Rong-Ming Xu
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Lei Chen
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
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Sattari SA, Xia Y, Azad TD, Caraway CA, Chang L. Advances in Implant Technologies for Spine Surgery. Neurosurg Clin N Am 2024; 35:217-227. [PMID: 38423737 DOI: 10.1016/j.nec.2023.11.003] [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: 03/02/2024]
Abstract
Spine implants are becoming increasingly diversified. Taking inspiration from other industries, three-dimensional modeling of the spinal column has helped meet the custom needs of individual patients as both en bloc replacements and pedicle screw designs. Intraoperative tailoring of devices, a common need in the operating room, has led to expandable versions of cages and interbody spacers.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, 6007 Zayed Tower, Baltimore, MD 21287, USA
| | - Chad A Caraway
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Louis Chang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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3
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Ghermandi R, Tosini G, Lorenzi A, Griffoni C, La Barbera L, Girolami M, Pipola V, Barbanti Brodano G, Bandiera S, Terzi S, Tedesco G, Evangelisti G, Monetta A, Noli LE, Falzetti L, Gasbarrini A. Carbon Fiber-Reinforced PolyEtherEtherKetone (CFR-PEEK) Instrumentation in Degenerative Disease of Lumbar Spine: A Pilot Study. Bioengineering (Basel) 2023; 10:872. [PMID: 37508899 PMCID: PMC10376430 DOI: 10.3390/bioengineering10070872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
CFR-PEEK is gaining popularity in spinal oncological applications due to its reduction of imaging artifacts and radiation scattering compared with titanium, which allows for better oncological follow-up and efficacy of radiotherapy. We evaluated the use of these materials for the treatment of lumbar degenerative diseases (DDs) and considered the biomechanical potential of the carbon fiber in relation to its modulus of elasticity being similar to that of bone. Twenty-eight patients with DDs were treated using CRF-PEEK instrumentation. The clinical and radiographic outcomes were collected at a 12-month FU. Spinal fusion was evaluated in the CT scans using Brantigan scores, while the clinical outcomes were evaluated using VAS, SF-12, and EQ-5D scores. Out of the patients evaluated at the 12-month FU, 89% showed complete or almost certain fusion (Brantigan score D and E) and presented a significant improvement in all clinical parameters; the patients also presented VAS scores ranging from 6.81 ± 2.01 to 0.85 ± 1.32, EQ-5D scores ranging from 53.4 ± 19.3 to 85.0 ± 13.7, SF-12 physical component scores (PCSs) ranging from 29.35 ± 7.04 to 51.36 ± 9.75, and SF-12 mental component scores (MCSs) ranging from 39.89 ± 11.70 to 53.24 ± 9.24. No mechanical complications related to the implant were detected, and the patients reported a better tolerance of the instrumentation compared with titanium. No other series of patients affected by DD that was stabilized using carbon fiber implants have been reported in the literature. The results of this pilot study indicate the efficacy and safety of these implants and support their use also for spinal degenerative diseases.
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Affiliation(s)
- Riccardo Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Tosini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Lorenzi
- Ortopedia e Traumatologia 3 ad Indirizzo Chirurgia Vertebrale, AOU Città della Salute e della Scienza (Presidio CTO), 10126 Torino, Italy
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20133 Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milano, Italy
| | - Marco Girolami
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valerio Pipola
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Stefano Bandiera
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Silvia Terzi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gisberto Evangelisti
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Annalisa Monetta
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Luigi Emanuele Noli
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Luigi Falzetti
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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4
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Wang YN, Ren YN, Han J, Chen C, Sun X, Di MY, Dou YM, Ma XL, Wang Z, Du CF, Yang Q. Biomechanical effects of screws of different materials on vertebra-pediculoplasty: a finite element study. Front Bioeng Biotechnol 2023; 11:1225925. [PMID: 37456721 PMCID: PMC10340523 DOI: 10.3389/fbioe.2023.1225925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
Background: The effects of cannulated screws made of polyetheretherketone (PEEK) on the biomechanical properties of the vertebral body during vertebra-pediculoplasty remain unclear. This study aimed to investigate whether PEEK screws have the potential to replace titanium alloy screws. Methods: The surgical model of two different materials of screws was constructed using the finite element method. The biomechanical effects of the two models on the vertebral body under different working conditions were compared. Results: ① The peak von Mises stress of PEEK screws was significantly lower than that of titanium screws, with a reduction ranging from 52% to 80%. ② The von Mises stress values for the injured T12 spine were similar for both materials. Additionally, the segmental range of motion and intervertebral disc pressure showed no significant difference between the two materials. Conclusion: PEEK screws demonstrated advantages over titanium screws and may serve as a viable alternative for screw materials in vertebra-pediculoplasty.
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Affiliation(s)
- Yan-Ni Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Ya-Nan Ren
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China
- National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Jun Han
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Chao Chen
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xun Sun
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Ming-Yuan Di
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Yi-Ming Dou
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xin-Long Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zheng Wang
- Department of Orthopaedics, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China
- National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
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Long JR, Kalani MA, Goulding KA, Ashman JB, Flug JA. Carbon-fiber-reinforced polyetheretherketone orthopedic implants in musculoskeletal and spinal tumors: imaging and clinical features. Skeletal Radiol 2023; 52:393-404. [PMID: 35536358 DOI: 10.1007/s00256-022-04069-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) orthopedic implants are gaining popularity in oncologic applications as they offer many potential advantages over traditional metallic implants. From an imaging perspective, this instrumentation allows for improved evaluation of adjacent anatomic structures during radiography, computed tomography (CT), and magnetic resonance imaging (MRI). This results in improved postoperative surveillance imaging quality as well as easier visualization of anatomy for potential image-guided percutaneous interventions (e.g., pain palliation injections, or ablative procedures for local disease control). CFR-PEEK devices are also advantageous in radiation oncology treatment due to their decreased imaging artifact during treatment planning imaging and decreased dose perturbation during radiotherapy delivery. As manufacturing processes for CFR-PEEK materials continue to evolve and improve, potential orthopedic applications in the spine and appendicular skeleton increase. An understanding of the unique properties of CFR-PEEK devices and their impact on imaging is valuable to radiologists delivering care to orthopedic oncology patients in both the diagnostic and interventional settings. This multidisciplinary review aims to provide a comprehensive insight into the radiologic, surgical, and radiation oncology impact of these innovative devices.
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Affiliation(s)
- Jeremiah R Long
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - Maziyar A Kalani
- Department of Neurosurgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Krista A Goulding
- Department of Orthopedic Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Jonathan A Flug
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
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Borrelli S, Putame G, Audenino AL, Bignardi C, Ferro A, Marone S, Terzini M. Cross-link augmentation enhances CFR-PEEK short fixation in lumbar metastasis stabilization. Front Bioeng Biotechnol 2023; 11:1114711. [PMID: 36937770 PMCID: PMC10020173 DOI: 10.3389/fbioe.2023.1114711] [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: 12/02/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction: Spinal stability plays a crucial role in the success of the surgical treatment of lumbar vertebral metastasis and, in current practice, less invasive approaches such as short constructs have been considered. Concurrently, carbon fiber-reinforced (CFR) poly-ether-ether-ketone (PEEK) fixation devices are expanding in oncologic spinal surgery thanks to their radiotransparency and valid mechanical properties. This study attempts to provide an exhaustive biomechanical comparison of different CFR-PEEK surgical stabilizations through a highly reproducible experimental setup. Methods: A Sawbones biomimetic phantom (T12-S1) was tested in flexion, extension, lateral bending, and axial rotation. An hemisome lesion on L3 vertebral body was mimicked and different pedicle screw posterior fixations were realized with implants from CarboFix Orthopedics Ltd: a long construct involving two spinal levels above and below the lesion, and a short construct involving only the levels adjacent to L3, with and without the addition of a transverse rod-rod cross-link; to provide additional insights on its long-term applicability, the event of a pedicle screw loosening was also accounted. Results: Short construct reduced the overloading onset caused by long stabilization. Particularly, the segmental motion contribution less deviated from the physiologic pattern and also the long-chain stiffness was reduced with respect to the prevalent long construct. The use of the cross-link enhanced the short stabilization by making it significantly stiffer in lateral bending and axial rotation, and by limiting mobiliza-tion in case of pedicle screw loosening. Discussion: The present study proved in vitro the biomechanical benefits of cross-link augmentation in short CFR-PEEK fixation, demonstrating it to be a potential alternative to standard long fixation in the surgical management of lumbar metastasis.
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Affiliation(s)
- Simone Borrelli
- PolitoMed Lab, Politecnico di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
- *Correspondence: Simone Borrelli,
| | - Giovanni Putame
- PolitoMed Lab, Politecnico di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Alberto L. Audenino
- PolitoMed Lab, Politecnico di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Cristina Bignardi
- PolitoMed Lab, Politecnico di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Andrea Ferro
- Oncologic Orthopaedic Surgery Division, CTO Hospital—Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Stefano Marone
- Oncologic Orthopaedic Surgery Division, CTO Hospital—Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Mara Terzini
- PolitoMed Lab, Politecnico di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Biomechanical Comparison of Multilevel Lumbar Instrumented Fusions in Adult Spinal Deformity According to the Upper and Lower Fusion Levels: A Finite Element Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2534350. [PMID: 36506913 PMCID: PMC9729043 DOI: 10.1155/2022/2534350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
Multilevel lumbar fusion with posterior pedicle screw fixation is a widely performed surgical procedure for the management of adult spinal deformity. However, there has not been a comprehensive biomechanical study on the different types of fusion levels in terms of stability and possible complications. We aimed to investigate the biomechanical properties of multilevel lumbar fusion according to different types of upper and lower fusion levels. Six different types of fusions were performed using three-dimensional finite element models. Type A and B referred to the group of which upper fusion level was L1 and T10, respectively. Subtype 1, 2, and 3 referred to the group of which lower fusion level was L5, S1, and ilium, respectively (A1, L1-L5; A2, L1-S1; A3, L1-ilium; B1, T10-L5; B2, T10-S1; B3, T10-ilium). Flexion, extension, axial rotation, and lateral bending moments were applied, and the risk of screw loosening and failure and adjacent segment degeneration (ASD) was analyzed. Stress at the bone-screw interface of type B3 was lowest in overall motions. The risk of screw failure showed increasing pattern as the upper and lower levels extended in all motions. Proximal range of motion (ROM) increased as the lower fusion level changed from L5 to S1 and the ilium. For axial rotation, type B3 showed higher proximal ROM (16.2°) than type A3 (11.8°). In multilevel lumbar fusion surgery for adult spinal deformity, adding iliac screws and increasing the fusion level to T10-ilium may lower the risk of screw loosening. In terms of screw failure and proximal ASD, however, T10-ilium fusion has a higher potential risk compared with other fusion types. These results will contribute for surgeons to provide adequate patient education regarding screw failure and proximal ASD, when performing multilevel lumbar fusion.
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Sciubba DM, Pennington Z, Colman MW, Goodwin CR, Laufer I, Patt JC, Redmond KJ, Saylor P, Shin JH, Schwab JH, Schoenfeld AJ. Spinal metastases 2021: a review of the current state of the art and future directions. Spine J 2021; 21:1414-1429. [PMID: 33887454 DOI: 10.1016/j.spinee.2021.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
Spinal metastases are an increasing societal health burden secondary to improvements in systemic therapy. Estimates indicate that 100,000 or more people have symptomatic spine metastases requiring management. While open surgery and external beam radiotherapy have been the pillars of treatment, there is growing interest in more minimally invasive technologies (eg separation surgery) and non-operative interventions (eg percutaneous cementoplasty, stereotactic radiosurgery). The great expansion of these alternatives to open surgery and the prevalence of adjuvant therapeutic options means that treatment decision making is now complex and reliant upon multidisciplinary collaboration. To help facilitate construction of care plans that meet patient goals and expectations, clinical decision aids and prognostic scores have been developed. These have been shown to have superior predictive value relative to more classic prediction models and may become an increasingly important aspect of the clinical practice of spinal oncology. Here we overview current therapeutic advances in the management of spine metastases and highlight emerging areas for research. Given the rapid advancements in surgical technologies and adjuvants, the field is likely to undergo further transformative changes in the coming decade.
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Affiliation(s)
- Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA.
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University School of Medicine, Chicago, IL USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Ilya Laufer
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Joshua C Patt
- Department of Orthopaedic Surgery, Atrium Musculoskeletal Institute, Levine Cancer Institute, Carolinas Medical Center - Atrium Health, Charlotte, NC 28204, USA
| | - Kristin J Redmond
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Philip Saylor
- Department of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard medical School, Boston, MD 02115, USA
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Xie H, Zhang C, Wang R, Tang H, Mu M, Li H, Guo Y, Yang L, Tang K. Femtosecond laser-induced periodic grooves and nanopore clusters make a synergistic effect on osteogenic differentiation. Colloids Surf B Biointerfaces 2021; 208:112021. [PMID: 34450511 DOI: 10.1016/j.colsurfb.2021.112021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/24/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Polyether-ether-ketone (PEEK) materials have good biocompatibility, excellent corrosion resistance, chemical stability and an elastic modulus close to that of natural bone. However, due to its biological inertness, PEEK may affect osteogenic differentiation and leads to osseointegration failure, though PEEK is expected to improve osseointegration. In this work, by changing the power of femtosecond laser, micro-grooves are made on the PEEK surface. As observed by scanning electron microscopy, the trench has a periodic structure, the micro shape is neat, and the trench is also covered with nanometer-level pore clusters. In the in vitro culture experiments, through the proliferation experiment of mouse bone marrow mesenchymalstem cells (mBMSCs), cell viability analysis and alkaline phosphatase activity analysis, it is proven that after femtosecond laser treatment of the PEEK surface, the micro-grooves on the surface and the nanopore clusters due to laser energy ablation can produce a synergistic effect, enhancing the osteogenic differentiation ability of cells, and improving the bone integration ability of PEEK materials.
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Affiliation(s)
- Haiqiong Xie
- Department of Orthopedics/Sports Medicine Center, The First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 400038, PR China; School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065, PR China
| | - Chenke Zhang
- Department of Orthopedics/Sports Medicine Center, The First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 400038, PR China
| | - Rui Wang
- School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065, PR China
| | - Hong Tang
- Department of Orthopedics/Sports Medicine Center, The First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 400038, PR China
| | - Miduo Mu
- Department of Orthopedics/Sports Medicine Center, The First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 400038, PR China
| | - Huaisheng Li
- Department of Orthopedics/Sports Medicine Center, The First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 400038, PR China
| | - Yupeng Guo
- Department of Orthopedics/Sports Medicine Center, The First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 400038, PR China
| | - Liang Yang
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, PR China.
| | - Kanglai Tang
- Department of Orthopedics/Sports Medicine Center, The First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 400038, PR China.
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Murthy NK, Wolinsky JP. Utility of carbon fiber instrumentation in spinal oncology. Heliyon 2021; 7:e07766. [PMID: 34430744 PMCID: PMC8367799 DOI: 10.1016/j.heliyon.2021.e07766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022] Open
Abstract
Spinal oncology has had many advancements often necessitating serial imaging for post-surgical treatment planning and close follow up. Traditional spinal instrumentation introduces artifact into MRI and CT imaging, which can reduce the efficacy of follow up imaging and treatment. Newly created carbon-fiber instrumentation can offer many advantages compared to traditional instrumentation while typically maintaining biomechanical stability. The utility of this new instrumentation continues to evolve as more surgeons utilize these materials, which can improve patient outcomes. We illustrate the utility of this new hardware technology through various patient examples.
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Affiliation(s)
- Nikhil K Murthy
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Jean-Paul Wolinsky
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
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Osterhoff G, Huber FA, Graf LC, Erdlen F, Pape HC, Sprengel K, Guggenberger R. Comparison of metal artifact reduction techniques in magnetic resonance imaging of carbon-reinforced PEEK and titanium spinal implants. Acta Radiol 2021; 63:1062-1070. [PMID: 34229463 DOI: 10.1177/02841851211029077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Carbon-reinforced PEEK (C-FRP) implants are non-magnetic and have increasingly been used for the fixation of spinal instabilities. PURPOSE To compare the effect of different metal artifact reduction (MAR) techniques in magnetic resonance imaging (MRI) on titanium and C-FRP spinal implants. MATERIAL AND METHODS Rod-pedicle screw constructs were mounted on ovine cadaver spine specimens and instrumented with either eight titanium pedicle screws or pedicle screws made of C-FRP and marked with an ultrathin titanium shell. MR scans were performed of each configuration on a 3-T scanner. MR sequences included transaxial conventional T1-weighted turbo spin echo (TSE) sequences, T2-weighted TSE, and short-tau inversion recovery (STIR) sequences and two different MAR-techniques: high-bandwidth (HB) and view-angle-tilting (VAT) with slice encoding for metal artifact correction (SEMAC). Metal artifact degree was assessed by qualitative and quantitative measures. RESULTS There was a much stronger effect on artifact reduction with using C-FRP implants compared to using specific MRI MAR-techniques (screw shank: P < 0.001; screw tulip: P < 0.001; rod: P < 0.001). VAT-SEMAC sequences were able to reduce screw-related signal loss artifacts in constructs with titanium screws to a certain degree. Constructs with C-FRP screws showed less artifact-related implant diameter amplification when compared to constructs with titanium screws (P < 0.001). CONCLUSION Constructs with C-FRP screws are associated with significantly less artifacts compared to constructs with titanium screws including dedicated MAR techniques. Artifact-reducing sequences are able to reduce implant-related artifacts. This effect is stronger in constructs with titanium screws than in constructs with C-FRP screws.
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Affiliation(s)
- Georg Osterhoff
- Department of Trauma, University Hospital Zurich, University Hospital Zurich, Zurich, Switzerland
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Florian A Huber
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Laura C Graf
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Ferdinand Erdlen
- Department of Trauma, University Hospital Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Roman Guggenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
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Prediction of the influence of vertical whole-body vibration on biomechanics of spinal segments after lumbar interbody fusion surgery. Clin Biomech (Bristol, Avon) 2021; 86:105389. [PMID: 34052692 DOI: 10.1016/j.clinbiomech.2021.105389] [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: 02/05/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies have shown that for healthy spine, cyclic loading encountered due to whole-body vibration exposure generated higher responses in spinal tissues than static loading. However, how whole-body vibration affects spine biomechanics after interbody fusion surgery is poorly understood. This study aimed at comparing the effects of vibration loading on spinal segments between postsurgical and healthy lumbar spines. METHODS A validated finite element model of healthy human lumbosacral spine was modified to simulate interbody fusion at L4-L5 level considering the statuses immediately after surgery (before bony fusion) and after bony fusion. Biomechanical responses at its adjacent levels for the healthy and fusion models to a sinusoidal axial vibration load of ±40 N and the corresponding static axal loads (-40 N and 40 N) were computed using transient dynamic and static analyses, respectively. FINDINGS For both healthy and fusion models, vibration amplitudes of the predicted responses were significantly higher than the corresponding changing amplitudes under static loads. Specifically, the increasing effect of vibration load in disc bulge, disc stress and intradiscal pressure at L3-L4 level reached 255.9%, 215.0% and 224.4% for the healthy model, 157.4%, 177.8% and 171.8% for the fusion model (before bony fusion), 141.9%, 152.6% and 160.1% for the fusion model (after bony fusion). INTERPRETATION Although whole-body vibration is still more dangerous for the lumbar spine after interbody fusion surgery than static loading, the sensitivity of adjacent segment in postsurgical spine to vibration loading is decreased compared with healthy spine, especially when reaching to bony fusion.
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Neal MT, Richards AE, Curley KL, Patel NP, Ashman JB, Vora SA, Kalani MA. Carbon fiber-reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes. Neurosurg Focus 2021; 50:E13. [PMID: 33932921 DOI: 10.3171/2021.2.focus20995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to demonstrate the feasibility and advantages of carbon fiber-reinforced PEEK (CFRP) composite implants in patients with both primary and secondary osseous spinal tumors. METHODS Twenty-eight spinal tumor patients who underwent fixation with CFRP hardware were retrospectively identified in a Spine Tumor Quality Database at a single institution. Demographic, procedural, and follow-up data were retrospectively collected. RESULTS The study population included 14 females and 14 males with a mean age of 60 years (range 30-86 years). Five patients had primary bone tumors, and the remaining patients had metastatic tumors. Breast cancer was the most common metastatic tumor. The most common presenting symptom was axial spine pain (25 patients, 89%), and the most common Spine Instability Neoplastic Score was 7 (range 6-14). Two patients in this series had anterior cervical procedures. The remaining patients underwent posterior thoracolumbar fixation. The average fusion length included 4.6 vertebral segments (range 3-8). The mean clinical follow-up time with surgical or oncology teams was 6.5 months (range 1-23 months), and the mean interval for last follow-up imaging (CT or MRI) was 6.5 months (range 1-22 months). Eighteen patients received postoperative radiation at the authors' institution (16 with photon therapy, 2 with proton therapy). Eleven of the patients (39%) in this series died. At the last clinical follow-up, 26 patients (93%) had stable or improved neurological function compared with their preoperative status. At the last imaging follow-up, local disease control was observed in 25 patients (89%). Two patients required reoperation in the immediate postoperative period, one for surgical site infection and the other for compressive epidural hematoma. One patient was noted to have lucencies around the most cephalad screws 3 months after surgery. No hardware fracture or malfunction occurred intraoperatively. No patients required delayed surgery for hardware loosening, fracture, or other failure. Early tumor recurrence was detected in 3 patients. Early detection was attributed to the imaging characteristics of the CFRP hardware. CONCLUSIONS CFRP spinal implants appear to be safe and comparable to conventional titanium implants in terms of functionality. The imaging characteristics of CFRP hardware facilitate radiation planning and assessment of surveillance imaging. CFRP hardware may enhance safety and efficacy, particularly with particle therapy dosimetry. Larger patient populations with longer-term follow-up are needed to confirm the various valuable aspects of CFRP spinal implants.
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Affiliation(s)
| | | | | | | | | | - Sujay A Vora
- 2Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
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Pennington Z, Ehresman J, McCarthy EF, Ahmed AK, Pittman PD, Lubelski D, Goodwin CR, Sciubba DM. Chordoma of the sacrum and mobile spine: a narrative review. Spine J 2021; 21:500-517. [PMID: 33589095 DOI: 10.1016/j.spinee.2020.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
Chordoma is a notochord-derived primary tumor of the skull base and vertebral column known to affect 0.08 to 0.5 per 100,000 persons worldwide. Patients commonly present with mechanical, midline pain with or without radicular features secondary to nerve root compression. Management of these lesions has classically revolved around oncologic resection, defined by en bloc resection of the lesion with negative margins as this was found to significantly improve both local control and overall survival. With advancement in radiation modalities, namely the increased availability of focused photon therapy and proton beam radiation, high-dose (>50 Gy) neoadjuvant or adjuvant radiotherapy is also becoming a standard of care. At present chemotherapy does not appear to have a role, but ongoing investigations into the ontogeny and molecular pathophysiology of chordoma promise to identify therapeutic targets that may further alter this paradigm. In this narrative review we describe the epidemiology, histopathology, diagnosis, and treatment of chordoma.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA.
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Verma S, Sharma N, Kango S, Sharma S. Developments of PEEK (Polyetheretherketone) as a biomedical material: A focused review. Eur Polym J 2021. [DOI: 10.1016/j.eurpolymj.2021.110295] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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