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He X, Li Y, Zou D, Zu H, Li W, Zheng Y. An overview of magnesium-based implants in orthopaedics and a prospect of its application in spine fusion. Bioact Mater 2024; 39:456-478. [PMID: 38873086 PMCID: PMC11170442 DOI: 10.1016/j.bioactmat.2024.04.026] [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: 12/29/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 06/15/2024] Open
Abstract
Due to matching biomechanical properties and significant biological activity, Mg-based implants present great potential in orthopedic applications. In recent years, the biocompatibility and therapeutic effect of magnesium-based implants have been widely investigated in trauma repair. In contrast, the R&D work of Mg-based implants in spinal fusion is still limited. This review firstly introduced the general background for Mg-based implants. Secondly, the mechanical properties and degradation behaviors of Mg and its traditional and novel alloys were reviewed. Then, different surface modification techniques of Mg-based implants were described. Thirdly, this review comprehensively summarized the biological pathways of Mg degradation to promote bone formation in neuro-musculoskeletal circuit, angiogenesis with H-type vessel formation, osteogenesis with osteoblasts activation and chondrocyte ossification as an integrated system. Fourthly, this review followed the translation process of Mg-based implants via updating the preclinical studies in fracture fixation, sports trauma repair and reconstruction, and bone distraction for large bone defect. Furthermore, the pilot clinical studies were involved to demonstrate the reliable clinical safety and satisfactory bioactive effects of Mg-based implants in bone formation. Finally, this review introduced the background of spine fusion surgeryand the challenges of biological matching cage development. At last, this review prospected the translation potential of a hybrid Mg-PEEK spine fusion cage design.
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Affiliation(s)
- Xuan He
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Ye Li
- Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hong Kong SAR, PR China
| | - Da Zou
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Haiyue Zu
- Department of Orthopaedics, The First Affiliated Hospital of Suchow University, PR China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Comprehensive Scientific Research Building, Beijing, PR China
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Kwon JW, Lee YH, Lee BH, Kim JH, Suk KS. Clinical and radiological outcomes of non-window-type bioactive glass-ceramic cage in single-level ACDF versus PEEK cage filled with autologous bone. Sci Rep 2024; 14:4035. [PMID: 38369553 PMCID: PMC10874951 DOI: 10.1038/s41598-024-54786-3] [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] [Received: 09/04/2023] [Accepted: 02/16/2024] [Indexed: 02/20/2024] Open
Abstract
Bioactive glass-ceramic (BGC) cage is a substitute for polyether ether ketone (PEEK) cages in anterior cervical discectomy and fusion (ACDF). Only a few comparative studies exist using PEEK and non-window-type BGC cages (CaO-SiO2-P2O5-B2O3) in single-level ACDF. This study compared PEEK cages filled with autologous iliac bone grafts and BGC cages regarding clinical safety and effectiveness. A retrospective case series was performed on 40 patients who underwent single-level ACDF between October 2020 and July 2021 by a single orthopedic spine surgeon. The spacers used in each ACDF were a PEEK cage with a void filled with an autologous iliac bone graft and a non-window-type BGC cage in 20 cases. The grafts were compared pre-operatively and post-operatively at 6 weeks and 3, 6, and 12 months. Post-operative complications were investigated in each group. Clinical outcome was measured, including Visual Analog Scale (VAS) scores of neck and arm pains, Japanese Orthopedic Association score (JOA), and Neck Disability Index (NDI). Dynamic lateral radiographs were used to assess the inter-spinous motion (ISM) between the fusion segment and subsidence. The fusion status was evaluated using a computed tomography (CT) scan. Overall, 39 patients (19 and 20 patients in the PEEK and BGC groups, respectively) were recruited. Eighteen (94.7%) and 19 (95.0%) patients in the PEEK and BGC groups, respectively, were fused 12 months post-operatively, as assessed by ISM in dynamic lateral radiograph and bone bridging formation proven in CT scan. The PEEK and BGC groups showed substantial improvement in neck and arm VAS, JOA, and NDI scores. No substantial difference was found in clinical and radiological outcomes between the PEEK and BGC groups. However, the operation time was considerably shorter in the BGC group than in the PEEK group. In conclusion, a non-window-type BCG cage is a feasible substitute for a PEEK cage with an autologous iliac bone graft in single-level ACDF.
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Affiliation(s)
- Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Yong Ho Lee
- Department of Orthopedic Surgery, Yonsei Baro-Chuk Hospital, Seoul, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Jae Hong Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Kyung Soo Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea.
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Jain A, Dhanjani S, Harris A, Cartagena M, Babu J, Riew D, Shin J, Wang JC, Yoon ST, Buser Z, Meisel HJ. Structural Allograft Versus Mechanical Interbody Devices Augmented With Osteobiologics in Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J 2024; 14:34S-42S. [PMID: 38421329 PMCID: PMC10913916 DOI: 10.1177/21925682231171857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic Literature Review. OBJECTIVE Perform a systematic review evaluating postoperative fusion rates for anterior cervical discectomy and fusion (ACDF) using structural allograft vs various interbody devices augmented with different osteobiologic materials. METHODS Comprehensive literature search using PubMed, Embase, The Cochrane Library, and Web of Science was performed. Included studies were those that reported results of 1-4 levels ACDF using pure structural allograft compared with a mechanical interbody device augmented with an osteobiologic. Excluded studies were those that reported on ACDF with cervical corpectomy; anterior and posterior cervical fusions; circumferential (360° or 540°) fusion or revision ACDF for nonunion or other conditions. Risk of bias was determined using the Cochrane review guidelines. RESULTS 8 articles reporting fusion rates of structural allograft and an interbody device/osteobiologic pair were included. All included studies compared fusion rates following ACDF among structural allograft vs non-allograft interbody device/osteobiologic pairs. Fusion rates were reported between 84% and 100% for structural allograft, while fusion rates for various interbody device/osteobiologic combinations ranged from 26% to 100%. Among non-allograft cage groups fusion rates varied from 73-100%. One study found PEEK cages filled with combinations of autograft, allograft, and demineralized bone matrix (DBM) to have an overall fusion rate of 26%. In one study comparing plate and zero-profile constructs, there was no difference in fusion rates for two-level fusions. CONCLUSION There was limited data comparing fusion outcomes of patients undergoing ACDF using structural allograft vs interbody devices augmented with osteobiologic materials to support superiority of one method.
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Affiliation(s)
- Amit Jain
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Andrew Harris
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Jacob Babu
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Daniel Riew
- Weill Cornell Brain and Spine Center, New York, NY, USA
| | - John Shin
- Mass General Brigham Inc, Boston, MA, USA
| | | | - S Tim Yoon
- Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Wei L, Sulian L, Tonglian L, Yan Z, Zongchao L. Anterior Cervical Spine Surgery Complicated With Dysphagia. Orthop Nurs 2023; 42:297-303. [PMID: 37708527 DOI: 10.1097/nor.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Anterior cervical spine surgery is a common type of neck surgery in orthopaedics. Swallowing disorder is one of the most common complications after surgery. It is characterized by food entering the esophagus from the mouth through the pharynx. The process of reaching the stomach is hampered and leads to increases in a range of risk factors that affect the health of the patient. This article reviews relevant literature reports from recent years retrieved from various national and international medical databases, aiming to find more economical, effective, and simple perioperative nursing strategies for patients with cervical anterior surgery through evidence-based thinking and methods, with the aim of developing a personalized care model that is easy to implement and has a long-lasting effect and a wide range of rehabilitation benefits to better serve patients.
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Affiliation(s)
- Liu Wei
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Li Sulian
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Li Tonglian
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Zhang Yan
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Liu Zongchao
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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Lv ZT, Xu Y, Cao B, Dai J, Zhang SY, Huang JM, Liang S, Jiang FX. Titanium-coated PEEK Versus Uncoated PEEK Cages in Lumbar Interbody Fusion: A Systematic Review and Meta-analysis of Randomized Controlled Trial. Clin Spine Surg 2023; 36:198-209. [PMID: 35994033 PMCID: PMC10231928 DOI: 10.1097/bsd.0000000000001378] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE This study was performed to compare the fusion and subsidence rate of titanium-coated polyetheretherketone (Ti-PEEK) versus polyetheretherketone (PEEK) cages after lumbar fusion and to investigate the clinical effect on patient-reported outcomes (PROMs). SUMMARY OF BACKGROUND DATA Ti-PEEK cages have been developed to combine the advantages of both titanium alloy and PEEK, but whether they are superior to uncoated PEEK cages in bone fusion is still inconclusive. METHODS PubMed, EMBASE, ISI Web of Science, CENTRAL, and CNKI were searched to identify randomized controlled trials that compared the efficacy of Ti-PEEK and PEEK cages in lumbar fusion. Difference in fusion rate and subsidence rate was indicated by risk ratio and its associated 95% confidence interval (95% confidence interval). Mean difference was calculated for Oswestry Disability Index and visual analogue scale for low back pain. Subgroup analysis was performed by time course after the surgery. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to evaluate the certainty of evidence. RESULTS Four randomized controlled trials involving 325 patients (160 patients in Ti-PEEK group and 165 patients in PEEK group) that underwent lumbar fusion were included by our current study. Low to moderate evidence suggested that Ti-PEEK and PEEK cages exhibited equivalent fusion rate and subsidence rate at any follow-up time. Low to moderate evidence suggested that there was no difference in PROMs except for visual analogue scale measured at 6 months (mean difference: -0.57, 95% confidence interval -0.94, -0.21; P =0.002) but the difference was not clinically relevant according to the minimal clinically important difference. CONCLUSION Low to moderate evidence showed that Ti-PEEK and PEEK had equivalent effect in bone fusion and cages subsidence at any follow-up time after lumbar fusion surgeries. Low to moderate evidence showed no clinically important difference in PROMs.
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Affiliation(s)
- Zheng-tao Lv
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Yong Xu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Bin Cao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University
| | - Jun Dai
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou
| | - Si-yuan Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou
| | - Jun-ming Huang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuang Liang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Feng-xian Jiang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou
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Mobbs RJ, Amin T, Ho D, McEvoy A, Lovric V, Walsh WR. Integral fixation titanium/polyetheretherketone cages for cervical arthrodesis: Two-year clinical outcomes and fusion rates using β-tricalcium phosphate or supercritical carbon dioxide treated allograft. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:368-375. [PMID: 35068818 PMCID: PMC8740808 DOI: 10.4103/jcvjs.jcvjs_129_21] [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: 10/09/2021] [Accepted: 11/06/2021] [Indexed: 11/13/2022] Open
Abstract
Context: Despite increasing promising reports regarding composite titanium (Ti)/PolyEtherEtherKetone (PEEK) cages, further longer-term, quality research is required. Synthetic bone graft substitutes are another rapidly developing area of spinal surgical research. Aims: The purpose of this study is to evaluate the outcomes of an integral fixation composite Ti/PEEK cage for anterior cervical discectomy and fusion (ACDF) and compare a synthetic bone graft substitute (β-tricalcium phosphate; [βTCP]) with allograft processed using supercritical fluid technology. Methods and Design: Data from 195 consecutive patients were prospectively collected from a single centre. Indications were largely degenerative. Allograft and βTCP were used in a 3:1 randomization protocol. Patients were followed up for a minimum of 6 months and up to 48 months. Clinical outcomes included visual analogue scale and neck oswestry disability index. Radiographic outcomes included fusion rates, subsidence rates and implant complications. Results: Graft sub-cohorts were largely comparable and included 133 and 52 patients in the allograft and βTCP sub-cohorts, respectively. Clinical outcomes overall significantly improved (P < 0.001), with no significant inter-cohort differences. There were no implant-related complications. Overall fusion rate was 94.1% (175/186). The allograft cohort produced a significantly greater fusion rate of 97.7% (126/129) compared to 77.6% (38/49) for the βTCP cohort (P = 0.001). Conclusions: This study demonstrates the viability of an integral fixation composite Ti/PEEK ACDF device in effectively and safely improving patient outcomes and achieving fusion. Allograft is more effective in achieving fusion compared to βTCP, though both were similarly efficacious in improving clinical outcomes.
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Affiliation(s)
- Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, UNSW Sydney, Australia.,Prince of Wales Clinical School, UNSW Sydney, Australia.,Surgical and Orthopaedic Research Labs (SORL), Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
| | - Tajrian Amin
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, UNSW Sydney, Australia.,Prince of Wales Clinical School, UNSW Sydney, Australia
| | - Daniel Ho
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, UNSW Sydney, Australia.,Prince of Wales Clinical School, UNSW Sydney, Australia
| | - Aidan McEvoy
- Matrix Medical Innovations, Randwick, Sydney, Australia
| | - Vedran Lovric
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Surgical and Orthopaedic Research Labs (SORL), Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
| | - William R Walsh
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Surgical and Orthopaedic Research Labs (SORL), Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
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Bhat S, Uthappa UT, Altalhi T, Jung HY, Kurkuri MD. Functionalized Porous Hydroxyapatite Scaffolds for Tissue Engineering Applications: A Focused Review. ACS Biomater Sci Eng 2021; 8:4039-4076. [PMID: 34499471 DOI: 10.1021/acsbiomaterials.1c00438] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biomaterials have been widely used in tissue engineering applications at an increasing rate in recent years. The increased clinical demand for safe scaffolds, as well as the diversity and availability of biomaterials, has sparked rapid interest in fabricating diverse scaffolds to make significant progress in tissue engineering. Hydroxyapatite (HAP) has drawn substantial attention in recent years owing to its excellent physical, chemical, and biological properties and facile adaptable surface functionalization with other innumerable essential materials. This focused review spotlights a brief introduction on HAP, scope, a historical outline, basic structural features/properties, various synthetic strategies, and their scientific applications concentrating on functionalized HAP in the diverse area of tissue engineering fields such as bone, skin, periodontal, bone tissue fixation, cartilage, blood vessel, liver, tendon/ligament, and corneal are emphasized. Besides clinical translation aspects, the future challenges and prospects of HAP based biomaterials involved in tissue engineering are also discussed. Furthermore, it is expected that researchers may find this review expedient in gaining an overall understanding of the latest advancement of HAP based biomaterials.
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Affiliation(s)
- Shrinath Bhat
- Centre for Nano and Material Sciences, Jain University, Jain Global Campus, Bengaluru 562112, Karnataka, India
| | - U T Uthappa
- Centre for Nano and Material Sciences, Jain University, Jain Global Campus, Bengaluru 562112, Karnataka, India.,Department of Environment and Energy Engineering, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Tariq Altalhi
- Department of Chemistry, College of Science, Taif University, P. O. Box 11099, Taif 21944, Saudi Arabia
| | - Ho-Young Jung
- Department of Environment and Energy Engineering, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Mahaveer D Kurkuri
- Centre for Nano and Material Sciences, Jain University, Jain Global Campus, Bengaluru 562112, Karnataka, India
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Lo WC, Tsai LW, Yang YS, Chan RWY. Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies. Int J Mol Sci 2021; 22:3638. [PMID: 33807361 PMCID: PMC8037583 DOI: 10.3390/ijms22073638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
Transforaminal lumber interbody fusion (TLIF) is the last resort to address the lumber degenerative disorders such as spondylolisthesis, causing lower back pain. The current surgical intervention for these abnormalities includes open TLIF. However, in recent years, minimally invasive TLIF (MIS-TLIF) has gained a high momentum, as it could minimize the risk of infection, blood loss, and post-operative complications pertaining to fusion surgery. Further advancement in visualizing and guiding techniques along with grafting cage and materials are continuously improving the safety and efficacy of MIS-TLIF. These assistive techniques are also playing a crucial role to increase and improve the learning curve of surgeons. However, achieving an appropriate output through TLIF still remains a challenge, which might be synergized through 3D-printing and tissue engineering-based regenerative therapy. Owing to their differentiation potential, biomaterials such as stem/progenitor cells may contribute to restructuring lost or damaged tissues during MIS-TLIF, and this therapeutic efficacy could be further supplemented by platelet-derived biomaterials, leading to improved clinical outcomes. Thus, based on the above-mentioned strategies, we have comprehensively summarized recent developments in MIS-TLIF and its possible combinatorial regenerative therapies for rapid and long-term relief.
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Affiliation(s)
- Wen-Cheng Lo
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Lung-Wen Tsai
- Department of Medical Education and Research, Taipei Medical University Hospital, Taipei 11031, Taiwan;
| | - Yi-Shan Yang
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Ryan Wing Yuk Chan
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
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9
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Yang C, Zhuo W, Li Q, Huang C, Yan H, Jin D. Preliminary outcomes of allograft and hydroxyapatite as substitutes for autograft in anterior cervical discectomy and fusion with self-locking standalone cages. J Orthop Surg Res 2021; 16:123. [PMID: 33557893 PMCID: PMC7869215 DOI: 10.1186/s13018-021-02257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/20/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose To investigate the efficacy and safety of allograft and hydroxyapatite (HA) as substitutes for autograft in anterior cervical discectomy and fusion (ACDF). Methods In this study, 49 patients (80 segments) treated with ACDF were included and allocated into three groups [group A, autogenous iliac bone, n = 18; group B, allogeneic bone, n = 16; group C, HA, n = 15]. The clinical efficacy and fusion status were compared among each group. Complications were recorded in detail, and the Bazaz classification and Voice Handicap Index-10 (VHI-10) were used to detect dysphagia and dysphonia. Results Patients exhibited similar clinical efficacy among the groups during the final follow-up. All patients in groups A and B achieved fusion compared to only 73.3% of patients in group C. Groups A and B had similar fusion score, both of which greater than that of group C. No cage subsidence was observed in group A; however, 6.3% of patients in group B and 53.3% in group C had cage subsidence. Two patients in group A (11.1%) had persistent pain at the donor site. One patient in group B had dysphagia and dysphonia (6.3%), while one patient in group C had dysphonia (6.7%). Conclusion In ACDF, the autogenous iliac bone was the most ideal bone graft. The allogeneic bone was an acceptable substitute but risked cage subsidence and dysphagia. HA had a much lower fusion rate and a high risk of cage subsidence. Better substitutes should be further explored for ACDF.
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Affiliation(s)
- Changsheng Yang
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Wentao Zhuo
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Qingchu Li
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Caiqiang Huang
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Huibo Yan
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dadi Jin
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
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10
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Abedi A, Formanek B, Russell N, Vizesi F, Boden SD, Wang JC, Buser Z. Examination of the Role of Cells in Commercially Available Cellular Allografts in Spine Fusion: An in Vivo Animal Study. J Bone Joint Surg Am 2020; 102:e135. [PMID: 33079897 DOI: 10.2106/jbjs.20.00330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the extensive use of cellular bone matrices (CBMs) in spine surgery, there is little evidence to support the contribution of cells within CBMs to bone formation. The objective of this study was to determine the contribution of cells to spinal fusion by direct comparisons among viable CBMs, devitalized CBMs, and cell-free demineralized bone matrix (DBM). METHODS Three commercially available grafts were tested: a CBM containing particulate DBM (CBM-particulate), a CBM containing DBM fibers (CBM-fiber), and a cell-free product with DBM fibers only (DBM-fiber). CBMs were used in viable states (CBM-particulatev and CBM-fiberv) and devitalized (lyophilized) states (CBM-particulated and CBM-fiberd), resulting in 5 groups. Viable cell counts and bone morphogenetic protein-2 (BMP-2) content on enzyme-linked immunosorbent assay (ELISA) within each graft material were measured. A single-level posterolateral lumbar fusion was performed on 45 athymic rats with 3 lots of each product implanted into 9 animals per group. After 6 weeks, fusion was assessed using manual palpation, micro-computed tomography (μ-CT), and histological analysis. RESULTS The 2 groups with viable cells were comparable with respect to cell counts, and pairwise comparisons showed no significant differences in BMP-2 content across the 5 groups. Manual palpation demonstrated fusion rates of 9 of 9 in the DBM-fiber specimens, 9 of 9 in the CBM-fiberd specimens, 8 of 9 in the CBM-fiberv specimens, and 0 of 9 in both CBM-particulate groups. The μ-CT maturity grade was significantly higher in the DBM-fiber group (2.78 ± 0.55) compared with the other groups (p < 0.0001), while none of the CBM-particulate samples demonstrated intertransverse fusion in qualitative assessments. The viable and devitalized samples in each CBM group were comparable with regard to fusion rates, bone volume fraction, μ-CT maturity grade, and histological features. CONCLUSIONS The cellular component of 2 commercially available CBMs yielded no additional benefits in terms of spinal fusion. Meanwhile, the groups with a fiber-based DBM demonstrated significantly higher fusion outcomes compared with the CBM groups with particulate DBM, indicating that the DBM component is probably the key determinant of fusion. CLINICAL RELEVANCE Data from the current study demonstrate that cells yielded no additional benefit in spinal fusion and emphasize the need for well-designed clinical studies on cellular graft materials.
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Affiliation(s)
- Aidin Abedi
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Blake Formanek
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | - Scott D Boden
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Anterior Cervical Arthrodesis With Polyetheretherketone Spacers: What is the Role of the Grafting Material? Clin Spine Surg 2020; 33:E539-E544. [PMID: 32324673 DOI: 10.1097/bsd.0000000000000995] [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: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study of 2 surgeons' use of a single polyetheretherketone (PEEK) device. OBJECTIVE Our objective was to investigate the fusion adjunct placed within PEEK devices to examine the likelihood of an arthrodesis, regardless of the PEEK interbody device itself. SUMMARY OF BACKGROUND DATA The effectiveness of PEEK interbody devices in anterior cervical arthrodesis has been questioned. METHODS The authors retrospectively reviewed the results of 121 patients with demineralized bone matrix (DBM) and 96 with local autograft bone placed within identical PEEK devices for anterior cervical arthrodesis (from 2011 to 2018); 1 surgeon used DBM and another local autograft bone. Arthrodesis was determined independently by a surgeon and 2 blinded neuroradiologists. RESULTS For DBM versus autograft; mean age was 60 versus 61 years, smoking status 42.1% versus 31%, diabetes mellitus 18.2% versus 28%, mean body mass index 31 versus 30, and follow up averaged 17 months in both groups. For DBM versus autograft; a radiographic arthrodesis was observed in 22.3% versus 76% of patients. Refusion at the index level was required in 5.8% of the DBM and 0% of the autograft patients. CONCLUSIONS A PEEK interbody device filled with local autograft resulted in a higher radiographic fusion rate and a lower need for reoperation at the index level than an identical device filled with DBM. Caution is warranted in assigning fusion failure to the PEEK device alone in anterior cervical discectomy and fusion surgery.
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Chen D, Shao MM, Wang XY, Li YM, Wu AM. Current strategies of reduce the rate of dysphagia and dysphonia after anterior cervical spine surgery and role of corticosteroids. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:S99. [PMID: 30740420 DOI: 10.21037/atm.2018.11.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dong Chen
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, the Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, China
| | - Min-Min Shao
- Department of Otolaryngology-Head and Neck Surgery, Wenzhou Center Hospital, Dingli Hospital of Wenzhou Medical University, The Dingli School of Medicine Wenzhou Medical University, Wenzhou 325027, China
| | - Xiang-Yang Wang
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, the Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, China
| | - Yan Michael Li
- Department of Neurosurgery and Oncology, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, USA
| | - Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, the Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, China.,Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
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