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Jia C, Zhang R, Wang J, Zhang B, Zhang H, Kang L, Zhou L, Shen C. Biomechanical Study of 3 Osteoconductive Materials Applied in Pedicle Augmentation and Revision for Osteoporotic Vertebrae: Allograft Bone Particles, Calcium Phosphate Cement, Demineralized Bone Matrix. Neurospine 2023; 20:1407-1420. [PMID: 38171307 PMCID: PMC10762407 DOI: 10.14245/ns.2346760.380] [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: 07/18/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This study assessed biomechanical properties of pedicle screws enhanced or revised with 3 materials. We aimed to compare the efficacy of these materials in pedicle augmentation and revision. METHODS One hundred twenty human cadaveric vertebrae were utilized for in vitro testing. Vertebrae bone density was evaluated. Allograft bone particles (ABP), calcium phosphate cement (CPC), and demineralized bone matrix (DBM) were used to augment or revise pedicle screw. Post the implantation of pedicle screws, parameters such as insertional torque, pullout strength, cycles to failure and failure load were measured using specialized instruments. RESULTS ABP, CPC, and DBM significantly enhanced biomechanical properties of the screws. CPC augmentation showed superior properties compared to ABP or DBM. ABP-augmented screws had higher cycles to failure and failure loads than DBM-augmented screws, with no difference in pullout strength. CPC-revised screws exhibited similar strength to the original screws, while ABP-revised screws showed comparable cycles to failure and failure loads but lower pullout strength. DBM-revised screws did not match the original screws' strength. CONCLUSION ABP, CPC, and DBM effectively improve pedicle screw stability for pedicle augmentation. CPC demonstrated the highest efficacy, followed by ABP, while DBM was less effective. For pedicle revision, CPC is recommended as the primary choice, with ABP as an alternative. However, using DBM for pedicle revision is not recommended.
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Affiliation(s)
- Chongyu Jia
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Renjie Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiaqi Wang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bo Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huaqing Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liang Kang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Luping Zhou
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cailiang Shen
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Narendran N, Nilssen PK, Walker CT, Skaggs DL. New technique and case report: Robot-assisted intralaminar screw fixation of spondylolysis in an adolescent. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100284. [PMID: 38025938 PMCID: PMC10654584 DOI: 10.1016/j.xnsj.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023]
Abstract
Introduction Management of spondylolysis in adolescents is generally successful with conservative management. Uncommonly, surgical fixation is necessary for refractory cases. Direct repair with intralaminar screws is one commonly utilized technique. Recently, less invasive spinal procedures are becoming viable with the enabling of technologies, including robotics. Case description A 14-year-old baseball player and surfer presented with low back pain, diagnosed by MRI as bony edema and stress fractures of the posterior spinal elements. After 18 months, the pain was unresponsive to rest, physical therapy, and bracing. There was no radicular pain or neurologic symptoms. Computed tomography (CT) revealed bilateral, chronic nonhealing pars defects at L5. He underwent outpatient, robot-assisted percutaneous intralaminar fixation with hydroxyapatite-coated screws through a 2 cm skin incision. Outcome On postoperative day 1, the patient reported relief of his preoperative pain and he was ambulating without difficulty. At 2 weeks follow-up, the patient was completely pain free and surfing. At 2 months follow-up, low-dose CT demonstrated partial incorporation of the hydroxyapatite-coated screws, and the patient returned to sports. At 6 months follow-up, the patient had no pain and was swinging his baseball bat with full force. Low-dose CT revealed complete healing of the defects with full incorporation of the hydroxyapatite-coated screws. Conclusions A novel minimally invasive robotic percutaneous approach for direct spondylolysis repair using hydroxyapatite-coated screws is a potential surgical treatment option for non-healing pars defects in adolescent patients.
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Affiliation(s)
- Nakul Narendran
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - Paal K. Nilssen
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - Corey T. Walker
- Department of Neurosurgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - David L. Skaggs
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
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Wang Y, Yang L, Li C, Sun H. A Biomechanical Study on Cortical Bone Trajectory Screw Fixation Augmented With Cement in Osteoporotic Spines. Global Spine J 2023; 13:2115-2123. [PMID: 35042407 PMCID: PMC10538326 DOI: 10.1177/21925682211070826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN A biomechanical study. OBJECTIVE To evaluate the efficacy and feasibility of cement-augmented cortical bone trajectory (CBT) screw fixation. METHODS Forty-nine CBT screws were inserted into lumbar vertebrae guided by three-dimensionally printed templates, and then injected with 0, .5, or 1.0 mL of polymethylmethacrylate. The screw placement accuracy, cement dispersion, and cement leakage rate were evaluated radiologically. Biomechanical tests were performed to measure the axial pull-out strength and torque value. RESULTS Overall, 83.67% of the screws were inserted without pedicle perforation. In the 1.0 mL group, cement dispersed into the pedicle zone and formed a concentrated mass more often than in the .5 mL group, but not significantly more often (P > .05). The total cement leakage rate was 18.75%. Compared with the control group, the torque value was slightly higher in the .5 mL group (P = .735) and significantly higher in the 1.0 mL group (P = .026). However, there was no significant difference between the .5 and 1.0 mL groups (P = .431). The maximal pull-out force (Fmax) was increased by 52.85% and 72.73% in the .5 and 1.0 mL groups, respectively, compared with the control group (P < .05). However, the difference was not significant between the 2 cemented groups (P = .985). CONCLUSIONS Cement augmentation is a useful method for increasing CBT screw stability in osteoporotic spines. The cement injection volume is recommended to be 1 mL for each screw, and the cement should disperse into the vertebral body than the pedicle zones.
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Affiliation(s)
- Yuetian Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Lei Yang
- Center for Health Science and Engineering (CHSE), School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, China
| | - Chunde Li
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Haolin Sun
- Department of Orthopedics, Peking University First Hospital, Beijing, China
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Nagashima K, Hara Y, Mutsuzaki H, Totoki Y, Okano E, Mataki K, Matsumoto Y, Yanagisawa Y, Noguchi H, Sogo Y, Ito A, Koda M, Yamazaki M. Clinical Trial for the Safety and Feasibility of Pedicle Screws Coated with a Fibroblast Growth Factor-2-Apatite Composite Layer for Posterior Cervical Fusion Surgery. J Clin Med 2023; 12:jcm12030947. [PMID: 36769595 PMCID: PMC9917677 DOI: 10.3390/jcm12030947] [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: 12/14/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
To solve the instrument loosening problem, we developed a fibroblast growth factor-2-calcium phosphate composite layer as a novel coating material to improve screw fixation strength. The primary aim of the present study was to demonstrate the safety and feasibility of screws coated with the FGF-2-calcium phosphate composite layer for posterior instrumented surgery of the cervical spine. The trial design was a single-arm, open-label, safety and feasibility study. Patients receiving fusion of the cervical spine from C2 (or C3) to C7 (or T1) were recruited. The primary endpoint to confirm safety was any screw-related adverse events. Seven patients who underwent posterior fusion surgery of the cervical spine were enrolled in the present study. The coated pedicle screws were inserted bilaterally into the lowest instrumented vertebrae. There was only one severe adverse event unrelated with the coated screw. Three out of the fourteen coated screws showed loosening. The present results prove the safety and feasibility of pedicle screws coated with the FGF-2-calcium phosphate composite layer for fusion surgery in the cervical spine. This is the first step to apply this novel surface coating in the field of spine surgery.
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Affiliation(s)
- Katsuya Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yuki Hara
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
| | - Yasukazu Totoki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Eriko Okano
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Kentaro Mataki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yukei Matsumoto
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yohei Yanagisawa
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yu Sogo
- Technology Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba 305-8560, Japan
| | - Atsuo Ito
- Technology Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba 305-8560, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
- Correspondence:
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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Kato G, Baba S, Kawaguchi K, Watanabe T, Mae T, Tomari S. Perpendicular probing and screwing technique: A simple method for accurate pedicle screw placement based on the human internal reference frame for angle estimation. PLoS One 2022; 17:e0277229. [PMID: 36441680 PMCID: PMC9704603 DOI: 10.1371/journal.pone.0277229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/22/2022] [Indexed: 11/29/2022] Open
Abstract
The pedicle screw (PS) is widely used for spinal fixation surgery. However, PS malpositioning can cause critical complications; thus, the accuracy of ascertaining PS trajectory is paramount. This study aimed to demonstrate the accuracy and safety of a simple and cost-effective PS placement technique using a human internal reference frame for angle estimation. Ex vivo lumbar porcine spine samples were fixed to a wooden board with rostrocaudal and mediolateral rotational angles adjusted by two angle vises. PS entry points (EPs) were identified using clear anatomical vertebral landmarks. PS placement was performed on one side using the perpendicular probing and screwing technique (PPST), wherein the attitude angle of the sample was adjusted such that the longitudinal axis of the target pedicle was perpendicular to the ground. The pedicle probe and PS driver were manually maintained perpendicular to the ground during probing and PS placement. PS placement on the contralateral side was performed freehand as a control. Offsets between the preoperatively planned and implanted PS rotational angles measured using computed tomography for PPST and freehand method were analyzed. Pedicle wall penetration was also evaluated. The mean ± standard error of the medial rotational offsets was 5.83° ± 0.57° in the freehand group versus 2.89° ± 0.31° in the PPST group (p <0.001), and the rostrocaudal rotational offsets were 4.81° ± 0.65° in the freehand group versus 2.92° ± 0.45° in the PPST group (p = 0.01). The mean pedicle wall penetration distance was significantly reduced by PPST (0.28 ± 0.12 mm vs 0.80 ± 0.17 mm in the freehand group, p = 0.0071). Thus, PPST improved PS positioning accuracy, resulting in reduced pedicle wall penetration and increased PS placement safety. This simple technique is also potentially cost-effective for institutions without computer-assisted surgical systems.
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Affiliation(s)
- Go Kato
- Department of Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
- * E-mail:
| | - Satoshi Baba
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
| | - Kenichi Kawaguchi
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takeshi Watanabe
- Department of Orthopedic Surgery, Watanabe Orthopedic Hospital, Fukuoka, Japan
| | - Takao Mae
- Department of Orthopedic Surgery, Saga Medical Center, Koseikan, Saga, Japan
| | - Shinji Tomari
- Department of Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
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The effect of hydroxyapatite on titanium pedicle screw resistance: an electrical model. Spine J 2022; 22:869-876. [PMID: 34813959 DOI: 10.1016/j.spinee.2021.11.009] [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: 03/24/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intraoperative detection of a pedicle wall breach implicitly reduces surgical risk, but the reliability of intraoperative neuromonitoring has been contested. Hydroxyapatite (HA) has been promulgated to increase pedicle screw resistance and negatively influence the accuracy of electromyography. PURPOSE The primary purpose of this experiment is to evaluate the effect of HA on pedicle screw electrical resistance using a controlled laboratory model. STUDY DESIGN Controlled laboratory study. METHODS Stimulation of pedicle screws was performed in normal saline (0.9% NaCl). The experimental group included 8 HA coated (HAC) pedicle screws and matched manufacturer control pedicle screws without HAC (Ti6Al4V). All screws were stimulated at 5, 10-, 15-, 20-, and 25-mm submersion depths. Circuit current return was recorded, and pedicle screw electrical resistance was calculated according to Ohm's Law. Data were assessed for normality and variance. Mann-Whitney U and Kruskal-Wallis tests compared groups with Bonferroni correction for multiple testing. Effect size is reported with 95% confidence intervals (95CI). p values <.05 were considered significant. RESULTS Current return was detected for all screws (N=24) following subclinical 8.5 µA stimulation at 5, 10-, 15-, 20-, and 25-mm submersion depths (N=144). The effect estimate of HA on pedicle screw electrical resistance is -0.07 (-0.17 to 0.01 95CI). The estimated effect of HA on pedicle screw electrical resistance did not differ across manufacturers. Electrical resistance values were inversely related to submersion depth. Electrical resistance values were lower in the experimental group at 10 mm (p=.04), 15 mm (p=.04), and 25 mm (p=.02) submersion depths. The HA effect ranged from -0.03 to -0.08 as submersion depth varied. CONCLUSIONS We found no evidence that HA increased pedicle screw electrical resistance in a matched manufacturer control laboratory model. Electrical stimulation of pedicle screws may be reliable for pedicle breach detection in the presence of HA. Future research should investigate if laboratory findings translate to clinical practice and confirm that electrical stimulation of pedicle screws is a reliable method to detect pedicle breach in the presence of HA.
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Hydroxyapatite Use in Spine Surgery—Molecular and Clinical Aspect. MATERIALS 2022; 15:ma15082906. [PMID: 35454598 PMCID: PMC9030649 DOI: 10.3390/ma15082906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022]
Abstract
Hydroxyapatite possesses desirable properties as a scaffold in tissue engineering: it is biocompatible at a site of implantation, and it is degradable to non-toxic products. Moreover, its porosity enables infiltration of cells, nutrients and waste products. The outcome of hydroxyapatite implantation highly depends on the extent of the host immune response. Authors emphasise major roles of the chemical, morphological and physical properties of the surface of biomaterial used. A number of techniques have been applied to transform the theoretical osteoconductive features of HAp into spinal fusion systems—from integration of HAp with autograft to synthetic intervertebral implants. The most popular uses of HAp in spine surgery include implants (ACDF), bone grafts in posterolateral lumbar fusion and transpedicular screws coating. In the past, autologous bone graft has been used as an intervertebral cage in ACDF. Due to the morbidity related to autograft harvesting from the iliac bone, a synthetic cage with osteoconductive material such as hydroxyapatite seems to be a good alternative. Regarding posterolateral lumbar fusion, it requires the graft to induce new bone growth and reinforce fusion between the vertebrae. Hydroxyapatite formulations have shown good results in that field. Moreover, the HAp coating has proven to be an efficient method of increasing screw fixation strength. It can decrease the risk of complications such as screw loosening after pedicle screw fixation in osteoporotic patients. The purpose of this literature review is to describe in vivo reaction to HAp implants and to summarise its current application in spine surgery.
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Effect of hydroxyapatite tubes on the lag screw intraoperative insertion torque for the treatment of intertrochanteric femoral fractures. Injury 2021; 52:3377-3381. [PMID: 34340840 DOI: 10.1016/j.injury.2021.07.032] [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: 03/17/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hydroxyapatite (HA) augments are frequently used in orthopedic surgery. However, the effectiveness of HA augments on the treatment of intertrochanteric femoral fractures remains unknown. This study aimed to investigate whether the use of HA tubes affects the intraoperative insertion torque of the lag screw during intertrochanteric femoral fracture surgery. METHODS From January 2016 to October 2020, 58 patients with intertrochanteric femoral fractures were included and divided into the HA treatment group (HA group, n = 29) and non-HA treatment group (N group, n = 29). Patients with intertrochanteric femoral fractures were treated using the Gamma3 nail system® with or without two HA tubes. HA tubes were inserted into the femoral head through the lag screw hole before the insertion of the lag screw. The mean and maximum intraoperative insertion torques of the lag screw, bone mineral density (BMD) of the uninjured opposite side femoral neck, and tip apex distance (TAD) of the lag screw on postoperative radiographs were assessed. To assess the loss of reduction after the surgery, we investigated the amounts of telescoping of the lag screw and the changes in the neck shaft angle. RESULTS The mean and maximum insertion torques were correlated with BMD in the HA and N groups, respectively. The mean and maximum insertion torques were not correlated with TAD in the HA and N groups, respectively. The mean torque/BMD ratio was significantly higher in the HA group than in the N group (p = 0.03). There were no significant differences in the maximum torque/BMD ratio between HA and N groups (p = 0.06), while the maximum torque/BMD ratio tended to be higher in the HA group than in the N group. The amounts of telescoping of the lag screw in the HA group were significantly lower than that in the N group (p = 0.04), while there were no significant differences in the changes in the neck shaft angle between two groups (p = 0.32). CONCLUSION Our results strongly suggest that the use of HA tubes increases the intraoperative lag screw insertion torque/BMD ratio and may improve the lag screw fixation by strengthening the bone/metal thread interface in the treatment of intertrochanteric femoral fractures.
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Krenzlin H, Foelger A, Mailänder V, Blase C, Brockmann M, Düber C, Ringel F, Keric N. Novel Biodegradable Composite of Calcium Phosphate Cement and the Collagen I Mimetic P-15 for Pedicle Screw Augmentation in Osteoporotic Bone. Biomedicines 2021; 9:biomedicines9101392. [PMID: 34680509 PMCID: PMC8533375 DOI: 10.3390/biomedicines9101392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022] Open
Abstract
Osteoporotic vertebral fractures often necessitate fusion surgery, with high rates of implant failure. We present a novel bioactive composite of calcium phosphate cement (CPC) and the collagen I mimetic P-15 for pedicle screw augmentation in osteoporotic bone. Methods involved expression analysis of osteogenesis-related genes during osteoblastic differentiation by RT-PCR and immunostaining of osteopontin and Ca2+ deposits. Untreated and decalcified sheep vertebrae were utilized for linear pullout testing of pedicle screws. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA). Expression of ALPI II (p < 0.0001), osteopontin (p < 0.0001), RUNX2 (p < 0.0001), and osteocalcin (p < 0.0001) was upregulated after co-culture of MSC with CPC-P-15. BMD was decreased by 28.75% ± 2.6%. Pullout loads in untreated vertebrae were 1405 ± 6 N (p < 0.001) without augmentation, 2010 ± 168 N (p < 0.0001) after augmentation with CPC-P-15, and 2112 ± 98 N (p < 0.0001) with PMMA. In decalcified vertebrae, pullout loads were 828 ± 66 N (p < 0.0001) without augmentation, 1324 ± 712 N (p = 0.04) with PMMA, and 1252 ± 131 N (p < 0.0078) with CPC-P-15. CPC-P-15 induces osteoblastic differentiation of human MES and improves pullout resistance of pedicle screws in osteoporotic and non-osteoporotic bone.
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Affiliation(s)
- Harald Krenzlin
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany; (A.F.); (F.R.); (N.K.)
- Correspondence:
| | - Andrea Foelger
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany; (A.F.); (F.R.); (N.K.)
| | - Volker Mailänder
- Max Planck Institute for Polymer Research, 55128 Mainz, Germany;
- Center for Translational Nanomedicine, University Medical Center Mainz, 55131 Maniz, Germany
| | - Christopher Blase
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, 60318 Frankfurt am Main, Germany;
| | - Marc Brockmann
- Department of Neuroradiology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Christoph Düber
- Department of Radiology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany; (A.F.); (F.R.); (N.K.)
| | - Naureen Keric
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany; (A.F.); (F.R.); (N.K.)
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Rosinski AA, Mittal A, Odeh K, Ungurean V, Leasure J, Telles C, Kondrashov D. Alternatives to Traditional Pedicle Screws for Posterior Fixation of the Degenerative Lumbar Spine. JBJS Rev 2021; 9:01874474-202107000-00016. [PMID: 34319968 DOI: 10.2106/jbjs.rvw.20.00177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Traditional pedicle screws are currently the gold standard to achieve stable 3-column fixation of the degenerative lumbar spine. However, there are cases in which pedicle screw fixation may not be ideal. Due to their starting point lateral to the pars interarticularis, pedicle screws require a relatively wide dissection along with a medialized trajectory directed toward the centrally located neural elements and prevertebral vasculature. In addition, low bone mineral density remains a major risk factor for pedicle screw loosening, pullout, and pseudarthrosis. The purpose of this article is to review the indications, advantages, disadvantages, and complications associated with posterior fixation techniques of the degenerative lumbar spine beyond the traditional pedicle screws. METHODS Comprehensive literature searches of the PubMed, Scopus, and Web of Science databases were performed for 5 methods of posterior spinal fixation, including (1) cortical bone trajectory (CBT) screws, (2) transfacet screws, (3) translaminar screws, (4) spinous process plates, and (5) fusion mass screws and hooks. Articles that had been published between January 1, 1990, and January 1, 2020, were considered. Non-English-language articles and studies involving fixation of the cervical or thoracic spine were excluded from our review. RESULTS After reviewing over 1,700 articles pertaining to CBT and non-pedicular fixation techniques, a total of 284 articles met our inclusion criteria. CBT and transfacet screws require less-extensive exposure and paraspinal muscle dissection compared with traditional pedicle screws and may therefore reduce blood loss, postoperative pain, and length of hospital stay. In addition, several methods of non-pedicular fixation such as translaminar and fusion mass screws have trajectories that are directed away from or posterior to the spinal canal, potentially decreasing the risk of neurologic injury. CBT, transfacet, and fusion mass screws can also be used as salvage techniques when traditional pedicle screw constructs fail. CONCLUSIONS CBT and non-pedicular fixation may be preferred in certain lumbar degenerative cases, particularly among patients with osteoporosis. Limitations of non-pedicular techniques include their reliance on intact posterior elements and the lack of 3-column fixation of the spine. As a result, transfacet and translaminar screws are infrequently used as the primary method of fixation. CBT, transfacet, and translaminar screws are effective in augmenting interbody fixation and have been shown to significantly improve fusion rates and clinical outcomes compared with stand-alone anterior lumbar interbody fusion. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander A Rosinski
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | - Ashish Mittal
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | - Khalid Odeh
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | | | | | | | - Dimitriy Kondrashov
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
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Wang TY, Mehta VA, Sankey EW, Shaffrey CI, Abd-El-Barr MM, Than KD. The Impact of Instrumentation and Implant Surface Technology on Cervical and Thoracolumbar Fusion. Oper Neurosurg (Hagerstown) 2021; 21:S12-S22. [PMID: 34128071 DOI: 10.1093/ons/opaa321] [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: 04/20/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022] Open
Abstract
Spinal fusion has undergone significant evolution and improvement over the past 50 yr. Historically, spine fusion was noninstrumented and arthrodesis was based entirely on autograft. Improved understanding of spinal anatomy and materials science ushered in a new era of spinal fusion equipped with screw-based technologies and various interbody devices. Osteobiologics is another important realm of spine fusion, and the evolution of various osteobiologics has perhaps undergone the most change within the past 20 yr. A new element to spinal instrumentation has recently gained traction-namely, surface technology. New data suggest that surface treatments play an increasingly well-recognized role in inducing osteogenesis and successful fusion. Until now, however, there has yet to be a unified resource summarizing the existing data and a lack of consensus exists on superior technology. Here, authors provide an in-depth review on surface technology and its impact on spinal arthrodesis.
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Affiliation(s)
- Timothy Y Wang
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Vikram A Mehta
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Eric W Sankey
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Muhammad M Abd-El-Barr
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Khoi D Than
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
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Massaad E, Rolle M, Hadzipasic M, Kiapour A, Shankar GM, Shin JH. Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability. Neurosurg Focus 2021; 50:E12. [PMID: 33932920 DOI: 10.3171/2021.2.focus201121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Achieving rigid spinal fixation can be challenging in patients with cancer-related instability, as factors such as osteopenia, radiation, and immunosuppression adversely affect bone quality. Augmenting pedicle screws with cement is a strategy to overcome construct failure. This study aimed to assess the safety and efficacy of cement augmentation with fenestrated pedicle screws in patients undergoing posterior, open thoracolumbar surgery for spinal metastases. METHODS A retrospective review was performed for patients who underwent surgery for cancer-related spine instability from 2016 to 2019 at the Massachusetts General Hospital. Patient demographics, surgical details, radiographic characteristics, patterns of cement extravasation, complications, and prospectively collected Patient-Reported Outcomes Measurement Information System Pain Interference and Pain Intensity scores were analyzed using descriptive statistics. Logistic regression was performed to determine factors associated with cement extravasation. RESULTS Sixty-nine patients underwent open posterior surgery with a total of 502 cement-augmented screws (mean 7.8 screws per construct). The median follow-up period for those who survived past 90 days was 25.3 months (IQR 10.8-34.6 months). Thirteen patients (18.8%) either died within 90 days or were lost to follow-up. Postoperative CT was performed to assess the instrumentation and patterns of cement extravasation. There was no screw loosening, pullout, or failure. The rate of cement extravasation was 28.9% (145/502), most commonly through the segmental veins (77/145, 53.1%). Screws breaching the lateral border of the pedicle but with fenestrations within the vertebral body were associated with a higher risk of leakage through the segmental veins compared with screws without any breach (OR 8.77, 95% CI 2.84-29.79; p < 0.001). Cement extravasation did not cause symptoms except in 1 patient who developed a symptomatic thoracic radiculopathy requiring decompression. There was 1 case of asymptomatic pulmonary cement embolism. Patients experienced significant pain improvement at the 3-month follow-up, with decreases in Pain Interference (mean change 15.8, 95% CI 14.5-17.1; p < 0.001) and Pain Intensity (mean change 28.5, 95% CI 26.7-30.4; p < 0.001). CONCLUSIONS Cement augmentation through fenestrated pedicle screws is a safe and effective option for spine stabilization in the cancer population. The risk of clinically significant adverse events from cement extravasation is very low.
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THE RESULTS OF EXPERIMENTAL COMPUTER MODELING IN STABILIZATION OF TRANSPEDICULAR SYSTEMS USED IN THE SURGICAL TREATMENT OF VARIOUS PATHOLOGIES OF THE SPINE. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-3-77-58-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Baba S, Kawaguchi K, Itamoto K, Watanabe T, Hayashida M, Mae T, Nakashima Y, Kato G. Use of an inertial measurement unit sensor in pedicle screw placement improves trajectory accuracy. PLoS One 2020; 15:e0242512. [PMID: 33196657 PMCID: PMC7668595 DOI: 10.1371/journal.pone.0242512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/03/2020] [Indexed: 12/02/2022] Open
Abstract
Ascertaining the accuracy of the pedicle screw (PS) trajectories is important as PS malpositioning can cause critical complications. We aimed to determine the angle range over which estimation is unreliable; build a low-cost PS placement support system that uses an inertial measurement unit (IMU) to enable the monitoring of surgical tools and PS trajectories, and determine the situations where IMU support would be most beneficial. In PS insertion experiments, we used cadaver samples that included lumbar porcine spines. Computed tomography images obtained before and after PS insertion were viewed. Offsets between the planned and implanted PS trajectories in the freehand and IMU-assisted groups were analyzed. The PS cortical bone breaches were classified according to the Gertzbein and Robbins criteria (GRC). Added head-down tilted sample experiments were repeated wherein we expected a decreased rostro-caudal rotational accuracy of the PS according to the angle estimation ability results. Evaluation of the PS trajectory accuracy revealed no significant advantage of IMU-assisted rostro-caudal rotational accuracy versus freehand accuracy. According to the GRC, IMU assistance significantly increased the rate of clinically acceptable PS positions (RoCA) than the freehand technique. In the head-down tilted sample experiments, IMU assist provided increased accuracies with both rostro-caudal and medial rotational techniques when compared with the freehand technique. In the freehand group, RoCA was significantly decreased in samples with rostral tilting relative to that in the samples without. However, In the IMU-assisted group, no significant difference in RoCA between the samples with and without head-down tilting was observed. Even when the planned PS medial and/or rostro-caudal rotational angle was relatively large and difficult to reproduce manually, IMU-support helped maintain the PS trajectory accuracy and positioning safety. IMU assist in PS placement was more beneficial, especially for larger rostro-caudal and/or medial rotational pedicle angles.
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Affiliation(s)
- Satoshi Baba
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
- Trauma Center, Saga Medical Center, Koseikan, Saga, Japan
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kenichi Kawaguchi
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kazuhito Itamoto
- Department of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Takeshi Watanabe
- Department of Orthopedic Surgery, Watanabe Orthopedic Hospital, Itoshima, Fukuoka, Japan
| | - Mitsumasa Hayashida
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
- Trauma Center, Saga Medical Center, Koseikan, Saga, Japan
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takao Mae
- Trauma Center, Saga Medical Center, Koseikan, Saga, Japan
- Department of Orthopedic Surgery, Saga Medical Center, Koseikan, Saga, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Go Kato
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
- Trauma Center, Saga Medical Center, Koseikan, Saga, Japan
- Department of Orthopedic Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
- * E-mail:
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Addevico F, Morandi M, Scaglione M, Solitro GF. Screw insertion torque as parameter to judge the fixation. Assessment of torque and pull-out strength in different bone densities and screw-pitches. Clin Biomech (Bristol, Avon) 2020; 72:130-135. [PMID: 31864036 DOI: 10.1016/j.clinbiomech.2019.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pull-out strength is a critical parameter to judge screw fixation in orthopaedic implants. However, the insertion torque is the main feeling in the hand of a surgeon relating to the strength of synthesis. The correlation between pull-out strength and torque is not completely understood. This creates uncertainty about the key-question: Should the torque be considered a valid parameter to judge the quality of fixation? METHODS Using the ASTM F543 as reference, three screws differing only in pitch (1.5, 2.1, 2.8 mm pitches) were tested in three foam-block densities (10, 15, and 20 pcf). The correlation was investigated by assessing the role of density and screw geometry. FINDINGS Torque was related to pull-out strength in all configurations (R = 0.979, P = 0.000). No difference in pull-out strength was found when screws were tightened to a range of 71.6%, SD = 7.6, of torque to fail (P > 0.05). Torque and pull-out strength were stratified according to density that influenced the two parameters up to 524% (P < 0.000). Pitch determined pull-out strength up to 33% (P < 0.000) while the 2.1 mm screw pitch showed the highest pull-out strength and torque in all configurations. INTERPRETATION Insertion torque was demonstrated to be a valid parameter to judge the quality of bone under fixation and therefore, the strength of the synthesis. Surgeons should not tighten the screws to values approaching torque to fail to obtain the highest pull-out strength. Density was the main factor influencing pull-out strength and torque. Pitch is another parameter deciding screw holding capacity.
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Affiliation(s)
| | - Massimo Morandi
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Louisiana State University Health, Science Center Shreveport, LA, USA
| | | | - Giovanni F Solitro
- Biomechanics Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, Science Center Shreveport, LA, USA
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Harper RA, Pfeiffer FM, Choma TJ. The minipig as a potential model for pedicle screw fixation: morphometry and mechanics. J Orthop Surg Res 2019; 14:246. [PMID: 31382997 PMCID: PMC6683400 DOI: 10.1186/s13018-019-1292-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/25/2019] [Indexed: 01/29/2023] Open
Abstract
Background While there are several different animal models for use in the characterization of spinal fixation, none have emerged as a definitive model for comparative studies in spinal fixation methods. The purpose of this study is to establish morphometric data of porcine vertebrae and to characterize the feasibility of pedicle screw fixation in porcine spines for potential comparative human study. Methods Four spines from 45 to 50 kg Hanford minipigs were cleaned of soft tissue and analyzed by computed tomography and dual-energy x-ray absorptiometry. Two 5 × 30-mm pedicle screws were placed in each vertebra and tested to failure using a combined moment-load protocol. Results Pedicle widths were measured from L6-T5. Widths ranged from 7.15 mm (T6) to 9.24 mm (T14). Posterior cortex to anterior cortex depth ranged from 25.9 to 32.6 mm. Mean bone mineral density was 1.0665 g/cm2 (range 1.139–1.016). Force-to-failure demonstrated mean 1171.40 N (+ 115.34). Conclusion Our baseline morphometric and compositional data demonstrate that porcine vertebrae can serve as a useful model for comparative studies due to their similar pedicle widths and bone mineral density to the human vertebra. This biomechanical data could provide a baseline comparison for future studies. This study also suggests that the minipig could be a suitable model for comparative studies due to similarities in pedicle width and bone mineral density to the human vertebrae.
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Affiliation(s)
- Robert A Harper
- Department of Orthopedic Surgery, University of California-Davis, 4860 Y Street, Sacramento, CA, 95817, USA
| | - Ferris M Pfeiffer
- Department of Biological Engineering, University of Missouri, 247 Ag Engineering Building, Columbia, MO, 65211, USA
| | - Theodore J Choma
- Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue DC953.00, Columbia, MO, 65212, USA.
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McCoy S, Tundo F, Chidambaram S, Baaj A. Clinical considerations for spinal surgery in the osteoporotic patient: A comprehensive review. Clin Neurol Neurosurg 2019; 180:40-47. [DOI: 10.1016/j.clineuro.2019.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
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Cai X, Yi X, Li H, He X. Preclinical evaluation of a novel anterior non-fusion fixation device for atlantoaxial instability: an in vivo comparison study in a canine model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1225-1233. [PMID: 30761421 DOI: 10.1007/s00586-019-05916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 12/28/2018] [Accepted: 02/09/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The Anterior Atlantoaxial Non-Fusion Fixation System (AANFS) was a novel motion preservation device for atlantoaxial instability to replace traditional fusion techniques. The purpose of this in vivo study was to evaluate the clinical features and biomechanical properties of this new device in a canine model by comparing it with a conventional method. METHODS Eighteen adult male canines were randomly divided into group 1, which received the AANFS replacement, group 2 which received the Harms rigid fixation procedures, and group 3, which served as the control group. Routine follow-up evaluations were performed postoperatively. Specimens were harvested 12 weeks after the operation. Biomechanical tests were conducted to obtain the range of motion (ROM) and neutral zone (NZ) at C1-C2 segment in different groups. RESULTS The canines successfully tolerated the entire experimental procedure. No significant differences were found in surgery time, blood loss and recovery time between the AANFS group and the Harms rigid fixation group. Radiological examinations revealed that the position of the implant was good. Biomechanical results showed that, compared with the intact group, the mean ROM and NZ in flexion, extension, lateral bending and rotation were significantly reduced after rigid fixation. However, after the AANFS implantation, ROM and NZ in all directions were similar to those of the intact state. CONCLUSIONS This study for the first time provides an animal model for studying non-fusion strategies of upper cervical spine. The AANFS was able to maintain movement function of the atlantoaxial joint and may be an alternative to traditional fusion techniques. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Xuan Cai
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xiaoqing Yi
- Department of Pediatrics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Haopeng Li
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xijing He
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
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Mitran V, Ion R, Miculescu F, Necula MG, Mocanu AC, Stan GE, Antoniac IV, Cimpean A. Osteoblast Cell Response to Naturally Derived Calcium Phosphate-Based Materials. MATERIALS 2018; 11:ma11071097. [PMID: 29954120 PMCID: PMC6073128 DOI: 10.3390/ma11071097] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 01/15/2023]
Abstract
The demand of calcium phosphate bioceramics for biomedical applications is constantly increasing. Efficient and cost-effective production can be achieved using naturally derived materials. In this work, calcium phosphate powders, obtained from dolomitic marble and Mytilus galloprovincialis seashells by a previously reported and improved Rathje method were used to fabricate microporous pellets through cold isostatic pressing followed by sintering at 1200 °C. The interaction of the developed materials with MC3T3-E1 pre-osteoblasts was explored in terms of cell adhesion, morphology, viability, proliferation, and differentiation to evaluate their potential for bone regeneration. Results showed appropriate cell adhesion and high viability without distinguishable differences in the morphological features. Likewise, the pre-osteoblast proliferation overtime on both naturally derived calcium phosphate materials showed a statistically significant increase comparable to that of commercial hydroxyapatite, used as reference material. Furthermore, evaluation of the intracellular alkaline phosphatase activity and collagen synthesis and deposition, used as markers of the osteogenic ability of these bioceramics, revealed that all samples promoted pre-osteoblast differentiation. However, a seashell-derived ceramic demonstrated a higher efficacy in inducing cell differentiation, almost equivalent to that of the commercial hydroxyapatite. Therefore, data obtained demonstrate that this naturally sourced calcium-phosphate material holds promise for applications in bone tissue regeneration.
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Affiliation(s)
- Valentina Mitran
- Department of Biochemistry and Molecular Biology, University of Bucharest, 91-95 Spl. Independentei, 050095 Bucharest, Romania.
| | - Raluca Ion
- Department of Biochemistry and Molecular Biology, University of Bucharest, 91-95 Spl. Independentei, 050095 Bucharest, Romania.
| | - Florin Miculescu
- Department of Metallic Materials Science, Physical Metallurgy, University Politehnica of Bucharest, 313 Splaiul Independentei, J Building, District 6, 060042 Bucharest, Romania.
| | - Madalina Georgiana Necula
- Department of Biochemistry and Molecular Biology, University of Bucharest, 91-95 Spl. Independentei, 050095 Bucharest, Romania.
| | - Aura-Catalina Mocanu
- Department of Metallic Materials Science, Physical Metallurgy, University Politehnica of Bucharest, 313 Splaiul Independentei, J Building, District 6, 060042 Bucharest, Romania.
- S.C. Nuclear NDT Research & Services S.R.L, Department of Research, Development and Innovation, 104 Berceni Str., Central Laboratory Building, District 4, 041912 Bucharest, Romania.
| | - George E Stan
- National Institute of Materials Physics, Laboratory of Multifunctional Materials and Structures, Atomistilor Str., No. 405A P.O. Box MG 7, 077125 Măgurele-Bucharest, Romania.
| | - Iulian Vasile Antoniac
- Department of Metallic Materials Science, Physical Metallurgy, University Politehnica of Bucharest, 313 Splaiul Independentei, J Building, District 6, 060042 Bucharest, Romania.
| | - Anisoara Cimpean
- Department of Biochemistry and Molecular Biology, University of Bucharest, 91-95 Spl. Independentei, 050095 Bucharest, Romania.
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