Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Spine J. 2022 Jun;22(6):1016-1027. doi: 10.1016/j.spinee.2021.12.004. Epub 2021 Dec 11.
Modernization of 3D printing has allowed for the production of porous titanium interbody cages (3D-pTi) which purportedly optimize implant characteristics and increase osseointegration; however, this remains largely unstudied in vivo.
To compare osseointegration of three-dimensional (3D) titanium cages without bone graft and Polyether-ether-ketone (PEEK) interbody cages with autologous iliac crest bone graft (AICBG).
Animal study utilizing an ovine in vivo model of lumbar fusion.
Interbody cages of PEEK or 3D-pTi supplied by Spineart SA (Geneva, Switzerland) were implanted in seven living sheep at L2-L3 and L4-L5, leaving the intervening disc space untreated. Both implant materials were used in each sheep and randomized to the aforementioned disc spaces. Computed tomography (CT) was obtained at 4 weeks and 8 weeks. MicroCT and histological sections were obtained to evaluate osseointegration.
MicroCT demonstrated osseous in-growth of native cancellous bone in the trabecular architecture of the 3D-pTi interbody cages and no interaction between the PEEK cages with the surrounding native bone. Qualitative histology revealed robust osseointegration in 3D-pTi implants and negligible osseointegration with localized fibrosis in PEEK implants. Evidence of intramembranous and endochondral ossification was apparent with the 3D-pTi cages. Quantitative histometric bone implant contact demonstrated significantly more contact in the 3D-pTi implants versus PEEK (p<.001); region of interest calculations also demonstrated significantly greater osseous and cartilaginous interdigitation at the implant-native bone interface with the 3D-pTi cages (p=.008 and p=.015, respectively).
3D-pTi interbody cages without bone graft outperform PEEK interbody cages with AICBG in terms of osseointegration at 4 and 8 weeks postoperatively in an ovine lumbar fusion model.
3D-pTi interbody cages demonstrated early and robust osseointegration without any bone graft or additive osteoinductive agents. This may yield early stability in anterior lumbar arthrodesis and potentially bolster the rate of successful fusion. This could be of particular advantage in patients with spinal neoplasms needing post-ablative arthrodesis, where local autograft use would be ill advised.
3D 打印技术的现代化使得多孔钛椎间融合器（3D-pTi）得以生产，据称其可优化植入物特性并增加骨整合；然而，这在很大程度上尚未在体内研究过。
比较无骨移植物的三维（3D）钛笼和聚醚醚酮（PEEK）椎间笼与自体髂嵴骨移植物（AICBG）的骨整合情况。
利用绵羊腰椎融合的体内动物模型进行的动物研究。
Spineart SA（瑞士日内瓦）提供的 PEEK 或 3D-pTi 椎间笼植入 7 只活绵羊的 L2-L3 和 L4-L5 处，不处理中间椎间盘间隙。每只绵羊都使用两种植入物材料，并随机分配到上述椎间盘间隙。在 4 周和 8 周时进行计算机断层扫描（CT）检查。使用微 CT 和组织学切片评估骨整合情况。
微 CT 显示 3D-pTi 椎间笼的原生松质骨小梁结构中有骨内生长，而 PEEK 笼与周围原生骨之间没有相互作用。定性组织学显示 3D-pTi 植入物具有强大的骨整合，而 PEEK 植入物则几乎没有骨整合，仅伴有局部纤维化。3D-pTi 笼可观察到膜内和软骨内成骨的证据。定量组织学骨植入物接触显示 3D-pTi 植入物与 PEEK 相比具有更多的接触（p<.001）；感兴趣区域计算还显示 3D-pTi 植入物与原生骨界面处的骨和软骨相互穿插明显更多（p=.008 和 p=.015）。
在绵羊腰椎融合模型中，与使用自体髂嵴骨移植物的 PEEK 椎间笼相比，无骨移植物的 3D-pTi 椎间笼在术后 4 周和 8 周时在骨整合方面表现更好。
3D-pTi 椎间笼无需任何骨移植物或添加的成骨诱导剂即可实现早期和强大的骨整合。这可能会在腰椎前路融合术中早期获得稳定性，并有可能提高融合成功率。对于需要进行消融后融合的脊柱肿瘤患者，这可能具有特别的优势，因为不建议使用局部自体移植物。
