Levy Hannah A, Karamian Brian A, Yalla Goutham R, Canseco Jose A, Vaccaro Alexander R, Kepler Christopher K
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Biomed Mater Res B Appl Biomater. 2023 Feb;111(2):478-489. doi: 10.1002/jbm.b.35161. Epub 2022 Sep 8.
Spinal fusion surgeries are performed to treat a multitude of cervical and lumbar diseases that lead to pain and disability. Spinal interbody fusion involves inserting a cage between the spinal vertebrae, and is often utilized for indirect neurologic decompression, correction of spinal alignment, anterior column stability, and increased fusion rate. The long-term success of interbody fusion relies on complete osseointegration between the implant surface and vertebral end plates. Titanium (Ti)-based alloys and polyetheretherketone (PEEK) interbody cages represent the most commonly utilized materials and provide sufficient mechanics and biocompatibility to assist in fusion. However, modification to the surface and bulk characteristics of these materials has been shown to maximize osseointegration and long-term stability. Specifically, the introduction of intrinsic porosity and surface roughness has been shown to affect spinal interbody mechanics, vascularization, osteoblast attachment, and ingrowth potential. This narrative review synthesizes the mechanical, in vitro, in vivo, and clinical effects on fusion efficacy associated with introduction of porosity in Ti (neat and alloy) and PEEK intervertebral implants.
脊柱融合手术用于治疗多种导致疼痛和残疾的颈椎和腰椎疾病。脊柱椎间融合术包括在脊椎之间插入一个椎间融合器，常用于间接神经减压、脊柱排列矫正、前柱稳定性和提高融合率。椎间融合术的长期成功依赖于植入物表面与椎体终板之间的完全骨整合。钛（Ti）基合金和聚醚醚酮（PEEK）椎间融合器是最常用的材料，具有足够的力学性能和生物相容性以辅助融合。然而，对这些材料的表面和整体特性进行改性已被证明可使骨整合和长期稳定性最大化。具体而言，引入固有孔隙率和表面粗糙度已被证明会影响脊柱椎间力学、血管化、成骨细胞附着和向内生长潜力。本叙述性综述综合了在Ti（纯钛和合金）和PEEK椎间植入物中引入孔隙率对融合效果的力学、体外、体内及临床影响
