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In recent years, interbody fusion cages have played an important role in interbody fusion surgery for treating diseases like disc protrusion and spondylolisthesis. However, traditional cages cannot achieve satisfactory results due to their unreasonable design, poor material biocompatibility, and induced osteogenesis ability, limiting their applicat...
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... One of the most popular techniques for treating spine diseases is vertebral fusion, which allows for the restoration of the proper alignment and stabilization of the vertebrae [1,10]. In 2020, in the USA alone, cervical discectomy with stabilization included 153,288 cases, and forecasts predict a further increase to almost 175,000 procedures in 2040 [8]. ...
Highly-porous titanium implants manufactured using additive methods open new perspectives for reconstructive medicine. Ti6Al4V alloy is one of the most frequently used biomaterials in medicine. It has proven biocompatibility and methods of modifying it to improve functionality have been extensively investigated. However, the translation of the current state of knowledge to products manufactured using additive methods is not clear. The complex architecture of scaffolds creates many challenges and limitations for surface modification, especially in internal parts of implants. The paper presents a developed surface modification using plasma electrolytic oxidation to improve the physicochemical properties of a spinal implant intended for the treatment of cervical discopathy. The properties of the produced surface layer were assessed based on SEM observations with EDS analysis, optical profilometry, XPS and XRD analysis, corrosion test and plasma atomic emission spectroscopy. The proposed modifications had a positive impact on the corrosion resistance of implants, limited the penetration of metal ions into the environment imitating the tissue environment, and significantly influenced the surface topographies, which should constitute a better substrate for the adhesion and proliferation of bone cells.
... Biocompatible materials are materials that are compatible with the host tissues and elicit a minimal foreign body reaction [126]. The use of biocompatible materials in spinal fusion can reduce the magnitude and duration of the foreign body reaction [127], leading to a smaller fibrous capsule and improved bone growth and fusion [128]. For example, biocompatible coatings, such as hydroxyapatite coatings, have been shown to reduce the foreign body reaction and improve the success of spinal fusion compared to uncoated implants [129]. ...
Spinal fusion surgery is a common procedure used to stabilize the spine and treat back pain. The procedure involves the use of foreign materials such as screws, rods, or cages, which can trigger a foreign body reaction, an immune response that involves the activation of immune cells such as macrophages and lymphocytes. The foreign body reaction can impact the success of spinal fusion, as it can interfere with bone growth and fusion. This review article provides an overview of the cellular and molecular events in the foreign body reaction, the impact of the immune response on spinal fusion, and strategies to minimize its impact. By carefully considering the use of foreign materials and optimizing surgical techniques, the impact of the foreign body reaction can be reduced, leading to better outcomes for patients.
... 500-600 µm is the pore size of human cancellous bone [13]. Examine the use of porous scaffolds in bone tissue engineering [14]. The porosity should be more than 50%, namely between 65 and 80%, where the structure and elastic modulus are comparable to human trabeculae. ...
The study aims to optimize the topology of the complete disc replacement. In this paper, we present a stress-based topology optimization of a complete disc replacement for the lumbar spine using the finite element level set method (LS). The disc was optimized to reduce stress and strain at the level of two segments. The new modified pro disc design was proposed to increase the space for bone ingrowth and increase the stability of fixation. The intact model was tested in six degrees of freedom (compression, extension, flexion, lateral bending, and torsion). The volume of the intact model was reduced by 50% by optimizing the topology, and validation showed more significant results under biomechanical loading conditions. The Von Mises stress remains the same with minor differences. Topology optimization allows to increase bone ingrowth and reduces stress-shield effects in the cortical bone and cancellous bone.KeywordsTopology OptimizationLumbar SpineComplete Disc ReplacementFinite Element Method
Tribology, an interdisciplinary field concerned with the science of interactions between surfaces in contact and their relative motion, plays a well-established role in the design of orthopedic implants, such as knee and hip replacements. However, its applications in spine surgery have received comparatively less attention in the literature. Understanding tribology is pivotal in elucidating the intricate interactions between metal, polymer, and ceramic components, as well as their interplay with the native human bone. Numerous studies have demonstrated that optimizing tribological factors is key to enhancing the longevity of joints and implants while simultaneously reducing complications and the need for revision surgeries in both arthroplasty and spinal fusion procedures. With an ever-growing and diverse array of spinal implant devices hitting the market for static and dynamic stabilization of the spine, it is important to consider how each of these devices optimizes these parameters and what factors may be inadequately addressed by currently available technology and methods. In this comprehensive review, the authors’ objectives were twofold: 1) delineate the unique challenges encountered in spine surgery that could be addressed through optimization of tribological parameters; and 2) summarize current innovations and products within spine surgery that look to optimize tribological parameters and highlight new avenues for implant design and research.
Study design
A randomized controlled trial.
Objective
The aim of this study is to compare the efficacy of allografts and bioactive glass-ceramic (BG) cages for anterior cervical discectomy and fusion (ACDF) in treating cervical degenerative disc disease.
Methods
We conducted a single-center, randomized controlled trial between August 2017 and August 2022. Participants were randomized into two groups, and consecutive patients requiring ACDF were randomly assigned to receive either the allograft cage or the BG cage. The surgical outcomes measured included pain levels, neck disability, surgical details, and radiological assessments.
Results
Of the 45 assessed, 40 participants were included, with 18 in the allograft cage group and 22 in the BG cage group. By the 12-month follow-up, both groups exhibited significant improvements in pain levels and disability scores, with no notable intergroup differences. Over 85% of patients in both groups were satisfied with their outcomes. Radiological assessments revealed stability in the cervical spine with both cage types post intervention. Although both materials showed a trend toward increased subsidence over time, the difference between them was not statistically significant. Fusion rates were comparable between the groups at 12 months, with BG cage showing a slightly higher early fusion rate at 6 months. No significant differences were observed between the two groups in terms of complications.
Conclusions
Both allograft and BG cages are effective in ACDF surgeries for cervical degenerative disc disease, with both contributing to substantial postoperative improvements. Differences in disc height, interspinous motion, and subsidence were not significant in the last follow-up, indicating both materials' suitability for clinical use. Future research with a larger cohort and longer follow-up is needed to confirm these preliminary findings.
Study design:
Retrospective cohort.
Objective:
To compare the rates of all-cause surgical complications of synthetic interbody devices versus allograft or autograft in patients undergoing 1-2 levels anterior cervical discectomy and fusion (ACDF) procedures.
Summary of background data:
Cervical degenerative disorders affects up to 60% of older adults in the US. Both traditional allograft or autograft and synthetic interbody devices (PEEK or titanium) are used for decompression and arthrodesis, with an increasing utilization of the latter. However, the differences in their postsurgical complication profiles are not well-characterized.
Methods:
Patients who underwent 1-2 level ACDF for cervical radiculopathy or myelopathy between 2010-2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed based on factors that were significant predictors of all-cause surgical complications in a linear regression model. The primary outcome measure was development of all-cause surgical complications following 1-2 levels ACDF. The secondary outcome was all-cause medical complications.
Results:
1:1 exact matching resulted in two equal groups of 11,430 patients who received treatment with synthetic interbody devices or allograft/autograft. No statistically significant difference in all-cause surgical complications were found between the synthetic cohort and the allograft or autograft cohort following 1-2 levels ACDFs (RR 0.86, 95% CI 0.730-1.014, P = 0.079). No significant differences were observed regarding any specific surgical complications except for pseudoarthrosis (RR 0.73, 0.554-0.974, P = 0.037), which was higher in the allograft/autograft cohort.
Conclusion:
After 1:1 exact matching to control for confounding variables, the findings of this study suggest that all-cause surgical complications are similar in patients undergoing ACDFs with synthetic interbody devices or allograft/autographs. However, the rate of pseudarthrosis appears to be higher in patients with allograft/autographs. Future prospective studies are needed to corroborate these findings.
The water industry is facing significant challenges due to the effects of climate change and energy crises. To address these issues, the water sector is undergoing a digital transformation, leveraging digital technologies and methods, such as artificial intelligence and smart sensors, to improve sustainable supply, distribution, and treatment of water resources. Water supply systems are a crucial piece of the water industry which has the demanding task of collecting water, transporting it and distributing it to various users. An example of how digitalisation supports the suitable use of water is hereafter proposed through a real case study. Exploiting the digital information with a proper hydraulic model and an innovative control algorithm allows for enhancing the hydraulic and energy performance of the water supply systems analysed. In fact, accurate management of the pressure in the mountain distribution network leads to a significant decrease in water losses and also to reduced energy consumption.KeywordsWater Supply SystemsDigitisationHydraulic ModellingOptimal Pressure ControlSustainabilityWater Smart Systems
