PubMed · 7416823
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V Wright. 1980. Beautifully engineered joints.. https://doi.org/10.1136/ard.39.3.296
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STUDY DESIGN: An in vitro biomechanical study of expandable cages for vertebral body replacement in the human thoracolumbar spine. OBJECTIVES: The purpose of this study was to compare the in vitro biomechanical properties of 3 different expandable cages with a nonexpandable cage. SUMMARY AND BACKGROUND DATA: Recently, there has been a rapid increase in the use and the commercial availability of expandable cages for vertebral body replacement in the thoracolumbar spine. Although all 3 expandable cages, evaluated in this study, are approved for clinical use in Europe, little information is available concerning the biomechanical properties of these implants. MATERIAL AND METHODS: Thirty-two human thoracolumbar spines (T11 to L3) were tested in flexion, extension, axial rotation, and lateral bending with a nondestructive loading technique using an unconstrained testing apparatus. Three-dimensional displacement was measured using an optical measurement system. First, all motion segments were tested intact. After complete corporectomy of L1, cages were implanted according to producer's information. The following implants (n = 8/group) were tested: 1) meshed titanium cage (nonexpandable cage, DePuy AcroMed); 2) X-tenz (expandable cage, DePuy AcroMed); 3) Synex (expandable Cage; Synthes); and 4) VBR (expandable cage, Ulrich). Finally, posterior stabilization using the Universal Spine System (Synthes), posterior-anterior stabilization using the Universal Spine System (Synthes), and anterior plating (Locking Compression Plate, Synthes) was applied to each test specimen. The mean apparent stiffness values, range of motion, and neutral and elastic zone were calculated from the corresponding load-displacement curves. RESULTS: No significant differences could be determined between the in vitro biomechanical properties of expandable and nonexpandable cages. In comparison to the intact motion segment, isolated anterior stabilization using cages and anterior plating significantly decreased stiffness and increased range of motion in all directions. In contrast, additional posterior stabilization significantly increased stiffness and decreased range of motion in all directions compared to the intact motion segment. The combined anterior-posterior stabilization demonstrated greatest stiffness results. CONCLUSION: Biomechanical results indicate that design variations of expandable cages for vertebral body replacement are of little importance. Additionally, no significant difference could be determined between the biomechanical properties of expandable and nonexpandable cages. After corporectomy, isolated implantation of expandable cages plus anterior plating was not able to restore normal stability of the motion segment. Therefore, isolated anterior stabilization using cages plus Locking Compression Plate should not be used for vertebral body replacement in the thoracolumbar spine.
The influence of additional dorsal structure damage on anterior stabilization of a thoracolumbar fracture is still unknown. Screw-cement enhancement can be used to reinforce the stability of anterior instrumentation. We have developed a new anchorage system for fixation of anterior stabilization devices, adapted through geometric optimization and the additional option of cementation after screw insertion. This study examines the question of whether this enhancement is strong enough to enable a single anterior procedure and still compensate for dorsal instability. Various spinal reconstruction procedures were evaluated biomechanically in an increasing ventrodorsal instability model for thoracolumbar fracture stabilization. A biomechanical in vitro study, simulating stabilized defect situations (corporectomy/vertebrectomy) with strut grafting and overbridging instrumentation, was performed on six human T10-L2 cadaveric specimens. The primary stability parameters, range of motion and neutral zone, were evaluated with or without anterior screw-cement enhancement. This was compared with a single conventional anterior stabilization without a dorsal defect (corporectomy). It was also compared with a single anterior, posterior or combined procedure in the presence of additional dorsal structure damage (vertebrectomy). The use of an additional cementable screw dowel enhanced the primary stability of the anterior instrumentation, compensating for dorsal instability. These results are warranted for the clinical use of minimally open or endoscopic techniques, creating the highest possible primary stability while performing a single anterior enhanced instrumentation with a tissue-preserving approach.
This article investigates mechanics issues related to potential use of a recently developed porous titanium (Ti) material for load-bearing implants. This material may have advantages over solid Ti of enhancing the bone-implant interface strength by promoting bone and soft tissue ingrowth and of reducing the bone-implant modulus mismatch, which can lead to stress shielding. Experimental data from ultrasound experiments and uniaxial compression testing on microporous Ti are presented. Analytic models to predict its elastic modulus and Poisson's ratio are discussed, including "structural" approaches (Gibson and Ashby's cellular solids) and a "composite material" approach (Mori-Tanaka). Finally, two-dimensional finite element models based on optical micrographs of the material are presented. Simulations were performed for different conditions and levels of approximation. Results demonstrate that simple analytic models provide good estimates of the elastic properties of the porous Ti and that the moduli can be significantly reduced to decrease the mismatch between solid Ti and bone. The finite element simulations show that bone ingrowth will dramatically reduce stress concentrations around the pores.