ABSTRACT
Objective At present, the mainstream surgical mode and the gold standard for the treatment of spine related diseases are still the intervertebral fusion with the intervertebral implantation of the intervertebral fusion device.The intervertebral fusion device routinely used in clinical practice cannot degrade in vivo after implantation, resulting in lifelong foreign body.High elastic modulus also leads to osteoporosis in adjacent vertebral bodies, which leads to implant sinking, stress shielding and'pseudomorphism'of fusion.The ideal biodegradable synthetic intervertebral fusion cage can be progressively degraded and eventually replaced by new bone, which has the advantages of elastic modulus close to cortical bone, good biocompatibility, X-ray permeability and good initial mechanical strength.In this paper, animal analysis of biodegradable intervertebral fusion cage, clinical effect analysis, current shortcomings and future trends were reviewed.
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Objective To evaluate the clinical outcome of artificial cervical disc arthroplasty combined with anchoring cervical intervertebral fusion cage (ACIFC) in the treatment of multilevel cervical disc herniation. Methods From October 2011 to September 2013, 0.26 patients with multilevel cervical disc herniation underwent artificial cervical disc arthroplasty combined with ACIFC, there were 10 male and 16 female with age from 32 to 60 years (mean 46.8 years). Two segment were involved in 15 patients, three segment were involved in 11 patients. Neck disability index (NDI) and Japanese Orthopaedic Association (JOA) score were used to evaluate neurofunctional recovery preoperatively and postoperatively. The postoperative stabilization and the range of motion (ROM) of implanted disc and the fusion of cage were observed on dynamic radiograph. Results The average operation time and amount of bleeding were (95±15) min and (100±20) ml respectively. The average postoperative follow-up was 15 months(range 6-20 months). At the end of follow up,the scores of JOA was increased and the scores of NDI was decreased:(9.08±1.72) scores vs. (14.88±1.37) scores, (40.31±4.97) scores vs. (25.23±4.10) scores,there had significant differences (P0.05). Solid fusion was achieved in all levels brought by cage.There was no cage subsidence or displacement. All artificial cervical disc achieved definite stabilization, no intraoperative and postoperative complication was noted. Conclusions Artificial cervical disc arthroplasty combined with ACIFC provides a feasible way for the treatment of multilevel cervical disc herniation. The definite stabilization and maintained ROM can reduce the fusion segments and avoid the increased stress of adjacent segment which can ensure a good preliminary clinical outcome.
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objective To introduce the design concept and structure of a new type of lumbar intervertebral fusion cage ,and to e-valuate its biomechanical properties .Method A partially bioasorbable interbody fusion cage(PBIFC) made of nano hydroxyapatite and poly amino acid /calcium sulfate copolymer materials was developed .Range of motion(ROM ) ,compressive load ,and pull-out test on flexion ,extension ,lateral bending ,and torsion moment on fresh calf L3/L4 specimens of functional spinal union were carried out of iliac bone group ,PBIFC group ,and nano hydroxyapatite/polyamide 66(nHA/PA66) group .Result Of each movement ,the ROM value of iliac bone group are higher than the other two groups ,the difference was statistically significant (P0 .05) .The pull-out strength of PB-IFC group are higher than iliac bone group ,and the difference was statistically significant (P0 .05) .The compressive load of iliac bone group was lower than that of two cage group ,the difference was statistically significant (P0 .05) .Conclusion With good implant stability ,pull-out resistance ,and compression resistance performance ,PBIFC can meet the biomechanics requirements of clinical implant .
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ObjectiveTo evaluate the mid-term clinical effect of nano-hydroxyapatite and polyamide 66 (n-HA/PA66) intervertebral fusion cage in treatment of thoracolumbar burst fractures.Methods A total of 87 patients with thoracolumbar burst fractures were managed by thoracolumbar body resection combined with n-HA/PA66 intervertebral fusion cage from December 2007 to September 2008.The clinical effect, safety and radiographic outcomes were evaluated.Results No nerve damage was deteriorated in all the patients.The neural function was improved for 1-2 grade except for four patients at Frankel grade A.The patients were followed up for mean 21.3 months (17-24 months).The kyphosis was (14.4 ± 12.6)° preoperatively, (3.7 ± 8.7) ° immediately after surgery and (4.0 ± 8.3)° at final follow-up.The distance between the upper and lower vertebral bodies was (96.9 ± 17.2) mm preoperatively, (109.5 ± 17.1) mm immediately after surgery and (108.3 ± 16.4) mm at final follow-up.No cage replacement, internal fixation breakage or neurologic impairment were observed during follow-up period.There were 58 patients with grade E fusion, 22 with grade D fusion and 7 with grade C fusion.ConclusionsAnterior decompression combined with n-HA/PA66 intervertebral fusion cage is an effective method for treatment of thoracolumbar burst fracture.The kyphosis is rectified and the intervertebral distance is corrected, with a high rate of fusion.