Comparative biomechanical analysis of a cervical cage made of an unsintered hydroxyapatite particle and poly-L-lactide composite in a cadaver model.
METHODS
A new cage made from a forged composite of unsintered hydroxyapatite particles and poly-L-lactide (F-u-HA/PLLA) is compared biomechanically with the Ray threaded fusion cage.


OBJECTIVE
To compare the stability imparted to the human cadaveric spine by two different threaded cervical cages and the effect of cyclic loading on construct stability.


BACKGROUND
Threaded cages have been developed for use in anterior cervical interbody fusions to provide initial stability during the fusion process. However, metallic instrumentation has several limitations. Recently, totally bioresorbable bone fixation devices made of F-u-HA/PLLA have been developed, including a cage for spinal interbody fusion. However, no biomechanical study has compared the F-u-HA/poly-L-lactide (PLLA) cage with metallic cages.


METHODS
For this study, 12 fresh ligamentous human cervical spines (C4-C7) were used. After anterior discectomy across C5-C6, stabilization was achieved with the F-u-HA/PLLA cage in six spines and with the Ray threaded fusion cage in the remaining six spines. Biomechanical testing of the spines was performed with six degrees of freedom before and after stabilization, and after cyclic loading of the stabilized spines (5000 cycles of flexion-extension at 0.5 Nm).


RESULTS
The specimens stabilized with either the F-u-HA/PLLA cage or the Ray cage were significantly more stable than the discectomy case in all directions except in extension. In extension, both groups were stiffer, although not at a significant level (P > 0.05). After fatigue, the stiffness, as compared with that in the prefatigue case, decreased in both groups, although not at a significant level. The Ray cage group exhibited better stability than the F-u-HA/PLLA cage group in all directions, although a significant difference was found only in right axial rotation.


CONCLUSIONS
The F-u-HA/PLLA cage has the possibility to supplant the use of metallic devices in interbody fusions of the cervical spine.
Totoribe
Koji
K
Department of Orthopaedic Surgery, Miyazaki Medical College, Miyazaki, Japan. totoribe@post1.miyazaki-med.ac.jp
Matsumoto
Masanori
M
Goel
Vijay K
VK
Yang
S J
SJ
Tajima
Naoya
N
Shikinami
Yasuo
Y
D001696:Biomechanical Phenomena; D002102:Cadaver; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D017886:Durapatite; D006801:Humans; D010316:Particle Size; D011091:Polyesters; D012399:Rotation; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013314:Stress, Mechanical
D011091:Polyesters; C033616:poly(lactide); D017886:Durapatite