Radiographic, histologic, and chemical evaluation of bioresorbable 70/30 poly-L-lactide-CO-D, L-lactide interbody fusion cages in a goat model.
METHODS
A study of lumbar interbody fusion using polylactic acid-based bioresorbable fusion cages in a goat model.


OBJECTIVE
To evaluate the effect of polylactic acid polymer composition, and internal stabilization on the rate and quality of interbody fusion.


BACKGROUND
A spinal cage should provide an appropriate biomechanical environment to facilitate interbody fusion. Previous studies have shown that bioresorbable polylactic acid-based cages can provide adequate stability for spinal fusion. However, at present and to our knowledge, the best bioresorbable materials, optimal cage stiffness, and desired period over which the cage should biodegrade are unknown.


METHODS
Interbody fusions were performed at L3-L4 level in 35 skeletally mature Dutch milk goats. Titanium and poly-L-lactide-CO-D,L-lactide (PLDLLA) cages were implanted at random as stand-alone cages. In addition, PLDLLA cages were implanted with anterior fixation. The goats were euthanized at 3, 6, or 12 months. Radiographic, magnetic resonance imaging, histologic, and histomorphometric analyses were performed on retrieved segments. Chemical analysis was used to assess degradation of the retrieved PLDLLA cages. Beforehand, chemical and mechanical degradation of the PLDLLA cages were assessed in vitro.


RESULTS
At 3 months, bone graft was almost completely remodeled. Endochondral bone formation was observed in all specimens. At 6 months, 50% of the PLDLLA stand-alone cages and 83% of the PLDLLA anterior fixation cages were fused. At 12 months, 38% of the PLDLLA stand-alone and 83% of the titanium cages realized fusion. A very mild and dispersed foreign body reaction was seen in all PLDLLA specimens. E-beam sterilized PLDLLA cages degraded more rapidly in vivo as compared to both, PLDLLA cages in vitro, and ethylene oxide sterilized poly-L-lactic acid cages in vivo.


CONCLUSIONS
Within the 3-6-month period, PLDLLA stand-alone cages provided insufficient mechanical stability, which manifested as cracking and deformation of the cages and lower fusion rates. This result implies that within this time, additional stabilization is required; supplemental internal fixation proved sufficient to obtain successful fusion. In all cases, only a mild host response was seen, indicating good biocompatibility.
Krijnen
Matthijs R
MR
Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Mullender
Margriet G
MG
Smit
Theo H
TH
Everts
Vincent
V
Wuisman
Paul I J M
PI
D020341:Absorbable Implants; D000818:Animals; D001672:Biocompatible Materials; D016723:Bone Remodeling; D004203:Disinfection; D004868:Equipment Failure; D005260:Female; D005549:Foreign-Body Reaction / Q000139:chemically induced; D006041:Goats; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D011091:Polyesters / Q000009:adverse effects; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation*; D013997:Time Factors; D014025:Titanium
D001672:Biocompatible Materials; D011091:Polyesters; C033616:poly(lactide); D014025:Titanium