title: Osseointegration of hollow cylinder based spinal implants in normal and osteoporotic vertebrae: a sheep study.
abstract: BACKGROUND
  Osteoporosis is not only responsible for an increased number of metaphyseal and spinal fractures but it also complicates their treatment. To prevent the initial loosening, we developed a new implant with an enlarged implant/bone interface based on the concept of perforated, hollow cylinders. We evaluated whether osseointegration of a hollow cylinder based implant takes place in normal or osteoporotic bone of sheep under functional loading conditions during anterior stabilization of the lumbar spine.
  
  
  METHODS
  Osseointegration of the cylinders and status of the fused segments (ventral corpectomy, replacement with iliac strut, and fixation with testing implant) were investigated in six osteoporotic (age 6.9 +/- 0.8 years, mean body weight 61.1 +/- 5.2 kg) and seven control sheep (age 6.1 +/- 0.2 years, mean body weight 64.9 +/- 5.7 kg). Osteoporosis was introduced using a combination protocol of ovariectomy, high-dose prednisone, calcium and phosphor reduced diet and movement restriction. Osseointegration was quantified using fluorescence and conventional histology; fusion status was determined using biomechanical testing of the stabilized segment in a six-degree-of-freedom loading device as well as with radiological and histological staging.
  
  
  RESULTS
  Intact bone trabeculae were found in 70% of all perforations without differences between the two groups (P = 0.26). Inside the cylinders, bone volume/total volume was significantly higher than in the control vertebra (50 +/- 16 vs. 28 +/- 13%) of the same animal (P<0.01), but significantly less (P<0.01) than in the near surrounding (60 +/- 21%). After biomechanical testing as described in Sect. "Materials and methods", seven spines (three healthy and four osteoporotic) were classified as completely fused and six (four healthy and two osteoporotic) as not fused after a 4-month observation time. All endplates were bridged with intact trabeculae in the histological slices.
  
  
  CONCLUSIONS
  The high number of perforations, filled with intact trabeculae, indicates an adequate fixation; bridging trabeculae between adjacent endplates and tricortical iliac struts in all vertebrae indicates that the anchorage is adequate to promote fusion in this animal model, even in the osteoporotic sheep.
authors.affiliation: AO Research Institute Davos, Davos, Switzerland. joerg.goldhahn@kws.ch
authors.forename: J
authors.initials: J
authors.lastname: Goldhahn
authors.forename: D
authors.initials: D
authors.lastname: Neuhoff
authors.forename: S
authors.initials: S
authors.lastname: Schaeren
authors.forename: B
authors.initials: B
authors.lastname: Steiner
authors.forename: B
authors.initials: B
authors.lastname: Linke
authors.forename: M
authors.initials: M
authors.lastname: Aebi
authors.forename: E
authors.initials: E
authors.lastname: Schneider
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D005260:Female; D023421:Models, Animal; D016348:Osseointegration / Q000502:physiology*; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000295:instrumentation*; D011859:Radiography; D012756:Sheep; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*