Optimizing the Spinal Interbody Implant: Current Advances in Material Modification and Surface Treatment Technologies
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UPDATES IN SPINE SURGERY—TECHNIQUES, BIOLOGICS, AND NON-OPERATIVE MANAGEMENT (W HSU, SECTION EDITOR)
Optimizing the Spinal Interbody Implant: Current Advances in Material Modification and Surface Treatment Technologies Paul J. Park 1 & Ronald A. Lehman 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Interbody implants allow for fusion of the anterior column of the spine between vertebral body endplates. As rates of spinal fusion surgery have increased over the past several years, significant research has been devoted to optimizing both the mechanical and biologic properties of the interbody implant in order to promote bony fusion. The first interbody implants used decades ago were fashioned from cortical autograft. Currently, titanium alloy and polyetheretherketone (PEEK) are the most widely used and studied materials for this purpose. This review focuses on recent innovations in material modification and surface treatment techniques for both titanium and PEEK implants to maximize fusion rates in spinal surgery. Recent Findings Titanium has an elastic modulus much higher than native bone and however has better osseointegrative properties than PEEK. PEEK, however, has an elastic modulus closer to that of bone without any of the advantageous biologic properties that titanium has. Increasing porosity and surface roughness of titanium implants have been shown to improve the mechanical properties of titanium implants, while the biologic properties of PEEK have been enhanced using surface coating technology, either with titanium or with hydroxyapatite (HA). Summary Techniques such as increasing porosity, surface roughening, and surface coating are just some of the recent innovations aimed at optimizing both mechanical and biologic properties of interbody implants to promote spinal fusion. The future of interbody implant design will rely on continued improvements of PEEK and titanium implants as well as exploring new implant materials altogether. Keywords Interbody . Titanium . PEEK . Porosity . Coating
Introduction Rates of spinal fusion surgery have been steadily increasing over the last several decades, and achieving adequate fusion is critical to patient outcomes [1, 2]. The use of an interbody implant in spinal surgery facilitates fusion between vertebral bodies anteriorly, often in conjunction with a posterior fusion allowing for circumferential bony growth. The role of the
This article is part of the Topical Collection on Updates In Spine Surgery—Techniques, Biologics, and Non-Operative Management
interbody implant is twofold—to provide a mechanical strut between the two endplates and to facilitate bony growth between the two vertebral bodies. Initially introduced in the 1930s, the first interbody implant used was cortical autograft—this evolved over time to stainless steel, titanium alloy, polyetheretherketone (PEEK), and more recently tantalum and silicon nitride [3]. Over the past several years, significant attention has been given in optimizing the balance
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