Open Access Open Access  Restricted Access Subscription Access

Comparative Analysis of Porous Titanium Spinal Cage with Conventional Spinal Cages: A Finite Element Study


Affiliations
1 Manufacturing Science and Instrumentation, CSIR-CSIO, Sector 30C, Chandigarh 160 030, India
 

The objective of this study is to compare the stress shielding effect of various conventional as well as modified additive manufactured porous materials used for spinal cages. A finite element study was performed by changing the design (fully porous and hybrid) and the materials (PEEK, CFR-PEEK, Titanium) of spinal cages. All the models were simulated under uniaxial compression, to study the stress shielding effect. The Finite Element Analysis results showed that the hybrid spinal cage transfers more stress to its adjacent vertebrae than the other design configurations under uniaxial compression. The hybrid titanium cage was most effective in reducing the stress shielding effect. The hybrid cage is stronger than PEEK & CFR-PEEK cages, however, due to the porous structure reduced stress shielding was observed.

Keywords

Additive manufacturing, CFR-PEEK, PEEK, PLIF, Ti6Al4V ELI.
User
Notifications
Font Size

  • Pannell W C, Savin D D, Scott T P, Wang J C & Daubs M D, Trends in the surgical treatment of lumbar spine disease in the United States, Spine J, 15(8) (2015) 1719–1727.
  • Norton R P, Bianco K, Klifto C, Errico T J & Bendo J A, Degenerative spondylolisthesis: an analysis of the nationwide inpatient sample database, Spine, 40(15) (2015) 1219–1227.
  • Adams M A & Roughley P J, What is intervertebral disc degeneration, and what causes it?, Spine, 31(18) (2006) 2151–2161.
  • Park Y & Ha J W, Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach, Spine, 32(5) (2007) 537–543.
  • Gussous Y M, Jain N & Khan S N, Posterior based lumbar interbody fusion devices: Static and expandable technology, Seminars in Spine Surgery:2018 (Elsevier), 2018, 203–206.
  • Bagby & George W, Arthrodesis by the distraction-compression method using a stainless steel implant, Orthopaedics, 11(6) (1988) 931–934.
  • Stadelmann V A, Terrier A & Pioletti D P, Microstimulation at the bone–implant interface upregulates osteoclast activation pathways, Bone, 42(2) (2008) 358–364.
  • Ramakrishna S, Mayer J, Wintermantel E & Leong K W, Biomedical applications of polymer-composite materials: A review, Compos Sci Technol, 61(9) (2001) 1189–1224.
  • Karikari I O, Jain D, Owens T R, Gottfried O, Hodges T R, Nimjee S M & Bagley C A, Impact of subsidence on clinical outcomes and radiographic fusion rates in anterior cervical discectomy and fusion: A systematic review, Clin. Spine Surg, 27(1) 2014 1–10.
  • Chen J-H, Liu C, You L & Simmons C A, Boning up on Wolff's Law: Mechanical regulation of the cells that make and maintain bone, J Biomech, 43(1) (2010) 108–118.
  • Stock J T, Wolff's law (bone functional adaptation), The International Encyclopedia of Biological Anthropology (Wiley:Hoboken, NJ, USA) 2018, 1–2.
  • Kurtz S M, Development and clinical performance of PEEK intervertebral cages, PEEK Biomaterials Handbook (Elsevier) 2019, 263–280.
  • Seaman S, Kerezoudis P, Bydon M, Torner J C & Hitchon P W, Titanium vs. polyetheretherketone (PEEK) interbody fusion: meta-analysis and review of the literature, J Clin Neurosci, 44 (2017) 23–29.
  • Nemoto O, Asazuma T, Yato Y, Imabayashi H, Yasuoka H & Fujikawa A, Comparison of fusion rates following transforaminal lumbar interbody fusion using polyetheretherketone cages or titanium cages with transpedicular instrumentation, Eur Spine J, 23(10) (2014) 2150–2155.
  • Kanayama M, Cunningham B W, Haggerty C J, Abumi K, Kaneda K & McAfee P C, In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices, J Neurosurg Spine, 93(2) (2000) 259–265.
  • Herrera A, Yánez A, Martel O, Afonso H & Monopoli D, Computational study and experimental validation of porous structures fabricated by electron beam melting: A challenge to avoid stress shielding, Mater Sci Eng C, 45 (2014) 89–93.
  • Tsai P I, Hsu C C, Chen S Y, Wu T H & Huang C C, Biomechanical investigation into the structural design of porous additive manufactured cages using numerical and experimental approaches, Comput Biol Med, 76 (2016) 14–23.
  • McGilvray K C, Easley J, Seim H B, Regan D, Berven S H, Hsu W K, Mroz T E & Puttlitz C M, Bony ingrowth potential of 3D-printed porous titanium alloy: A direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model, Spine J, 18(7) (2018) 1250–1260.
  • Taniguchi N, Fujibayashi S, Takemoto M, Sasaki K, Otsuki B, Nakamura T, Matsushita T, Kokubo T & Matsuda S, Effect of pore size on bone ingrowth into porous titanium implants fabricated by additive manufacturing: An in vivo experiment, Mater Sci Eng C, 59 (2016) 690–701.
  • Wu S H, Li Y, Zhang Y Q, Li X K, Yuan C F, Hao Y L, Zhang Z Y & Guo Z, Porous titanium‐6 aluminum‐4 vanadium cage has better osseointegration and less micromotion than a poly‐ether‐ether‐ketone cage in sheep vertebral fusion, Artif Organs, 37(12) (2013) E191–E201.
  • Lim K M, Park T H, Lee S J & Park S J, Design and biomechanical verification of additive manufactured composite spinal cage composed of porous titanium cover and PEEK body, Appl Sci, 9(20) (2019) 4258.
  • Pitzen T, Geisler F, Matthis D, Müller-Storz H, Barbier D, Steudel W I & Feldges A, A finite element model for predicting the biomechanical behaviour of the human lumbar spine, Control Eng Pract, 10(1) (2002) 83–90.
  • Vadapalli S, Sairyo K, Goel V K, Robon M, Biyani A, Khandha A & Ebraheim N A, Biomechanical rationale for using polyetheretherketone (PEEK) spacers for lumbar interbody fusion–A finite element study, Spine, 31(26) (2006) E992–E998.
  • Zhang Z, Li H, Fogel G R, Liao Z, Li Y & Liu W, Biomechanical analysis of porous additive manufactured cages for lateral lumbar interbody fusion: A finite element analysis, World Neurosurg, 111 (2018) e581–e591.
  • Ambati D V, Wright Jr E K, Lehman Jr R A, Kang D G, Wagner S C & Dmitriev A E, Bilateral pedicle screw fixation provides superior biomechanical stability in transforaminal lumbar interbody fusion: A finite element study, Spine J, 15(8) (2015) 1812–1822.
  • Shirazi-Adl A, Ahmed A M & Shrivastava S C, Mechanical response of a lumbar motion segment in axial torque alone and combined with compression, Spine, 11(9) (1986) 914–927.
  • Zhong Z C, Wei S H, Wang J P, Feng C K, Chen C S & Yu C H, Finite element analysis of the lumbar spine with a new cage using a topology optimization method, Med Eng Phys, 28(1) (2006) 90–98.
  • Chosa E, Goto K, Totoribe K & Tajima N, Analysis of the effect of lumbar spine fusion on the superior adjacent intervertebral disk in the presence of disk degeneration, using the three-dimensional finite element method, Clin Spine Surg, 17(2) (2004) 134–139.
  • Xiao Z, Wang L, Gong H & Zhu D, Biomechanical evaluation of three surgical scenarios of posterior lumbar interbody fusion by finite element analysis, Biomed Eng Online, 11(1) (2012) 31.
  • Fan D Y, Li Y, Wang X, Zhu T J, Wang Q, Cai H, Li W S, Tian Y & Liu ZJ, Progressive 3D printing technology and its application in medical materials, Front Pharmacol, 11 (2020) 12.
  • Kurutz M, Finite element modelling of human lumbar spine, In: Finite Element Analysis (Editor: David Moratal) (IntechOpen, London) 2010, 209–236.
  • Epasto G, Distefano F, Mineo R & Guglielmino E, Subject-specific finite element analysis of a lumbar cage produced by electron beam melting, Med Biol Eng Comput, 57(12) (2019) 2771–2781.
  • Choi K C, Ryu K S, Lee S H, Kim Y H, Lee S J & Park C K, Biomechanical comparison of anterior lumbar interbody fusion: stand-alone interbody cage versus interbody cage with pedicle screw fixation-a finite element analysis, BMC Musculoskelet Disord, 14(1) (2013) 1–9.
  • Zhang Q H, Zhou Y L, Petit D & Teo E C, Evaluation of load transfer characteristics of a dynamic stabilization device on disc loading under compression, Med Eng Phys, 31(5) (2009) 533–538.
  • Goel V, Monroe B, Gilbertson L & Brinckmann P, Interlaminar shear stresses and laminae separation in a disc: finite element analysis of the L3-L4 motion segment subjected to axial compressive loads, Spine, 20(6) (1995) 689–698.
  • Simon U, Augat P, Ignatius A & Claes L, Influence of the stiffness of bone defect implants on the mechanical conditions at the interface — a finite element analysis with contact, J Biomech, 36(8) (2003) 1079–1086.
  • Panjabi M M, Crisco J J, Vasavada A, Oda T, Cholewicki J, Nibu K & Shin E, Mechanical properties of the human cervical spine as shown by three-dimensional load – displacement curves, Spine, 26(24) (2001) 2 692–2700.
  • Lee J H, Park W M, Kim Y H & Jahng T A, A biomechanical analysis of an artificial disc with a shock-absorbing core property by using whole-cervical spine finite element analysis, Spine, 41(15) (2016) E893–E901.

Abstract Views: 34

PDF Views: 26




  • Comparative Analysis of Porous Titanium Spinal Cage with Conventional Spinal Cages: A Finite Element Study

Abstract Views: 34  |  PDF Views: 26

Authors

Prashant Kumar
Manufacturing Science and Instrumentation, CSIR-CSIO, Sector 30C, Chandigarh 160 030, India
Rahul Bhardwaj
Manufacturing Science and Instrumentation, CSIR-CSIO, Sector 30C, Chandigarh 160 030, India
Amrit Lal Matharu
Manufacturing Science and Instrumentation, CSIR-CSIO, Sector 30C, Chandigarh 160 030, India
Vijay Kumar Meena
Manufacturing Science and Instrumentation, CSIR-CSIO, Sector 30C, Chandigarh 160 030, India

Abstract


The objective of this study is to compare the stress shielding effect of various conventional as well as modified additive manufactured porous materials used for spinal cages. A finite element study was performed by changing the design (fully porous and hybrid) and the materials (PEEK, CFR-PEEK, Titanium) of spinal cages. All the models were simulated under uniaxial compression, to study the stress shielding effect. The Finite Element Analysis results showed that the hybrid spinal cage transfers more stress to its adjacent vertebrae than the other design configurations under uniaxial compression. The hybrid titanium cage was most effective in reducing the stress shielding effect. The hybrid cage is stronger than PEEK & CFR-PEEK cages, however, due to the porous structure reduced stress shielding was observed.

Keywords


Additive manufacturing, CFR-PEEK, PEEK, PLIF, Ti6Al4V ELI.

References