Intervertebral cages used in clinical applications were often general products with standard specifications, which were challenging to match with the cervical vertebra and prone to cause stress shielding and subsidence.
OBJECTIVE:
To design and fabricate customized tantalum (Ta) intervertebral fusion cages that meets the biomechanical requirements of the cervical segment.
METHODS:
The lattice intervertebral cages were customized designed and fabricated by the selective laser melting. The joint and muscle forces of the cervical segment under different movements were analyzed using reverse dynamics method. The stress characteristics of cage, plate, screws and vertebral endplate were analyzed by finite element analysis. The fluid flow behaviors and permeability of three lattice structures were simulated by computational fluid dynamics. Compression tests were executed to investigate the biomechanical properties of the cages.
RESULTS:
Compared with the solid cages, the lattice-filled structures significantly reduced the stress of cages and anterior fixation system. In comparison to the octahedroid and quaddiametral lattice-filled cages, the bitriangle lattice-filled cage had a lower stress shielding rate, higher permeability, and superior subsidence resistance ability.
CONCLUSION:
The inverse dynamics simulation combined with finite element analysis is an effective method to investigate the biomechanical properties of the cervical vertebra during movements.
CarrierC.S.BonoC.M. and LeblD.R., Evidence-based analysis of adjacent segment degeneration and disease after ACDF: A systematic review, The Spine Journal13(10) (2013), 1370–1378. doi:10.1016/j.spinee.2013.05.050.
2.
NouriA.ShirvanA.R.LiY.C. and WenC.E., Additive manufacturing of metallic and polymeric load-bearing biomaterials using laser powder bed fusion: A review, Journal of Materials Science & Technology94 (2021), 196–215. doi:10.1016/j.jmst.2021.03.058.
3.
NgoT.D.KashaniA.ImbalzanoG.NguyenK.T.Q. and HuiD., Additive manufacturing (3D printing): A review of materials, methods, applications and challenges, Composites Part B: Engineering143 (2018), 172–196. doi:10.1016/j.compositesb.2018.02.012.
4.
HuangH.LiuJ.WangL. and FanY., A critical review on the biomechanical study of cervical interbody fusion cage, Medicine in Novel Technology and Devices11 (2021), 100070. doi:10.1016/j.medntd.2021.100070.
5.
LarattaJ.L.VivaceB.J.Lopez-PenaM.GuzonF.M.Gonzalez-CantalpeidraA.Jorge-MoraA., 3D-printed titanium cages without bone graft outperform PEEK cages with autograft in an animal model, Spine Journal22(6) (2022), 1016–1027. doi:10.1016/j.spinee.2021.12.004.
6.
FogelG.MartinN.WilliamsG.M.UngerJ.Yee-YanagishitaC.PelletierM., Choice of spinal interbody fusion cage material and design influences subsidence and osseointegration performance, World Neurosurgery162 (2022), e626–e634. doi:10.1016/j.wneu.2022.03.087.
7.
JiangH.F.AihemaitiP.AiyitiW. and KasimuA., Study Of the compression behaviours of 3D-printed PEEK/CFR-PEEK sandwich composite structures, Virtual and Physical Prototyping17(2) (2022), 138–155. doi:10.1080/17452759.2021.2014636.
8.
ZhengJ.ZhaoH.OuyangZ.ZhouX.KangJ.YangC., Additively-manufactured PEEK/HA porous scaffolds with excellent osteogenesis for bone tissue repairing, Composites Part B: Engineering232 (2022), 109508. doi:10.1016/j.compositesb.2021.109508.
9.
AufaA.N.HassanM.Z. and IsmailZ., Recent advances in Ti-6Al-4V additively manufactured by selective laser melting for biomedical implants: Prospect development, Journal of Alloys and Compounds896 (2022), 163072. doi:10.1016/j.jallcom.2021.163072.
10.
WangX.XuS.ZhouS.XuW.LearyM.ChoongP., Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: A review, Biomaterials83 (2016), 127–141. doi:10.1016/j.biomaterials.2016.01.012.
11.
ZhouZ. and LiuD., Mesenchymal stem cell-seeded porous tantalum-based biomaterial: A promising choice for promoting bone regeneration, Colloids and Surfaces B: Biointerfaces215 (2022), 112491. doi:10.1016/j.colsurfb.2022.112491.
12.
WangX.NingB.Y. and PeiX.B., Tantalum and its derivatives in orthopedic and dental implants: Osteogenesis and antibacterial properties, Colloids and Surfaces B-Biointerfaces208 (2021), 112055. doi:10.1016/j.colsurfb.2021.112055.
13.
BencharitS.ByrdW.C.AltarawnehS.HosseiniB.LeongA.ResideG., Development and applications of porous tantalum trabecular metal-enhanced titanium dental implants, Clinical Implant Dentistry and Related Research16(6) (2014), 817–826. doi:10.1111/cid.12059.
14.
PiglionicoS.BousquetJ.FatimaN.RenaudM.Collart-DutilleulP.Y. and BousquetP., Porous tantalum vs. titanium implants: Enhanced mineralized matrix formation after stem cells proliferation and differentiation, Journal of Clinical Medicine9(11) (2020), 3657. doi:10.3390/jcm9113657.
15.
LiX.WangL.YuX.M.FengY.F.WangC.T.YangK., Tantalum coating on porous Ti6Al4V scaffold using chemical vapor deposition and preliminary biological evaluation, Materials Science & Engineering C-Materials for Biological Applications33(5) (2013), 2987–2994. doi:10.1016/j.msec.2013.03.027.
16.
PrajapatiM.J.KumarA.LinS.-C. and JengJ.-Y., Multi-material additive manufacturing with lightweight closed-cell foam-filled lattice structures for enhanced mechanical and functional properties, Additive Manufacturing54 (2022), 102766. doi:10.1016/j.addma.2022.102766.
HsiehM.T.BegleyM.R. and ValdevitL., Architected implant designs for long bones: Advantages of minimal surface-based topologies, Materials & Design207 (2021), 109838. doi:10.1016/j.matdes.2021.109838.
19.
PeretsT.Ben Ghedalia-PeledN.VagoR.GoldmanJ.ShirizlyA. and AghionE., In vitro behavior of bioactive hybrid implant composed of additively manufactured titanium alloy lattice infiltrated with Mg-based alloy, Materials Science and Engineering C-Materials for Biological Applications129 (2021), 112418. doi:10.1016/j.msec.2021.112418.
20.
LeiP.F.QianH.ZhangT.M.LeiT.HuY.H.ChenC., Porous tantalum structure integrated on Ti6Al4V base by laser powder bed fusion for enhanced bony-ingrowth implants: In vitro and in vivo validation, Bioactive Materials7 (2022), 3–13. doi:10.1016/j.bioactmat.2021.05.025.
21.
LuT.RenJ.K.SunZ.W.ZhangJ.XuK.SunL., Relationship between the elastic modulus of the cage material and the biomechanical properties of transforaminal lumbar interbody fusion: A logarithmic regression analysis based on parametric finite element simulations, Computer Methods and Programs in Biomedicine214 (2022), 106570. doi:10.1016/j.cmpb.2021.106570.
22.
FanW. and GuoL.-X., The effect of non-fusion dynamic stabilization on biomechanical responses of the implanted lumbar spine during whole-body vibration, Computer Methods and Programs in Biomedicine192 (2020), 105441. doi:10.1016/j.cmpb.2020.105441.
23.
ZhouE.Z.HuangH.W.ZhaoY.B.WangL.Z. and FanY.B., The effects of titanium mesh cage size on the biomechanical responses of cervical spine after anterior cervical corpectomy and fusion: A finite element study, Clinical Biomechanics91 (2022), 105547. doi:10.1016/j.clinbiomech.2021.105547.
24.
HuaW.B.ZhiJ.G.KeW.C.WangB.J.YangS.H.LiL., Adjacent segment biomechanical changes after one- or two-level anterior cervical discectomy and fusion using either a zero-profile device or cage plus plate: A finite element analysis, Computers in Biology and Medicine120 (2020), 103760. doi:10.1016/j.compbiomed.2020.103760.
25.
WangH.W.WanY.LiQ.H.XiaY.LiuX.Y.LiuZ.Q., Porous fusion cage design via integrated global-local topology optimization and biomechanical analysis of performance, Journal of the Mechanical Behavior of Biomedical Materials112 (2020), 103982. doi:10.1016/j.jmbbm.2020.103982.
26.
KunzeM.SchallerA.SteinkeH.ScholzR. and VoigtC., Combined multi-body and finite element investigation of the effect of the seat height on acetabular implant stability during the activity of getting up, Computer Methods and Programs in Biomedicine105(2) (2012), 175–182. doi:10.1016/j.cmpb.2011.09.008.
27.
ZhangY.ChenZ.ZhaoH.ZhaoD.ZhangX.MaX., Comparison of joint load, motions and contact stress and bone-implant interface micromotion of three implant designs for total ankle arthroplasty, Computer Methods and Programs in Biomedicine223 (2022), 106976. doi:10.1016/j.cmpb.2022.106976.
28.
WangS.B.ParkW.M.KimY.H.ChaT.WoodK. and LiG.A., In vivo loads in the lumbar L3-4 disc during a weight lifting extension, Clinical Biomechanics29(2) (2014), 155–160. doi:10.1016/j.clinbiomech.2013.11.018.
29.
ZairiF.MoulartM.FontaineC.ZairiF.TiffreauV. and LogierR., Relevance of a novel external dynamic distraction device for treating back pain, Proceedings of the Institution of Mechanical Engineers Part H-Journal of Engineering in Medicine235(3) (2021), 264–272. doi:10.1177/0954411920971401.
30.
GrujicicM.PanduranganB.XieX.GramopadhyeA.K.WagnerD. and OzenM., Musculoskeletal computational analysis of the influence of car-seat design/adjustments on long-distance driving fatigue, International Journal of Industrial Ergonomics40(3) (2010), 345–355. doi:10.1016/j.ergon.2010.01.002.
31.
IgnasiakD., A novel method for prediction of postoperative global sagittal alignment based on full-body musculoskeletal modeling and posture optimization, Journal of Biomechanics102 (2020), 109324. doi:10.1016/j.jbiomech.2019.109324.
32.
ScholzM.SchnakeK.J.PingelA.HoffmannR. and KandzioraF., A new zero-profile implant for stand-alone anterior cervical interbody fusion, Clinical Orthopaedics and Related Research469(3) (2011), 666–673. doi:10.1007/s11999-010-1597-9.
33.
TaniguchiN.FujibayashiS.TakemotoM.SasakiK.OtsukiB.NakamuraT., Effect of pore size on bone ingrowth into porous titanium implants fabricated by additive manufacturing: An in vivo experiment, Materials Science & Engineering C-Materials for Biological Applications59 (2016), 690–701. doi:10.1016/j.msec.2015.10.069.
34.
Diez-EscuderoA.AnderssonB.CarlssonE.ReckerB.LinkH.JarhultJ.D., 3D-printed porous Ti6Al4V alloys with silver coating combine osteocompatibility and antimicrobial properties, Materials Science & Engineering C, Materials for Biological Applications133 (2021), 112629. doi:10.1016/j.msec.2021.112629.
35.
HuaW.ZhiJ.WangB.KeW.SunW.YangS., Biomechanical evaluation of adjacent segment degeneration after one- or two-level anterior cervical discectomy and fusion versus cervical disc arthroplasty: A finite element analysis, Computer Methods and Programs in Biomedicine189 (2020), 105352. doi:10.1016/j.cmpb.2020.105352.
36.
ALTAIR. Altair SimSolid®Structural Analysis for Rapid Design Iterations Troy (MI): Altair Engineering Inc; 2023. Available from: https://altair.com/simsolid.
37.
BenadyA.MeyerS.J.GoldenE.DadiaS. and Katarivas LevyG., Patient-specific Ti-6Al-4V lattice implants for critical-sized load-bearing bone defects reconstruction, Materials & Design226 (2023), 111605. doi:10.1016/j.matdes.2023.111605.
38.
ZhangS.DaD. and WangY., TPMS-infill MMC-based topology optimization considering overlapped component property, International Journal of Mechanical Sciences235 (2022), 107713. doi:10.1016/j.ijmecsci.2022.107713.
39.
FanW.GuoL.X. and ZhaoD., Posterior lumbar interbody fusion versus transforaminal lumbar interbody fusion: finite element analysis of the vibration characteristics of fused lumbar spine, World Neurosurgery150 (2021), E81–E88. doi:10.1016/j.wneu.2021.02.094.
40.
ShimV.P.W.YangL.M.LiuJ.F. and LeeV.S., Characterisation of the dynamic compressive mechanical properties of cancellous bone from the human cervical spine, International Journal of Impact Engineering32(1-4) (2005), 525–540. doi:10.1016/j.ijimpeng.2005.03.006.
41.
LinM.H.ShapiroS.Z.DoulgerisJ.EngebergE.D.TsaiC.T. and VrionisF.D., Cage-screw and anterior plating combination reduces the risk of micromotion and subsidence in multilevel anterior cervical discectomy and fusion-a finite element study, Spine Journal21(5) (2021), 874–882. doi:10.1016/j.spinee.2021.01.015.
42.
PolikeitA.FergusonS.J.NolteL.P. and OrrT.E., Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: Finite element analysis, European Spine Journal12(4) (2003), 413–420. doi:10.1007/s00586-002-0505-8.
43.
ZengS.LiuG.LiC.YeJ. and LiD., Porous structure design and mechanical properties analysis of femoral stem based on selective laser melting, Chinese Journal of Lasers49(2) (2022), 0202016.
44.
VossenbergP.HigueraG.A.van StratenG.van BlitterswijkC.A. and van BoxtelA.J.B., Darcian permeability constant as indicator for shear stresses in regular scaffold systems for tissue engineering, Biomechanics and Modeling in Mechanobiology8(6) (2009), 499–507. doi:10.1007/s10237-009-0153-6.
45.
SchiaviA.FiumeE.OrlygssonG.SchwentenweinM.VernéE. and BainoF., High-reliability data processing and calculation of microstructural parameters in hydroxyapatite scaffolds produced by vat photopolymerization, Journal of the European Ceramic Society42 (2022), 6206–6212. doi:10.1016/j.jeurceramsoc.2022.06.022.
46.
KumarN.Alathur RamakrishnanS.LopezK.G.ChinB.Z.DevyapriyaS.KumarL., Current trends and future scope in 3D printing for surgical management of spine pathologies, Bioprinting26 (2022), e00197. doi:10.1016/j.bprint.2022.e00197.
47.
MinodaY.KobayashiA.IkebuchiM.IwakiH.InoriF. and NakamuraH., Periprosthetic loss of bone mineral density after cementless porous tantalum and cemented total knee arthroplasties: A mean of 11-year concise follow-up of a previous report, Journal of Arthroplasty35(11) (2020), 3156–3160. doi:10.1016/j.arth.2020.06.014.
48.
YuanW.Kaliya-PerumalA.K.ChouS.M. and OhJ.Y.L., Does lumbar interbody cage size influence subsidence? A biomechanical study, Spine45(2) (2020), 88–95. doi:10.1097/brs.0000000000003194.
49.
PanF.M.WangS.J.YongZ.Y.LiuX.M.HuangY.F. and WuD.S., Risk factors for cage retropulsion after lumbar interbody fusion surgery: Series of cases and literature review, International Journal of Surgery30 (2016), 56–62. doi:10.1016/j.ijsu.2016.04.025.
50.
Calvo-EcheniqueA.CegoñinoJ.ChuecaR. and Pérez-del PalomarA., Stand-alone lumbar cage subsidence: A biomechanical sensitivity study of cage design and placement, Computer Methods and Programs in Biomedicine162 (2018), 211–219. doi:10.1016/j.cmpb.2018.05.022.
51.
BolestaM.J.Rechtine 2ndG.R. and ChrinA.M., One- and two-level anterior cervical discectomy and fusion: The effect of plate fixation, The Spine Journal: Official Journal of the North American Spine Society2(3) (2002), 197–203. doi:10.1016/s1529-9430(02)00186-9.
52.
AliD.OzalpM.BlanquerS.B.G. and OnelS., Permeability and fluid flow-induced wall shear stress in bone scaffolds with TPMS and lattice architectures: A CFD analysis, European Journal of Mechanics B-Fluids79 (2020), 376–385. doi:10.1016/j.euromechflu.2019.09.015.
53.
DiasM.R.FernandesP.R.GuedesJ.M. and HollisterS.J., Permeability analysis of scaffolds for bone tissue engineering, Journal of Biomechanics45(6) (2012), 938–944. doi:10.1016/j.jbiomech.2012.01.019.
54.
du PlessisA.YadroitsavaI.YadroitsevI.le RouxaS.G. and BlaineD.C., Numerical comparison of lattice unit cell designs for medical implants by additive manufacturing, Virtual and Physical Prototyping13(4) (2018), 266–281. doi:10.1080/17452759.2018.1491713.
55.
YangC.X.LiQ.M. and WangY., Compressive properties of cuttlebone-like lattice (CLL) materials with functionally graded density, European Journal of Mechanics a-Solids87 (2021), 104215. doi:10.1016/j.euromechsol.2021.104215.
56.
BenedettiM.du PlessisA.RitchieR.O.DallagoM.RazaviS.M.J. and BertoF., Architected cellular materials: A review on their mechanical properties towards fatigue-tolerant design and fabrication, Materials Science & Engineering R-Reports144 (2021), 100606. doi:10.1016/j.mser.2021.100606.
57.
PeckJ.H.SingD.C.NagarajaS.PeckD.G.LotzJ.C. and DmitrievA.E., Mechanical performance of cervical intervertebral body fusion devices: A systematic analysis of data submitted to the Food and Drug Administration, Journal of Biomechanics54 (2017), 26–32. doi:10.1016/j.jbiomech.2017.01.032.
