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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 10/2009

01-10-2009 | Trauma Surgery

A new distractable implant for vertebral body replacement: biomechanical testing of four implants for the thoracolumbar spine

Authors: M. Reinhold, W. Schmoelz, F. Canto, D. Krappinger, M. Blauth, Christian Knop

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2009

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Abstract

Introduction

Expandable titanium implants for vertebral body replacement in the thoracolumbar spine have been well established in the reconstruction of the anterior spinal column. Load transfer at the bone-implant interface remains a point of concern. The purpose of the study was to compare the performance in axial load transfer from the implant to the vertebral body in four different implants, all of them in clinical use to date.

Materials and methods

We tested a second generation implant (Synex II) in comparison to three different expandable titanium cages: Synex I, Obelisc and X-Tenz. Twenty-four intact fresh frozen human lumbar vertebrae (L1–L4) were distributed into four identical groups according to bone mineral density (BMD). The BMD was determined by quantitative computed tomography (qCT). Specimens were loaded in craniocaudal direction with a material testing machine (Mini Bionix II) at a constant speed of 5 mm/min. Load displacement curves were continuously recorded for each specimen until failure (diminishment of compressive force (F) and/or obvious implant migration through the vertebral body end plate). One-way analysis of variance (ANOVA) and post-hoc tests (Bonferroni) were applied to detect differences at 1, 2, 3, and 4 mm displacement (F 1–4 mm) between implant groups.

Result

No significant differences were observed with regard to maximum compression force (F max) and displacement (d max) until failure: Synex II (1,782.3 N/4.67 mm); Synex I (1,645.3 N/4.72 mm); Obelisc (1,314.0 N/4.24 mm); X-Tenz (1470.3 N/6.92 mm). However, the mean compression force at 1–4 mm displacement (F 1–4 mm: 300–1,600 N) was highest for Synex II. The difference at 2 mm displacement was significant (p = 0.028) between Synex II (F 2 mm = 879 N) and X-Tenz (F 2 mm = 339 N).

Conclusion

The modified end plate design of Synex II was found to perform comparably at least with regard to the compressive performance at the implant-bone interface. The risk of the new implant for collapse into the vertebral body might be reduced when compared to the competitors.
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Metadata
Title
A new distractable implant for vertebral body replacement: biomechanical testing of four implants for the thoracolumbar spine
Authors
M. Reinhold
W. Schmoelz
F. Canto
D. Krappinger
M. Blauth
Christian Knop
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2009
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-009-0823-y

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