EXPERIMENTAL STUDY ON POLY-AMINO ACID/NANO-HYDROXYAPATITE/CALCIUM SULFATE CAGE FOR LUMBAR INTERBODY FUSION IN GOATS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XUEYoudi ^1,2 ,  SONGYueming ¹ , LIULimin ¹ , RENChunpeng ¹ , ZHOUZhongjie ¹ , ZHOUChunguang ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, Xuzhou Central Hospital. Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

SONGYueming, Email: hx-sym@163.com

Keywords：

Poly-amino acid/nano-hydroxyapatite/calcium sulfate; Cage; Interbody fusion; Lumbar spine; Goat

DOI：

10.7507/1002-1892.20150210

Video：

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Objective To evaluate the effect of poly-amino acid/nano-hydroxyapatite/calcium sulfate (PHC) Cage in lumbar interbody fusion of the goat. Methods Eighteen mature female goats (weighing 29-33 kg) were divided into 3 groups randomly: PHC Cage group (group A), titanium Cage group (group B), and ilium group (group C). A left extraperitoneal approach was used to establish the animal model of discectomy and interbody fusion with Cage or ilium. The general situation was observed for 24 weeks after operation. X-ray films were taken to measure disc space height (DSH) before operation and at 4, 12, and 24 weeks after operation. CT three dimensional reconstuction was performed at 24 weeks after operation to evaluate the interbody fusion according to modified Brantigan grading. The specimens of L3, 4 were harvested for mechanical test, histological, and scanning electron microscope (SEM) observation at 24 weeks after operation. Results All goats survived to the end of experiment. DSH at 4 weeks after operation increased when compared with preoperative one in each group, and then decreased;DSH was significantly lower at 12 and 24 weeks after operation than preoperative one in group C (P<0.05). There was no significant difference in DSH among 3 groups at preoperation and 4 weeks after operation (P>0.05);at 12 and 24 weeks after operation, DSH of groups A and B was significantly higher than that of group C (P<0.05), but no significant difference was found between groups A and B (P>0.05). CT three dimensional reconstuction showed that bony fusion was obtained in all goats of groups A and C, and in 3 goats of group B;according to modified Brantigan grading, the scores of groups A and C were significantlly higher than that of group B (P<0.05), but no significant difference between groups A and C (P>0.05). The biomechanical test showed that there was no significant difference in range of motion between group A and group B (P>0.05), which were significantly lower than that of group C (P<0.05). Microscopy and SEM observations showed that the interface between the Cage and vertebral body in group A was compact without obvious gap, and most conjunctive region was filled with osseous tissue;the interface was filled with soft tissue, and the connection was slack with obvious gap in some region in group B;the interface connection was compact, most region was filled with osseous tissue in group C. Conclusion The interbody fusion with PHC Cage is effective in goat lumbar interbody fusion model. The interface connection is compact between the Cage and the host bone followed by micro-degradation of PHC Cage, but the long-term degradation need further observation.

Citation： XUEYoudi, SONGYueming, LIULimin, RENChunpeng, ZHOUZhongjie, ZHOUChunguang. EXPERIMENTAL STUDY ON POLY-AMINO ACID/NANO-HYDROXYAPATITE/CALCIUM SULFATE CAGE FOR LUMBAR INTERBODY FUSION IN GOATS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(8): 972-977. doi: 10.7507/1002-1892.20150210 Copy

1.	Wagner P,Grant B,Bagby G,et al.Evaluation of cervical spinal fusion as a treatment in the equine "wobbler" syndrome.Vet Surg,1979,8(3):84-89.
2.	Bagby GW.Arthrodesis by the distraction-compression method using a stainless steel implant.Orthopedics,1988,11(6):931-934.
3.	McAfee PC,Cunningham BW,Lee GA,et al.Revision strategies for salvaging or improving failed cylindrical cages.Spine (Phila Pa 1976),1999,24(20):2147-2153.
4.	Steffen T,Tsantrizos A,Fruth I,et al.Cages:designs and concepts.Eur Spine J,2000,9 Suppl 1:S89-S94.
5.	魏克冰,严永刚,吕国玉,等.可降解生物活性氨基酸共聚物复合骨修复材料的研究.功能材料,2011,42(4):767-770.
6.	Li H,Yan Y,Wei J,et al.Bone substitute biomedical material of multi-(amino acid) copolymer:in vitro degradation and biocompatibility.J Mater Sci Mater Med,2011,22(11):2555-2563.
7.	van Dijk M,Smit TH,Sugihara S,et al.The effect of cage stiffness on the rate of lumbar interbody fusion:an in vivo model using poly (l-lactic Acid) and tantalum cages.Spine (Phila Pa 1976),2002,27(7):682-688.
8.	Kanayama M,Cunningham BW,Haggerty CJ,et al.in vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices.J Neurosurg,2000,93(2 Suppl):259-265.
9.	Brantigan JW,Stefee AD.A carbon fiber implant to aid interbody lumbar fusion.Two-year clinical results in the first 26 patients.Spine (Phila Pa 1976),1993,18(14):2106-2117.
10.	Smit TH.The use of a quadruped as an in vivo model for the study of the spine-biomechanical considerations.Eur Spine J,2002,11(2):137-144.
11.	Kandziora F,Pflugmacher R,Scholz M,et al.Comparison between sheep and human cervical spines:an anatomic,radiographic,bone mineral density,and biomechanical study.Spine (Phila Pa 1976),2001,26(9):1028-1037.
12.	Wilke HJ,Kettler A,Claes LE.Are sheep spines a valid biomechanical model for human spines? Spine (Phila Pa 1976),1997,22(20):2365-2374.
13.	Zhou CG,Song YM,Tu CQ,et al.Evaluation of bioabsorbable multiamino acid copolymer/alpha-tri-calcium phosphate interbody fusion cages in a goat model.Spine (Phila Pa 1976),2011,36(25):E1615-1622.
14.	Slivka MA,Spenciner DB,Seim HB 3rd,et al.High rate of fusion in sheep cervical spines following anterior interbody surgery with absorbable and nonabsorbable implant devices.Spine (Phila Pa 1976),2006,31(24):2772-2777.
15.	Erulkar JS,Grauer JN,Patel TC,et al.Flexibility analysis of posterolateral fusions in a New Zealand white rabbit model.Spine (Phila Pa 1976),2001,26(10):1125-1130.
16.	Cook SD,Patron LP,Christakis PM,et al.Comparison of methods for determining the presence and extent of anterior lumbar interbody fusion.Spine (Phila Pa 1976),2004,29(10):1118-1123.
17.	Sandhu HS,Kanim LE,Kabo JM,et al.Evaluation of rhBMP-2 with an OPLA carrier in a canine posterolateral (transverse process) spinal fusion model.Spine (Phila Pa 1976),1995,20(24):2669-2682.
18.	Caroli E,Orlando ER,D'Andrea G,et al.Anterior cervical fusion with interbody titanium cage containing surgical bone site graft:our institution's experience in 103 consecutive cases of degenerative spondylosis.J Spinal Disord Tech,2007,20(3):216-220.
19.	吕超亮,宋跃明,刘浩,等.新型人工椎板预防后路椎板切除术后瘢痕粘连的实验研究.中国修复重建外科杂志,2013,27(7):829-835.
20.	辛兵,侯筱魁,李永刚.脊柱内固定器的应力遮挡.中国矫形外科杂志,2000,7(2):154-155.
21.	周宗科,裴福兴,屠重棋,等.墨汁血管灌注和四环素荧光标记评价异体移植骨板活化状态.生物骨科材料与临床研究,2004,1(3):10-13.

1. Wagner P,Grant B,Bagby G,et al.Evaluation of cervical spinal fusion as a treatment in the equine "wobbler" syndrome.Vet Surg,1979,8(3):84-89.
2. Bagby GW.Arthrodesis by the distraction-compression method using a stainless steel implant.Orthopedics,1988,11(6):931-934.
3. McAfee PC,Cunningham BW,Lee GA,et al.Revision strategies for salvaging or improving failed cylindrical cages.Spine (Phila Pa 1976),1999,24(20):2147-2153.
4. Steffen T,Tsantrizos A,Fruth I,et al.Cages:designs and concepts.Eur Spine J,2000,9 Suppl 1:S89-S94.
5. 魏克冰,严永刚,吕国玉,等.可降解生物活性氨基酸共聚物复合骨修复材料的研究.功能材料,2011,42(4):767-770.
6. Li H,Yan Y,Wei J,et al.Bone substitute biomedical material of multi-(amino acid) copolymer:in vitro degradation and biocompatibility.J Mater Sci Mater Med,2011,22(11):2555-2563.
7. van Dijk M,Smit TH,Sugihara S,et al.The effect of cage stiffness on the rate of lumbar interbody fusion:an in vivo model using poly (l-lactic Acid) and tantalum cages.Spine (Phila Pa 1976),2002,27(7):682-688.
8. Kanayama M,Cunningham BW,Haggerty CJ,et al.in vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices.J Neurosurg,2000,93(2 Suppl):259-265.
9. Brantigan JW,Stefee AD.A carbon fiber implant to aid interbody lumbar fusion.Two-year clinical results in the first 26 patients.Spine (Phila Pa 1976),1993,18(14):2106-2117.
10. Smit TH.The use of a quadruped as an in vivo model for the study of the spine-biomechanical considerations.Eur Spine J,2002,11(2):137-144.
11. Kandziora F,Pflugmacher R,Scholz M,et al.Comparison between sheep and human cervical spines:an anatomic,radiographic,bone mineral density,and biomechanical study.Spine (Phila Pa 1976),2001,26(9):1028-1037.
12. Wilke HJ,Kettler A,Claes LE.Are sheep spines a valid biomechanical model for human spines? Spine (Phila Pa 1976),1997,22(20):2365-2374.
13. Zhou CG,Song YM,Tu CQ,et al.Evaluation of bioabsorbable multiamino acid copolymer/alpha-tri-calcium phosphate interbody fusion cages in a goat model.Spine (Phila Pa 1976),2011,36(25):E1615-1622.
14. Slivka MA,Spenciner DB,Seim HB 3rd,et al.High rate of fusion in sheep cervical spines following anterior interbody surgery with absorbable and nonabsorbable implant devices.Spine (Phila Pa 1976),2006,31(24):2772-2777.
15. Erulkar JS,Grauer JN,Patel TC,et al.Flexibility analysis of posterolateral fusions in a New Zealand white rabbit model.Spine (Phila Pa 1976),2001,26(10):1125-1130.
16. Cook SD,Patron LP,Christakis PM,et al.Comparison of methods for determining the presence and extent of anterior lumbar interbody fusion.Spine (Phila Pa 1976),2004,29(10):1118-1123.
17. Sandhu HS,Kanim LE,Kabo JM,et al.Evaluation of rhBMP-2 with an OPLA carrier in a canine posterolateral (transverse process) spinal fusion model.Spine (Phila Pa 1976),1995,20(24):2669-2682.
18. Caroli E,Orlando ER,D'Andrea G,et al.Anterior cervical fusion with interbody titanium cage containing surgical bone site graft:our institution's experience in 103 consecutive cases of degenerative spondylosis.J Spinal Disord Tech,2007,20(3):216-220.
19. 吕超亮,宋跃明,刘浩,等.新型人工椎板预防后路椎板切除术后瘢痕粘连的实验研究.中国修复重建外科杂志,2013,27(7):829-835.
20. 辛兵,侯筱魁,李永刚.脊柱内固定器的应力遮挡.中国矫形外科杂志,2000,7(2):154-155.
21. 周宗科,裴福兴,屠重棋,等.墨汁血管灌注和四环素荧光标记评价异体移植骨板活化状态.生物骨科材料与临床研究,2004,1(3):10-13.

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Chinese Journal of Reparative and Reconstructive Surgery

EXPERIMENTAL STUDY ON POLY-AMINO ACID/NANO-HYDROXYAPATITE/CALCIUM SULFATE CAGE FOR LUMBAR INTERBODY FUSION IN GOATS

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