Evolution of materials for implants in metastatic spine disease till date - Have we found an ideal material?

Autor: Kumar N; Department of Orthopaedic Surgery, National University Health System, Singapore. Electronic address: dosksn@nus.edu.sg., Lopez KG; Department of Orthopaedic Surgery, National University Health System, Singapore., Alathur Ramakrishnan S; Department of Orthopaedic Surgery, National University Health System, Singapore., Hallinan JTPD; Department of Diagnostic Imaging, National University Hospital, Singapore., Fuh JYH; Department of Mechanical Engineering, National University of Singapore, Singapore., Pandita N; Department of Orthopaedic Surgery, National University Health System, Singapore., Madhu S; Department of Orthopaedic Surgery, National University Health System, Singapore., Kumar A; Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore., Benneker LM; Department of Orthopaedics, Spine Surgery, Sonnenhofspital, Bern, Switzerland., Vellayappan BA; Department of Radiation Oncology, National University Health System, Singapore.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2021 Oct; Vol. 163, pp. 93-104. Date of Electronic Publication: 2021 Aug 19.
DOI: 10.1016/j.radonc.2021.08.007
Abstrakt: "Metastatic Spine Disease" (MSD) often requires surgical intervention and instrumentation with spinal implants. Ti6Al4V is widely used in metastatic spine tumor surgery (MSTS) and is the current implant material of choice due to improved biocompatibility, mechanical properties, and compatibility with imaging modalities compared to stainless steel. However, it is still not the ideal implant material due to the following issues. Ti6Al4V implants cause stress-shielding as their Young's modulus (110 gigapascal [GPa]) is higher than cortical bone (17-21 GPa). Ti6Al4V also generates artifacts on CT and MRI, which interfere with the process of postoperative radiotherapy (RT), including treatment planning and delivery. Similarly, charged particle therapy is hindered in the presence of Ti6Al4V. In addition, artifacts on CT and MRI may result in delayed recognition of tumor recurrence and postoperative complications. In comparison, polyether-ether-ketone (PEEK) is a promising alternative. PEEK has a low Young's modulus (3.6 GPa), which results in optimal load-sharing and produces minimal artifacts on imaging with less hinderance on postoperative RT. However, PEEK is bioinert and unable to provide sufficient stability in the immediate postoperative period. This issue may possibly be mitigated by combining PEEK with other materials to form composites or through surface modification, although further research is required in these areas. With the increasing incidence of MSD, it is an opportune time for the development of spinal implants that possess all the ideal material properties for use in MSTS. Our review will explore whether there is a current ideal implant material, available alternatives and whether these require further investigation.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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