Impaction durability of porous PEEK and titanium-coated PEEK interbody fusion devices

Publication date: Available online 31 January 2018
Source:The Spine Journal
Author(s): F. Brennan Torstrick, Brett S. Klosterhoff, L. Erik Westerlund, Kevin T. Foley, Joanna Gochuico, Christopher S.D. Lee, Ken Gall, David L. Safranski
Background ContextVarious surface modifications, often incorporating roughened or porous surfaces, have recently been introduced to enhance osseointegration of interbody fusion devices. However, these topographical features can be vulnerable to damage during clinical impaction. Despite the potential negative impact of surface damage on clinical outcomes, current testing standards do not replicate clinically relevant impaction loading conditions.PurposeThe purpose of this study was to compare the impaction durability of conventional smooth PEEK cervical interbody fusion devices with two surface-modified PEEK devices that feature either a porous structure or plasma-sprayed titanium coating.Study Design/SettingA recently developed biomechanical test method was adapted to simulate clinically relevant impaction loading conditions during cervical interbody fusion procedures.MethodsThree cervical interbody fusion devices were used in this study: smooth PEEK, plasma-sprayed titanium-coated PEEK, and porous PEEK (n=6). Following Kienle et al., devices were impacted between two polyurethane blocks mimicking vertebral bodies under a constant 200 N pre-load. The posterior tip of the device was placed at the entrance between the polyurethane blocks and a guided 1 lb weight was impacted upon the anterior face with a maximum speed of 2.6 m/s to represent the strike force of a surgical mallet. Impacts were repeated until the device was fully impacted. Porous PEEK durability was assessed using micro-computed tomography (µCT) pre- and post- impaction. Titanium-coating coverage pre- and post-impaction was assessed using scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDX). Changes to the surface roughness of smooth and titanium-coated devices were also evaluated.ResultsPorous PEEK and smooth PEEK devices showed minimal macroscopic signs of surface damage, while the titanium-coated devices exhibited substantial visible coating loss. Quantification of the porous PEEK deformation demonstrated that the porous structure maintained a high porosity (>65%) following impaction that would be available for bone ingrowth, and exhibited minimal changes to pore size and depth. SEM and EDX analysis of titanium-coated devices demonstrated substantial titanium coating loss after impaction that was corroborated with a decrease in surface roughness. Smooth PEEK showed minimal signs of damage using SEM, but demonstrated a decrease in surface roughness.ConclusionThough recent surface modifications to interbody fusion devices are beneficial for osseointegration, they may be susceptible to damage and wear during impaction. The current study found porous PEEK devices to show minimal damage during simulated cervical impaction, whereas titanium-coated PEEK devices lost substantial titanium coverage.



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