Impaction durability of porous polyether-ether-ketone (PEEK) and titanium-coated PEEK interbody fusion devices

F. Brennan Torstrick, Brett S. Klosterhoff, L. Erik Westerlund, Kevin Foley, Joanna Gochuico, Christopher S.D. Lee, Ken Gall, David L. Safranski

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Context: Various 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. Purpose: The purpose of this study was to compare the impaction durability of conventional smooth polyether-ether-ketone (PEEK) cervical interbody fusion devices with two surface-modified PEEK devices that feature either a porous structure or plasma-sprayed titanium coating. Study Design/Setting: A recently developed biomechanical test method was adapted to simulate clinically relevant impaction loading conditions during cervical interbody fusion procedures. Methods: Three 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 preload. 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 postimpaction. Titanium-coating coverage pre- and postimpaction was assessed using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy. Changes to the surface roughness of smooth and titanium-coated devices were also evaluated. Results: Porous PEEK and smooth PEEK devices showed minimal macroscopic signs of surface damage, whereas 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 energy dispersive X-ray spectroscopy 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. Conclusion: Although 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.

Original languageEnglish (US)
Pages (from-to)857-865
Number of pages9
JournalSpine Journal
Volume18
Issue number5
DOIs
StatePublished - May 1 2018

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Titanium
Ketones
Ether
Equipment and Supplies
Electron Scanning Microscopy
X-Ray Emission Spectrometry
Osseointegration
Polyurethanes
Porosity
Tomography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Torstrick, F. B., Klosterhoff, B. S., Westerlund, L. E., Foley, K., Gochuico, J., Lee, C. S. D., ... Safranski, D. L. (2018). Impaction durability of porous polyether-ether-ketone (PEEK) and titanium-coated PEEK interbody fusion devices. Spine Journal, 18(5), 857-865. https://doi.org/10.1016/j.spinee.2018.01.003

Impaction durability of porous polyether-ether-ketone (PEEK) and titanium-coated PEEK interbody fusion devices. / Torstrick, F. Brennan; Klosterhoff, Brett S.; Westerlund, L. Erik; Foley, Kevin; Gochuico, Joanna; Lee, Christopher S.D.; Gall, Ken; Safranski, David L.

In: Spine Journal, Vol. 18, No. 5, 01.05.2018, p. 857-865.

Research output: Contribution to journalArticle

Torstrick, FB, Klosterhoff, BS, Westerlund, LE, Foley, K, Gochuico, J, Lee, CSD, Gall, K & Safranski, DL 2018, 'Impaction durability of porous polyether-ether-ketone (PEEK) and titanium-coated PEEK interbody fusion devices', Spine Journal, vol. 18, no. 5, pp. 857-865. https://doi.org/10.1016/j.spinee.2018.01.003
Torstrick, F. Brennan ; Klosterhoff, Brett S. ; Westerlund, L. Erik ; Foley, Kevin ; Gochuico, Joanna ; Lee, Christopher S.D. ; Gall, Ken ; Safranski, David L. / Impaction durability of porous polyether-ether-ketone (PEEK) and titanium-coated PEEK interbody fusion devices. In: Spine Journal. 2018 ; Vol. 18, No. 5. pp. 857-865.
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abstract = "Background Context: Various 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. Purpose: The purpose of this study was to compare the impaction durability of conventional smooth polyether-ether-ketone (PEEK) cervical interbody fusion devices with two surface-modified PEEK devices that feature either a porous structure or plasma-sprayed titanium coating. Study Design/Setting: A recently developed biomechanical test method was adapted to simulate clinically relevant impaction loading conditions during cervical interbody fusion procedures. Methods: Three 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 preload. 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 postimpaction. Titanium-coating coverage pre- and postimpaction was assessed using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy. Changes to the surface roughness of smooth and titanium-coated devices were also evaluated. Results: Porous PEEK and smooth PEEK devices showed minimal macroscopic signs of surface damage, whereas 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 energy dispersive X-ray spectroscopy 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. Conclusion: Although 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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AU - Torstrick, F. Brennan

AU - Klosterhoff, Brett S.

AU - Westerlund, L. Erik

AU - Foley, Kevin

AU - Gochuico, Joanna

AU - Lee, Christopher S.D.

AU - Gall, Ken

AU - Safranski, David L.

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