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      Biomaterials in Spinal Implants: A Review

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          Abstract

          The aim to find the perfect biomaterial for spinal implant has been the focus of spinal research since the 1800s. Spinal surgery and the devices used therein have undergone a constant evolution in order to meet the needs of surgeons who have continued to further understand the biomechanical principles of spinal stability and have improved as new technologies and materials are available for production use. The perfect biomaterial would be one that is biologically inert/compatible, has a Young’s modulus similar to that of the bone where it is implanted, high tensile strength, stiffness, fatigue strength, and low artifacts on imaging. Today, the materials that have been most commonly used include stainless steel, titanium, cobalt chrome, nitinol (a nickel titanium alloy), tantalum, and polyetheretherketone in rods, screws, cages, and plates. Current advancements such as 3-dimensional printing, the ProDisc-L and ProDisc-C, the ApiFix, and the Mobi-C which all aim to improve range of motion, reduce pain, and improve patient satisfaction. Spine surgeons should remain vigilant regarding the current literature and technological advancements in spinal materials and procedures. The progression of spinal implant materials for cages, rods, screws, and plates with advantages and disadvantages for each material will be discussed.

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          Most cited references85

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          Titanium alloys in total joint replacement--a materials science perspective.

          Increased use of titanium alloys as biomaterials is occurring due to their lower modulus, superior biocompatibility and enhanced corrosion resistance when compared to more conventional stainless steels and cobalt-based alloys. These attractive properties were a driving force for the early introduction of alpha (cpTi) and alpha + beta (Ti-6A1-4V) alloys as well as for the more recent development of new Ti-alloy compositions and orthopaedic metastable beta titanium alloys. The later possess enhanced biocompatibility, reduced elastic modulus, and superior strain-controlled and notch fatigue resistance. However, the poor shear strength and wear resistance of titanium alloys have nevertheless limited their biomedical use. Although the wear resistance of beta-Ti alloys has shown some improvement when compared to alpha + beta alloys, the ultimate utility of orthopaedic titanium alloys as wear components will require a more complete fundamental understanding of the wear mechanisms involved. This review examines current information on the physical and mechanical characteristics of titanium alloys used in artifical joint replacement prostheses, with a special focus on those issues associated with the long-term prosthetic requirements, e.g., fatigue and wear.
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            Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members.

            A limited survey analysis of 617 surgical cases in which pedicle screw implants were used was undertaken to ascertain the incidence and variety of associated complications. The different implant systems used included variable spinal plating (n = 249), Edwards (n = 143), and AO fixateur interne (n = 101). The most common intraoperative problem was unrecognized screw misplacement (5.2%). Fracturing of the pedicle during screw insertion and iatrogenic cerebrospinal fluid leak occurred in 4.2% of cases. The postoperative deep infection rate was 4.2%. Transient neuropraxia occurred in 2.4% of cases, and permanent nerve root injury occurred in 2.3% of cases. Previously unreported injury to nerve roots occurred late in the postoperative course in three cases. Screw breakage occurred in 2.9% of cases. All other complications had an incidence of less than 2%. The authors conclude that pedicle screw placement may be associated with significant intraoperative and postoperative complications. This information is of value to surgeons using pedicle implant systems as well as to their patients. Repeat surgery is associated with greater numbers of complications.
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              Treatment of scoliosis. Correction and internal fixation by spine instrumentation.

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                Author and article information

                Journal
                Neurospine
                Neurospine
                NS
                Neurospine
                Korean Spinal Neurosurgery Society
                2586-6583
                2586-6591
                March 2020
                4 November 2019
                : 17
                : 1
                : 101-110
                Affiliations
                Mount Sinai Health System, New York, NY, USA
                Author notes
                Corresponding Author Samuel K. Cho https://orcid.org/0000-0001-7511-2486 Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 4th Floor, New York, NY 10029, USA E-mail: samuel.cho@ 123456mountsinai.org
                Author information
                http://orcid.org/0000-0001-7511-2486
                Article
                ns-1938296-148
                10.14245/ns.1938296.148
                7136103
                31694360
                1628b4e4-7803-495b-91e9-b5910af72894
                Copyright © 2020 by the Korean Spinal Neurosurgery Society

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 August 2019
                : 27 September 2019
                : 27 September 2019
                Categories
                Review Article
                New Technology

                spine,surgery,biomaterials,rods,screws,cages
                spine, surgery, biomaterials, rods, screws, cages

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