Four-year follow-up of poly-L-lactic acid cages for lumbar interbody fusion in goats

Martijn Van Dijk, Paul J. Van Diest, Theo H. Smit, Hans Berkhof, Elisabeth H. Burger, Paul I J M Wuisman

Research output: Contribution to journalArticle

Abstract

Background. New applications of bioabsorbable polymer implants demand for histologic evaluation because a host tissue response is elicited and late complications after polymer implantation have been reported. Furthermore, in load-bearing regions an accelerated polymer degradation and foreign body reaction may be observed. Methods. Lumbar interbody fusion procedures were performed using poly-L-lactic acid (PLLA) and titanium cages in 43 goats. At 3, 6, 12, 24, 36, and 48 months after surgery, sequential histologic analysis of instrumented motion segments, lymph nodes, and nervous structures was performed. Blood samples were retrieved for laboratory analysis. Results. No adverse local or distant histologic or systemic effects were observed during the absorption of the poly-L-lactic acid cages. Interbody fusion was maintained, and only a very mild inflammatory response was observed. In half the specimens complete absorption was observed, and in the remaining specimens an estimated 1-10% of the original PLLA was present at the 3-year follow-up. At the 4-year follow-up, five out of seven PLLA specimens showed no PLLA particles under polarized light microscopy. In the remaining two specimens an estimated 1% of the original PLLA could be observed. Conclusions. Poly-L-lactic acid cages are feasible for lumbar interbody fusion, and the biocompatibility under high load bearing conditions is excellent during the complete absorption of the PLLA interbody fusion cages.

Original languageEnglish (US)
Pages (from-to)125-138
Number of pages14
JournalJournal of Long-Term Effects of Medical Implants
Volume15
Issue number2
DOIs
StatePublished - 2005
Externally publishedYes

Fingerprint

Lactic acid
Goats
Fusion reactions
Bearings (structural)
Polymers
Weight-Bearing
Absorbable Implants
Polarization Microscopy
Foreign-Body Reaction
poly(lactic acid)
Light polarization
Titanium
Biocompatibility
Surgery
Optical microscopy
Blood
Lymph Nodes
Tissue
Degradation

Keywords

  • Bioresorbable
  • Cage
  • Poly-L-lactic acid
  • Spinal fusion

ASJC Scopus subject areas

  • Biomedical Engineering
  • Medicine (miscellaneous)
  • Orthopedics and Sports Medicine
  • Pathology and Forensic Medicine

Cite this

Four-year follow-up of poly-L-lactic acid cages for lumbar interbody fusion in goats. / Van Dijk, Martijn; Van Diest, Paul J.; Smit, Theo H.; Berkhof, Hans; Burger, Elisabeth H.; Wuisman, Paul I J M.

In: Journal of Long-Term Effects of Medical Implants, Vol. 15, No. 2, 2005, p. 125-138.

Research output: Contribution to journalArticle

Van Dijk, Martijn ; Van Diest, Paul J. ; Smit, Theo H. ; Berkhof, Hans ; Burger, Elisabeth H. ; Wuisman, Paul I J M. / Four-year follow-up of poly-L-lactic acid cages for lumbar interbody fusion in goats. In: Journal of Long-Term Effects of Medical Implants. 2005 ; Vol. 15, No. 2. pp. 125-138.
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abstract = "Background. New applications of bioabsorbable polymer implants demand for histologic evaluation because a host tissue response is elicited and late complications after polymer implantation have been reported. Furthermore, in load-bearing regions an accelerated polymer degradation and foreign body reaction may be observed. Methods. Lumbar interbody fusion procedures were performed using poly-L-lactic acid (PLLA) and titanium cages in 43 goats. At 3, 6, 12, 24, 36, and 48 months after surgery, sequential histologic analysis of instrumented motion segments, lymph nodes, and nervous structures was performed. Blood samples were retrieved for laboratory analysis. Results. No adverse local or distant histologic or systemic effects were observed during the absorption of the poly-L-lactic acid cages. Interbody fusion was maintained, and only a very mild inflammatory response was observed. In half the specimens complete absorption was observed, and in the remaining specimens an estimated 1-10{\%} of the original PLLA was present at the 3-year follow-up. At the 4-year follow-up, five out of seven PLLA specimens showed no PLLA particles under polarized light microscopy. In the remaining two specimens an estimated 1{\%} of the original PLLA could be observed. Conclusions. Poly-L-lactic acid cages are feasible for lumbar interbody fusion, and the biocompatibility under high load bearing conditions is excellent during the complete absorption of the PLLA interbody fusion cages.",
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