doi: 10.1016/j.jbiomech.2021.110412.
Online ahead of print.
Affiliations
Affiliations
- 1 U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA. Electronic address: [email protected].
- 2 U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, Office of Orthopedic Devices (OHT6), Division of Spinal Devices (DHT6B), Silver Spring, MD 20993, USA.
- 3 U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA.
- 4 Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
- 5 Walter Reed National Military Medical Center, Department of Orthopaedics, Bethesda, MD 20889, USA.
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Vivek Palepu et al.
J Biomech.
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doi: 10.1016/j.jbiomech.2021.110412.
Online ahead of print.
Affiliations
- 1 U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA. Electronic address: [email protected].
- 2 U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, Office of Orthopedic Devices (OHT6), Division of Spinal Devices (DHT6B), Silver Spring, MD 20993, USA.
- 3 U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA.
- 4 Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
- 5 Walter Reed National Military Medical Center, Department of Orthopaedics, Bethesda, MD 20889, USA.
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Abstract
Intervertebral body fusion devices (IBFDs) are commonly used in the treatment of various spinal pathologies. Intra-operative fractures of polyether-ether-ketone (PEEK) implants have been reported in the literature and to the FDA as device-related adverse events. The device and/or implant inserter failures typically occur during device impaction into the disc space and require implant removal and replacement. These additional steps may cause further complications along with increased surgical time and cost. Currently, there are no standardized test methods that evaluate clinically relevant impaction loading conditions on IBFDs. This study aims to develop an in vitro test method that would evaluate implant resistance to failure during intra-operative impaction. To achieve this, (1) surgical implantations of IBFDs were simulated in nine lumbar cadaver specimens by three different orthopedic spine surgeons (n = 3/surgeon). Impact force and mallet speed data were acquired for each surgeon. (2) Based on the acquired surgeon data, a benchtop mechanical test setup was developed to differentiate between two TLIF IBFD designs and two inserter designs (for a total of four IBFD-inserter combinations) under impaction loading. During implant insertion, impact force measurements indicated that lumbar IBFDs are subjected to high energy forces that may exceed their mechanical strength. Our test method successfully replicated clinically-relevant loading conditions and was effective at differentiating failure parameters between different implant and inserter instrument designs. The mechanical test method developed shows promise in its ability to assess impaction resistance of IBFD/inserter designs and evaluate potential risks of device failure during intraoperative loading.
Keywords:
Impaction; Insertion; Intra-operative fractures; Lumbar intervertebral body fusion device; Spinal cage fracture; Spinal fusion.
Published by Elsevier Ltd.
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