Stability analysis of an enhanced load sharing posterior fixation device and its equivalent conventional device in a calf spine model.

STUDY DESIGN: An in vitro test of calf spine lumbar segments to compare biomechanical stabilization of a rigid versus a dynamic posterior fixation device. OBJECTIVES: To compare flexibility of a dynamic pedicle screw fixation device with an equivalent rigid device. SUMMARY OF BACKGROUND DATA: Dynamic pedicle screw device studies are not as prevalent in the literature as studies of rigid devices. These devices contain the potential to enhance load sharing and optimize fusion potential while maintaining stability similar to that of rigid systems. METHODS: Load-displacement tests were performed on intact and stabilized calf spines for the dynamic and rigid devices. Stability across a destabilized L3-L4 segment was restored by insertion of either a 6 mm x 40 mm dynamic or rigid pedicle screw fixation device across the L2-L4 segment. The screws then were removed, 7 mm x 45 mm pedicle screws of the opposite type were inserted, and the construct then was re-tested. Axial pull-out tests were performed to assess the likely effects of pedicle screw replacement on the load-displacement data. RESULTS: Results indicated a 65% reduction in motion in flexion-extension and a 90% reduction in lateral bending across the destabilized level for both devices, compared with intact spine values. Reduction in axial rotation motion was much smaller than in other modes. Axial pull-out tests showed no weakening of the bone-screw interface. CONCLUSIONS: Both devices provided significant stability of similar magnitudes in flexion, extension, and lateral bending. In axial rotation, the devices only could restore stability to levels similar to those in an intact spine. The dynamic device offers a design that may enhance load sharing without sacrificing construct stability.

Healing response to various forms of human demineralized bone matrix in athymic rat cranial defects.

PURPOSE: This study compared the ability of a bone autograft and four distinct forms of human demineralized bone (DBM) to elicit bone repair in a critical size cranial defect in athymic rats. MATERIALS AND METHODS: Cranial defects were created in athymic rats and then grafted with either an autograft, rat DBM particles in glycerol (rGel), or one of four forms of human DBM: 1) hGel; 2) Putty (DBM fibers in glycerol); 3) Sheet (sheet of DBM fibers); or 4) Flex (DBM fiber sheet with glycerol). Histology, histomorphometry, and radiographic density of the graft sites were evaluated at 8 weeks. RESULTS: Of the grafted defects, 29% to 58% were found to be filled with new bone. The rGel and human forms of DBM stimulated similar amounts of new bone growth in comparison with the autograft-filled defects. The fiber-based grafts produced the largest amounts of new bone. CONCLUSIONS: Human DBM in gel, putty and sheet forms were found to perform as well as an autograft in a critical size cranial defect in the athymic rat.

Cellular responses to chemical and morphologic aspects of biomaterial surfaces. I. A novel in vitro model system.

The clinical success of any implant is directly dependent upon the cellular behavior in the immediate vicinity of the interface established between the host tissue and the biomaterial(s) used to fabricate the device. All biomaterials have morphologic, chemical, and electrical surface characteristics that influence the cellular response to the implant. Quantitative measurement of specific aspects of this local host response to different but well-characterized biomaterial surfaces provides a crucial link in the understanding of the overall phenomenon of implant biocompatibility. A system has been devised for in vitro examination of responses of cells to controlled but independent changes in both the chemistry and morphology of polystyrene (PS) tissue culture surfaces. Micromachined silicon wafers were used as templates to solvent-cast PS replicas [using 0, 1, or 2 wt % styrene (S) monomer additions] with either none, 0.5- or 5.0-microns-deep surface grooves arranged in a radial array. When all possible morphologies were combined with all possible polymers, nine model biomaterial surfaces (MBSs) were produced. The chemical characteristics of the MBSs were determined using electron spectroscopy for chemical analysis, secondary ion mass spectroscopy, and contact angle techniques and were found to be distinct. The types and amount of proteins that adsorb onto these surfaces from serum containing media were examined and found to consist of multiple molecular layers of relatively uniform composition. Self-contained tissue culture vessels formed from the MBSs were capable of supporting the growth of confluent cultures of rat calvarial cells. The model biomaterial system described here can be used to examine how simultaneous stimuli resulting from the chemical and morphological characteristics of a test material may influence biologic responses. Such multifactorial biocompatibility research is needed to properly document material-host interactions.

Cellular responses to chemical and morphologic aspects of biomaterial surfaces. II. The biosynthetic and migratory response of bone cell populations.

The biosynthetic and migratory response of bone cells to changes in both surface composition and morphology of polystyrene (PS) substrates was examined. A system was devised wherein micromachined silicon wafers were used as templates to solvent-cast PS replicas [using 0, 1, or 2 wt % styrene (S) monomer additions] with either 0.5- or 5.0- microns-deep surface grooves. Smooth replicas (0% S) served as the control surfaces. The chemical and morphologic characteristics of the nine unique model biomaterial surfaces (MBSs) produced using this system were documented and were found to be distinct. For the biosynthetic studies, bone cells isolated from neonatal rat calvaria were plated onto the MBSs and labeled at postconfluence with [14C]proline for 24 h. Total DNA per surface, total newly synthesized collagenous (CP), and noncollagenous protein (NCP) (cell associated and secreted) were determined. Cell-associated CP was found to increase significantly for the bone cells cultured on the substrates with 0.5-micron grooves and 2% S (P < .05). Cell-associated NCP was found to be elevated for all 2% S substrates and for the 0.5-micron grooves substrates with 1% S. For the migration studies, bone cells were plated first onto 5-mm nitrocellulose disks that were attached to standard Petri dishes using a plasma clot. At confluence, the disks were removed aseptically and placed on the replicas. The cellular area occupied as a result of the outward migration of the bone cells was measured after 4 days of culture using an image analysis system. An average velocity for the leading edge of bone cell populations on each of the nine MBSs was calculated: Cells on surfaces with either 1% S or 5.0-microns grooves displayed significantly higher velocities than did the control cultures. A significant interaction effect between chemistry and morphology was observed. The biosynthetic and migratory responses of in vitro cultures of bone cells were not predictable from the observations of the cellular responses to the individual features, but appeared to depend on cellular responses to more than one substrate factor.