Five spine surgeons discuss key trends for spinal surgery implant material and where surface technology is headed in the future.
Contact Laura Dyrda at ldyrda@beckershealthcare.com to add to this discussion.
Todd Lansford, MD. South Carolina Sports Medicine & Orthopaedic Center: "The biggest innovations in implant material would certainly be the low modulus titanium. For so long we have avoided metal for implants due to subsidence risk. Companies now have developed titanium/tritanium with lower modulus of elasticity. This allows for all the benefits of titanium — fusion potential, in growth and bacterial resistance — without the risks."
Scott Blumenthal, MD. Texas Back Institute (Plano): "There are titanium materials, PEEK implants, titanium-coated PEEK implants, micro-textured PEEK, pure metals and others. Titan says they have the only true nanotechnology on the market, and we still need stronger data backed up by clinical science. In terms of outcomes, I haven't seen presented clinical data to show one beats the other. They can market against each other, but ultimately they need clinical studies."
Jocelyn Idema, MD. Advanced Orthopaedics & Rehabilitation (Pittsburgh and Washington, Pa.): "Tritanium and other nanotechnologies are the newest, innovative 3-D printing technologies that most closely mimic human cancellous bone. Early animal trials and studies have suggested sooner incorporation to fusion. This is imperative in that there is a race for the body to fuse before the hardware fails. Obviously we cannot keep a patient in a brace indefinitely and these types of technologies greatly enhance this process. The sooner we can move a patient, the more compliant the patient will be, the faster return to normal activities and work, the less the patient will lose muscle strength and endurance and overall a patient's quality of life drastically improves."
Kade Huntsman, MD. Salt Lake Orthopaedic Clinic at St. Marks Hospital (Salt Lake City): "I think implant selection is extremely important in impacting patient care. While PEEK still has the most usage, I think titanium is making huge strides. Bone loves titanium and hates PEEK. In a PEEK product, the body actually walls off the PEEK, surrounding it with fibrous tissue. Titanium is much better, and bone grows and binds directly to the titanium. I prefer titanium because it helps me to achieve fusion, rather than inhibiting it with fibrous tissue as PEEK does. This leads to more rapid fusion and earlier stability so patients feel better earlier on in the recovery process. The surface of the titanium is extremely important because it allows the osteoblasts and titanium to interact, and with the nanotechnology that surface can actually cause bone cells to produce bone."
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): "Anterior cervical plate systems with "stand-alone" graft technology seem to follow the bundling schedules for cervical surgery reimbursements. The interchangeable plug (Sea-Spine) allows for certain variance in size of plug placement to the plating system and the different arrays of screw insertion offer significant options dependent on vertebral body surface area."