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Kevin T. Foley, Eric J. Woodard, Jonathan R. Slotkin, Cassandra K. Mayotte, Abigail C. Baldwin, Michael C. Brown and Brian J. Hess

fibrosis in this group was consistently high. In contrast, the TTCP-PS groups had minimal fibrosis. Test group 1 exhibited no soft tissue in the kerf at any point, and new pink bone can be seen propagating across the kerf and through the implant material. This histology also shows the black implant material contacting nearly all of the surrounding bone, indicating a high level of osteointegration. The TTCP-PS also demonstrates resorption over time as the black becomes replaced with new, pink bone. FIG. 4. Representative histological images obtained at all timepoints

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Jason P. Sheehan, Jonas M. Sheehan, Howard Seeherman, Mark Quigg and Gregory A. Helm

, craniofacial disorders, or tumor invasion. The causes of some cranial- and/or calvarial-based defects are thought to be as follows: infection (0–4%); resorption (0–25%); CSF leak (1–18%); and migration (< 1%). 26 Currently used artificial bone substitutes (for example, polymethylmethacrylate or hydroxyapatite) and metal plating systems demonstrate minimal osteointegration, represent a potential source of perioperative infections, and add a substantial amount to the operative cost billed to the patient. An ideal bone agent would rapidly, safely, and inexpensively form bone

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Neurosurgical Forum: Letters to the Editor To The Editor Thomas B. Ducker , M.D. Annapolis, Maryland 114 114 Abstract: Object. The purposes of bone substitutes for anterior cervical fusion (ACF) are immediate biomechanical support and osteointegration of the graft. The authors report their preliminary results in performing ACF in which carbon fiber cages (CFCs) containing coralline hydroxyapatite (HA) are used as bone substitute. Methods. During a 24-month period, anterior microsurgical discectomy was

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Umberto Agrillo, Luciano Mastronardi and Fabrizio Puzzilli

biomechanical support, to restore foraminal height, to maintain cervical lordosis, and to allow optimum intervertebral arthrodesis to occur. 19 The use of synthetic graft materials allows for short hospital stays and reduced donor site—related complications. Currently, the ideal device for the osseous fusion, which would provide immediate structural support and subsequent osteointegration and stability, has yet not been identified. On the basis of these considerations, we investigated the extent of osseous incorporation achieved using an implant of CFC containing a

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—metal contact; this is most likely due to a biological film or layer that develops between the two stainless steel interfaces. This provides lubrication that minimizes fretting. The solid affixation of the implant to each adjacent vertebral body, however, is a more difficult problem. Bone—metal interfaces, exposed to repetitive loading stress, will eventually degrade unless some form of osteointegration occurs. Although titanium, used by the authors, has osteointegration potential, its ability to integrate totally with such biological structures as bone is suboptimal. This

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Paolo Frassanito, Luca Massimi, Massimo Caldarelli, Gianpiero Tamburrini and Concezio Di Rocco

of mechanical strain and subsequent decrease of osteogenic growth factors, and impaired CSF dynamics (subdural collections, hydrocephalus). In particular, we have pointed out that “in infants and young toddlers, the cranioplastic graft is subjected to the ab interno forces resulting from the concomitant brain growth, which, in turn, are attenuated after the second year of age. These forces, which play a positive remodelling role after bilateral cranioplasty (e.g. in the treatment of craniosynostoses), could be critical in the osteointegration of unilateral

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Aatman M. Shah, Henry Jung and Stephen Skirboll

, inflammation, lack of incorporation hydroxyapatite noninflammatory, decent chemical bonding to bone, excellent cosmesis & contouring ability low tensile strength, brittle, infection, fragmentation, lack of osteointegration titanium mesh noninflammatory, noncorrosive, strong, malleability, low infection rate, good cosmesis expensive, image artifact on imaging alumina ceramics hard, chemically stable, tissue compatible, low infection rate expensive, prone to shatter PEEK implant radiolucent, chemically inert, strong, elastic, does not create

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Patrick Fransen

coating of screws with hydroxyapatite improved osteointegration of the implant by creating better bone purchase on an expanded bone–screw interface. Hasegawa et al. 7 reported achieving the same results with hydroxyapatite-coated screws in a canine model. In an experimental study by Goldhahn et al., 5 the authors evaluated the osteointegration of a hollow cylinder–based implant. They found that trabecular bone filled the perforations in the implant, and therefore they assumed that such implants would provide better anchorage even in osteoporotic vertebrae. Although

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Abdullah H. Feroze, Graham G. Walmsley, Omar Choudhri, H. Peter Lorenz, Gerald A. Grant and Michael S. B. Edwards

titanium mesh combined with hydroxyapatite and other alloplasts, have also allowed for substances that provide improved osteointegration with adequate aesthetic restoration of cranial contour and with minimal side effects in the treatment of larger cranial defects, even in the setting of pediatric procedures. 11 , 17 , 29 , 127 In a recent retrospective analysis by Williams et al., 23 pediatric patients underwent titanium cranioplasty for a mean defect size of 41.8 cm 2 (range 5.3 cm 2 –116.5 cm 2 ) with no noted complications after 1 year of follow-up. 128

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Yoshihisa Kotani, Kuniyoshi Abumi, Yasuo Shikinami, Masahiko Takahata, Ken Kadoya, Tsuyoshi Kadosawa, Akio Minami and Kiyoshi Kaneda

was shown with a tendency toward anterior device subluxation. No quantitative biomechanical data were reported. In the largest baboon study Cunningham, et al., 8 evaluated anterior lumbar disc replacement with an AcroFlex prosthesis. Twelve-month histological examination demonstrated excellent osteointegration at the bone—metal interface; however, segmental motion was significantly decreased compared with intact spinal segments in axial rotation, flexion—extension, and lateral bending. In a sheep model our short-term results indicated that nearly equivalent ROM was