Freeze-Dried Secretome (Lyosecretome) from Mesenchymal Stem/Stromal Cells Promotes the Osteoinductive and Osteoconductive Properties of Titanium Cages

Titanium is one of the most frequently used materials in bone regeneration due to its good biocompatibility, excellent mechanical properties, and great osteogenic performance. However, osseointegration with host tissue is often not definite, which may cause implant failure at times. The present study investigates the capacity of the mesenchymal stem cell (MSC)-secretome, formulated as a ready-to-use and freeze-dried medicinal product (the Lyosecretome), to promote the osteoinductive and osteoconductive properties of titanium cages. In vitro tests were conducted using adipose tissue-derived MSCs seeded on titanium cages with or without Lyosecretome. After 14 days, in the presence of Lyosecretome, significant cell proliferation improvement was observed. Scanning electron microscopy revealed the cytocompatibility of titanium cages: the seeded MSCs showed a spread morphology and an initial formation of filopodia. After 7 days, in the presence of Lyosecretome, more frequent and complex cellular processes forming bridges across the porous surface of the scaffold were revealed. Also, after 14 and 28 days of culturing in osteogenic medium, the amount of mineralized matrix detected by alizarin red was significantly higher when Lyosecretome was used. Finally, improved osteogenesis with Lyosecretome was confirmed by confocal analysis after 28 and 56 days of treatment, and demonstrating the production by osteoblast-differentiated MSCs of osteocalcin, a specific bone matrix protein.

Comprehensive treatment of tuberculous spondylitis with short course pre-operative anti-tuberculosis therapy

The objective: to increase the effectiveness of treatment of patients with tuberculous spondylitis by using short course pre-operative anti-tuberculosis therapy.Subjects and methods. Experimental and clinical studies have been performed. The experiment was carried out on 40 guinea pigs by making a model of tuberculous spondylitis in 30 of them. In the clinic, the effectiveness of short course pre-operative anti-tuberculosis therapy with second line drugs, radical decompression plastic interventions using a sliding titanium cage was studied in 30 patients with tuberculous spondylitis versus 30 patients in whom classical methods of preparation and surgical intervention were used.Results. The created model of experimental tuberculous spondylitis made it possible to study parameters of the clinical and morphological course of the disease. The results obtained substantiated the effectiveness of short course pre-operative anti-tuberculosis therapy without the risk of generalization of the disease after radical surgery.The method of surgical treatment of tuberculous spondylitis used in patients and utilizing telescopic titanium cages against the background of short course pre-operative anti-tuberculosis therapy, taking into account the drug resistance of Mycobacterium tuberculosis and therapy continuation after surgery, significantly improved the frequency of excellent treatment results (up to 54.0% versus 32%). At the same time, the period of preparation for radical surgery was significantly reduced, the frequency of complications went down to 13.3% versus 33.3%, the period of in-patient treatment decreased to 96 ± 12 bed-days versus 190 ± 21 (p < 0.01), and the chances of social rehabilitation of operated patients improved.

Analysis of the results of surgical treatment of cervical spine hernias by anterior decompression and interbody cage stabilization

The research objective is to study the results of surgical treatment of the cervical spine with anterior decompression and interbody cage stabilization. Material and methods. The analysis of immediate and long-term (from 12 months to 5 years) results of surgical treatment by the method of anterior intercorporal fusion of 57 patients with cervical spine diseases was performed. Results. The treatment results were evaluated by the data of clinical examination in accordance with the Odom criteria, and neurostatus — in accordance with the criteria proposed by the Japanese Orthopedic Association (JOA). Conclusions. The study of long-term results of surgical treatment of patients with cervical spine degenerative-dystrophic diseases using the ACDF method showed high efficiency, reliability and safety of anterior decompression and stabilization with titanium cages.

Clinical Outcomes of 3D Printed Titanium Cage Implantation for Foot and Ankle Surgery

Category Ankle; Trauma Introduction/Purpose: Critical Sized Defects (CSD) defined as bone loss greater than 1-2 cm in length or greater than 50% loss in circumference of bone remains a significant challenge in orthopaedic surgery. Patients can acquire these defects through trauma, nonunion post fracture, tumor removal, avascular necrosis, and congenital abnormalities. Custom 3D printed porous Titanium scaffolds are increasingly being used to treat CSD in Foot and Ankle Surgery. Implantation of 3D printed cages is considered a salvage procedure offered after the patient has failed other procedures. Implants fill the space of the defect, provide mechanical strength and provide opportunity for osseous integration. As implementation of this surgical technique is relatively new, further research is needed to assess surgical outcomes and inform future surgical decision making. Methods: This is a retrospective chart review study which examines surgical outcomes after using 3D printed Titanium cages. Patients who received a 3D printed Titanium cage between 1/1/2013 and 11/01/2018 with at least 1 year follow-up were included in this study. Primary outcome is device failure defined as removal of implant for any reason. If applicable, mechanism of failure was recorded for each case. Patient specific factors such as age, gender, race, BMI, diabetes status, Charlson Comorbidity Index, tobacco use, number of foot and ankle surgeries, prior limb infections and laterality of defect were recorded in addition to surgical variables including geometry of implant, duration of surgery, and perioperative antibiotics Results: 18 patients who received custom 3D printed Titanium cages were included in this study. Of the 18 patients, 5 patients (27.8%) had device failure, defined as removal of implant. Of the 5 failures, 2 were removed due to infection while the other 3 were removed due to hardware failure including fractured cage, broken screw and loose fixation. Conclusion: Custom 3D printed Titanium was successfully implemented in 72.2% of patients. Implants were only removed due to infection (2 patients) or mechanical failure of device (3 patients). Future studies need to be powered to determine if certain patient specific factors are associated with device failure. Data from this study and subsequent studies can be used to design better implants, decide who is a good surgical candidate, and create preoperative therapies to improve modifiable risk factors

PEEK versus titanium cages in lateral lumbar interbody fusion: a comparative analysis of subsidence

OBJECTIVEThe authors have provided a review of radiographic subsidence after lateral lumbar interbody fusion (LLIF) as a comparative analysis between titanium and polyetheretherketone (PEEK) cages. Many authors describe a reluctance to use titanium cages in spinal fusion secondary to subsidence concerns due to the increased modulus of elasticity of metal cages. The authors intend for this report to provide observational data regarding the juxtaposition of these two materials in the LLIF domain.METHODSA retrospective review of a prospectively maintained database identified 113 consecutive patients undergoing lateral fusion for degenerative indications from January to December 2017. The surgeons performing the cage implantations were two orthopedic spine surgeons and two neurosurgeons. Plain standing radiographs were obtained at 1–2 weeks, 8–12 weeks, and 12 months postoperatively. Using a validated grading system, interbody subsidence into the endplates was graded at these time points on a scale of 0 to III. The primary outcome measure was subsidence between the two groups. Secondary outcomes were analyzed as well.RESULTSOf the 113 patients in the sample, groups receiving PEEK and titanium implants were closely matched at 57 and 56 patients, respectively. Cumulatively, 156 cages were inserted and recombinant human bone morphogenetic protein–2 (rhBMP-2) was used in 38.1%. The average patient age was 60.4 years and average follow-up was 75.1 weeks. Subsidence in the titanium group in this study was less common than in the PEEK cage group. At early follow-up, groups had similar subsidence outcomes. Statistical significance was reached at the 8- to 12-week and 52-week follow-ups, demonstrating more subsidence in the PEEK cage group than the titanium cage group. rhBMP-2 usage was also highly correlated with higher subsidence rates at all 3 follow-up time points. Age was correlated with higher subsidence rates in univariate and multivariate analysis.CONCLUSIONSTitanium cages were associated with lower subsidence rates than PEEK cages in this investigation. Usage of rhBMP-2 was also robustly associated with higher endplate subsidence. Each additional year of age correlated with an increased subsidence risk. Subsidence in LLIF is likely a response to a myriad of factors that include but are certainly not limited to cage material. Hence, the avoidance of titanium interbody implants secondary solely to concerns over a modulus of elasticity likely overlooks other variables of equal or greater importance.