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Orthopaedic spinal implants are designed to stabilise and support the spinal column during the recovery process. These implants have different features, are made from various materials, and are suitable for specific spinal conditions.
Some of these spinal implants include:
Interbody cages are designed to be placed between adjacent vertebrae after removing a degenerated disc. They are used in spinal fusion procedures to provide support, maintain disc height, and promote bone growth between vertebrae. They are made from titanium, PEEK, or bone graft material and come in different shapes and sizes to match the patient's anatomical requirements. Some have a porous surface to enhance bone ingrowth, and many cages feature lateral or anterior landing zones for better integration with fusion constructs.
rods and screws used in spinal deformity correction offer solid support for unstable spinal segments. The screws are fixed into the vertebrae, and spinal rods connect the screws to create a rigid construct. This alignment allows the spine to heal and fuse over time by reducing motion at the targeted levels. Materials like titanium and stainless steel are also chosen for their strength and biocompatibility, and several configurations exist to address varying surgical needs, including pre-curved rods for specific deformities.
Pedicle hooks are used with rods to connect to the vertebrae by securing the hook under the pedicle bone portion and over the posterior arch. It helps in stabilisation and reduces spinal segment mobility, allowing for better fusion. They are used in cases where pedicle screws cannot be fixed, such as in osteoporotic bone or in revision surgeries. They provide a reliable option for spinal constructs and are often used in treatment for deformity correction.
Spinal plates are used for ventral stabilisation of the cervical region and are applied in anterior cervical fusion or corpectomy. The spinal plate's fixation on vertebrae enhances stability at the surgical site, allowing for a reduced risk of displacement for bone grafts or intervertebral cages. They are made from lightweight titanium and inconel alloys and have low profiles for minimal discomfort. Plates are available in several designs, including locking mechanisms for secure screw fixation.
Expandable cages are interbody fusion devices that are inserted in a collapsed state and expanded once in the correct position to provide optimal spinal fusion. They offer great disc height restoration and anterior column support by allowing adjustable intervertebral spacing. They are made from flexible titanium alloys and medical stainless steel that ensure strong yet deformable constructs.
Orthopaedic spinal implants have several features that help treat various spinal conditions successfully.
Dural protection: Dural tissue is the outer protective covering surrounding the spinal cord and nerve roots. Some spinal implants are equipped with features like protective tunnels, obturator covers, and specially designed screws to safeguard the dura from harm. These protective elements lower the possibility of dural injury during insertion or migration, which could result in neural problems. Such systems are especially beneficial in surgeries near sensitive neural structures.
loaded as a tension-compression: flexible rods are designed to provide support and allow controlled movement. They are beneficial in conditions that require spinal fusion while still permitting some degree of motion, which can help in adjacent segment health. This feature reduces stiffness associated with traditional metal constructs by providing a biomechanical environment supporting natural spinal motion and optimising fusion.
Lordotic and kyphotic parameters: The correction of normal cervical spinal curvature is vital to restoring proper spinal alignment and reducing nerve root compression. Many modern spinal systems have rods and pedicle screws designed to enhance lordosis and kyphosis, making it easier to obtain ideal spinal posture post-surgery. Such constructs are essential for deformity correction procedures, ensuring improved sagittal balance while minimising complications from abnormal spinal angles.
Adjustable hardware for intraoperative correction: Spinal systems with adjustable screws or rods allow real-time modifications to the construct during surgery. This feature enables finer alignment and tension adjustments without needing multiple implants or extensive revisions. Such flexibility optimises intraoperative spinal correction and minimizes the need for subsequent surgeries to achieve desired alignment.
Dynamic stabilization: systems permit limited motion compared to rigid fusion constructs. These devices are designed to reduce excessive movement at targeted segments while preserving adjacent segment function. Dynamic stabilisation reduces the risk of adjacent segment disease by allowing physiological motion and potentially improving postoperative outcomes in deformity correction and degenerenerative disc disease treatment.
Spinal implant quality: The quality of spinal implants is vital for patient safety and surgical success. Implants are typically made from biocompatible materials such as titanium and stainless steel alloys, which resist corrosion, adhere to living tissues and ensure adequate strength in supporting spinal structures. These materials are selected for their ability to withstand functional loads, decreasing the risk of implant failure. Quality assurance is ensured through rigorous testing and certification standards, including mechanical testing for durability, fatigue resistance, sterility for infection prevention, and non-toxicity.
How to maintain Spinal implants: The maintenance of spinal implants primarily involves monitoring their integrity and functionality over time. Post-surgical care includes regular follow-up imaging to assess bone healing and implant positioning. Patients are advised to follow activity restrictions and avoid excessive strain on the spine to prevent overloading the implants. Early detection of issues like pseudoarthrosis or hardware loosening is essential, and physical therapy may strengthen surrounding musculature to support the construct. In some cases, metal implants require periodic maintenance or revision, which necess close monitoring of the implant's condition.
Inspection of spinal implants: Inspection involves a visual and imaging evaluation to assess the state of the implants and their alignment. During the follow-up, physical examination looks for clinical signs of infection or abnormal prominence. Imaging techniques like X-rays, CT scans, or MRI help in evaluating implant position and bone integration. Inspection may also include checks for wear and tear on components such as rods and screws. Regular monitoring is crucial for identifying problems early, like hardware failure or loosening, and provides guidance on whether timely interventions, such as surgical revision or conservative management, are required.
Implant material: Spinal implants are made from several materials that provide unique benefits. Titanium is highly biocompatible, non-corrosive, and lightweight, which makes it easy to tolerate by the body, and it's also used for its strength and non-magnetism during radiographic studies. Stainless steel is stronger and more affordable. The titanium alloy contains aluminium and vanadium, which makes it stronger and is used in aerospace engineering. Cobalt-chromium is hard, wear-resistant, and corrosion-resistant. Cages are often made of PEEK polymer that has strength and elasticity, similar to bone, and doesn't trigger metal allergies. Biodegradable implants slowly restore over months or years.
Surgical approach: The preferred spinal-veterinary surgery approach will determine the spinal implants used. Anterior approaches use implants like interbody cages, bone grafts, and anterior plates for the anterior column's stability and fusion. Posterior approaches use pedicle screws, rods, and laminectomy grafts for posterior stabilisation and fusion. The combined approach applies different anterior and posterior constructs for extensive deformities.
Biomechanical considerations: The biomechanics of the spinal implant and their interaction with the spinal motion segment should be considered and the effects on the adjacent levels. The implants should provide sufficient rigidity at the fusion site to enable the expected load-sharing with minimal motion. In dynamic stabilisation systems, implant allow functional movements, reducing stiffness and preserving adjacent motion for delaying degeneration. Stronger implants withstand the higher demands of the cervical or lumbar regions.
Regulatory clearance: Some spinal implants are sought after in multiple markets. Other implants are made locally and need regulatory approval for clearance. The implants are submitted with the data that support the claims to safety, efficacy, and performance. These reports are written following good clinical practices.
Business policy: Spinal devices manufacturing businesses adopt implants that fit their intended use business and patients' needs. Some manufacturers prefer promoting posterior insurance for intraoperative feasibility. Other companies focus on metaphyseal or epiphyseal fixation of deformity correction.
A1: Metal recycling involves the collection and sorting of used spinal implants by type of metal they are made from.
A2: Stainless steel implants are dismantled manually or mechanically to remove non-metal components and obtained using pyrometallurgy, which involves melting in furnaces at high temperatures to retrieve alloying metals like nickel, chromium, and iron, and hydrometallurgy which uses chemical solutions to dissolve and selectively obtain metals.
A3: Titanium rods for spinal surgery are employed to correct spinal deformities and stabilise unstable spinal regions. They offer excellent strength, lightweight, and superior biocompatibility.
A4: The titanium rods undergo a thorough sterilisation process before implantation, including heat sterilisation.
A5: The spinal hardware system and implants are embedded using non-ferromagnetic metals like titanium for effective magnetic resonance imaging in the post-operative period.
