Biomechanical Testing of Anterior Cervical Spine Implants: Evaluation of Changes in Strength Characteristics and Metal Fatigue Resulting from Minimal Bending and Cyclic Loading

  • Kim, Sung-Bum (Department of Neurosurgery, School of Medicine, Hanyang University) ;
  • Bak, Koang-Hum (Department of Neurosurgery, School of Medicine, Hanyang University) ;
  • Cheong, Jin-Hwan (Department of Neurosurgery, School of Medicine, Hanyang University) ;
  • Kim, Jae-Min (Department of Neurosurgery, School of Medicine, Hanyang University) ;
  • Kim, Choong-Hyun (Department of Neurosurgery, School of Medicine, Hanyang University) ;
  • Oh, Seong-Hoon (Department of Neurosurgery, School of Medicine, Hanyang University)
  • Published : 2005.03.31

Abstract

Objective: To achieve optimal fit of implant, it is necessary to bend the implant during spine surgery. Bending procedure may decrease stiffness of plate especially made of titanium and stainless steel. Typically titanium suffers adverse effects including early crack propagation when it is bent. We investigate whether 6 degree bending of titanium plates would decrease the stiffness after full cyclic loading by comparing with non-bending titanium plates group. Methods: Authors experimented 40 titanium alloy plates of 57mm in length, manufactured by 5 different companies. Total 40 plates were divided into two groups (20 bent plates for experimental group and 20 non-bent plates for control group). Twenty plates of experimental group were bent to 6 degree with 3-point bending technique and verified with image analyzer. Using the electron microscope, we sought for a initial crack before and after 3-point bending. Mechanical testing by means of 6000 cyclic axial-compression loading of 35N in compression with moment arm of 35mm-1.1 Nm was conducted on each plate and followed by the electron microscopic examination to detect crack or fissure on plates. Results: The stiffness was decreased after 6000 cyclic loading, but there was no statistically significant difference in stiffness between experimental and control group. There was no evidence of change in grain structure on the electron microscopic magnification. Conclusion: The titanium cervical plates can be bent to 6 degree without any crack or weakness of plate. We also assume that minimal bending may increase the resistance to fatigue fracture in cervical flexion-extension movement.

Keywords

References

  1. Baldwin NG, Hartman GP, Weiser MW, Benzel EC : Failure of a titanium anterior cervical plate implant: microstructural analysis of failure. Case report. J Neurosurg 83 : 741-743, 1995 https://doi.org/10.3171/jns.1995.83.4.0741
  2. Banovetz JM, Sharp R, Probe RA, Anglen JO : Titanium plate fixation: a review of implant failures. J Orthop Trauma 10 : 389-394, 1996 https://doi.org/10.1097/00005131-199608000-00005
  3. Cook SD, Thomas KA : Fatigue failure of noncemented porous-coated implants : a retrieval study. J Bone Joint Surg 73 : 20-24, 1991
  4. Cunningham BW, Sefter JC, Shono Y, McAfee PC : Static and cyclical biomechanical analysis of pedicle screw spine constructs. Spine 18 : 1677-1688, 1993 https://doi.org/10.1097/00007632-199309000-00017
  5. Dick JC, Bourgeault CA : Notch sensitivity of titanium alloy, commercially pure titanium, and stainless steel spinal implants. Spine 26 : 1668-1672, 2001 https://doi.org/10.1097/00007632-200108010-00008
  6. Dick JC, Brodke DS, Zdeblick TA, Bartel BD, Kunz DN, Rapoff AJ : Anterior instrumentation of the thoracolumbar spine : a biomechanical comparison. Spine 22 : 744-750, 1997 https://doi.org/10.1097/00007632-199704010-00005
  7. Disegi JA : Magnetic Resonance Imaging of AO/ASIF stainless steel and titanium implants. Injury 23 : 1-4, 1992
  8. Ebraheim NA, Rupp RE, Savolaine ER, Reinke D : Use of titanium implants in pedicular screw fixation. J Spinal Disord 7 : 478-486, 1994
  9. Ebraheim NA, Savolaine ER, Stitgen SH, Jackson WT : Magnetic resonance imaging after pedicular screw fixation of the spine. Clin Orthop 279 : 133-137, 1992
  10. Goel VK, Voo LM, Weinstein JN, Liu YK, Okuma T, Njus GO : Response of the ligamentous lumbar spine to cyclic bending loads. Spine 13 : 294-300, 1988 https://doi.org/10.1097/00007632-198803000-00012
  11. Gore DR, Sepic SB, Gardner GM : Roentgenographic findings of the cervical spine in asymptomatic people. Spine 6 : 521-524, 1986
  12. Gotman I : Characteristics of metals used in implants. J Endourol 11 : 383-389, 1997 https://doi.org/10.1089/end.1997.11.383
  13. Kim CH, Ryu KY, Seok KS, Kang DG, Kim SC : Instrument Failure in Anterior Cervical Plate Fixation. J Korean Neurosurg Soc 32 : 436- 442, 2002
  14. Liu YK, Njus G, Buckwalter J, Wakano K : Fatigue response of lumbar intervertebral joints under axial cyclic loading. Spine 8 : 857-865, 1983 https://doi.org/10.1097/00007632-198311000-00008
  15. Long M, Rack HJ : Titanium alloys in total joint replacement : a materials science perspective. Biomaterials 19 : 1621-1639, 1998 https://doi.org/10.1016/S0142-9612(97)00146-4
  16. McGeachie J, Smith E, Roberts P, Grounds M : Reaction of skeletal muscle to small implants of titanium or stainless steel : a quantitative histological and autoradiographic study. Biomaterials 13 : 562-568, 1992 https://doi.org/10.1016/0142-9612(92)90109-2
  17. Perren SM, Buchanan JS : The concept of biological plating using the limited contact dynamic compression plate. Injury 23 : 1-41, 1991
  18. Pfeiffer M, Brennwald J, Buchler U, Hanel D, Jupiter J, Lowka K, et al : Implants of Pure Titanium for Internal Fixation of the Peripheral Skeleton. Injury 25 : 87-89, 1994 https://doi.org/10.1016/0020-1383(94)90108-2
  19. Pienkowski D, Stephens GC, Doers TM, Hamilton DM : Multicycle mechanical performance of titanium and stainless steel transpedicular spine implants. Spine 23 : 782-788, 1998 https://doi.org/10.1097/00007632-199804010-00008
  20. Rupp RE, Ebraheim NA, Wong FF : The value of magnetic resonance imaging of the postoperative spine with titanium implants. J Spinal Disord 9 : 342-346, 1996
  21. Shannon C, Thull R, von Recum A : Types I and III collagen in the tissue capsules of titanium and stainless steel implants. J Biomed Mater Res 34 : 401-408, 1997 https://doi.org/10.1002/(SICI)1097-4636(19970305)34:3<401::AID-JBM15>3.0.CO;2-I
  22. Stambough JL, Genaidy AM, Huston RL, Serhan H, El-khatib F, Sabri EH : Biomechanical assessment of titanium and stainless steel posterior spinal constructs : Effects of absolute/relative loading and frequency on fatigue life and determination of failure modes. J Spinal Disord 10 : 473-481, 1997