Design and fabrication of a lumbar interbody fusion spine cage combining titanium and PEEK materials

Yudan Whulanza

doi:10.71452/9j5vvz23

Authors

Yudan Whulanza Universitas Indonesia Author

DOI:

https://doi.org/10.71452/9j5vvz23

Keywords:

Lower back pain, degenerative disk disease, TLIF, spine cage, banana shape, PEEK, titanium, CNC machining, selective laser melting.

Abstract

Lower back pain (LBP) is a common condition that significantly affects patient quality of life. One of the pathological causes of LBP is degenerative disk disease (DDD), resulting from the degeneration of the intervertebral disc (IVD). A surgical option for addressing this is transforaminal lumbar interbody fusion (TLIF), which involves the use of an implant known as a spine cage to maintain spacing between vertebrae during bone fusion. Spine cages are commonly made from either polyether ether ketone (PEEK) or titanium, both of which have distinct advantages and limitations. PEEK exhibits a bone-like elastic modulus but limited osseoconductivity, whereas titanium offers good osseoconductivity but an elastic modulus much higher than bone. This study proposes a hybrid spine cage combining both materials: PEEK machined via computer numerical control (CNC) machining and titanium fabricated using selective laser melting (SLM). The cage features a banana shape, nose insertion, pins-and-holes connection system, and dimensions customized for the Indonesian lumbar morphometry. Realized prototype showed a maximum margin of 3.9% for titanium part and 2.14% for PEEK part. Further results showed a compressive elastic modulus of 1.36 GPa, indicating the current model followed mechanical property of titanium material.

References

U. Zehra et al., “Intervertebral disc degeneration,” in Spine Phenotypes, Elsevier, 2022, pp. 105–135. doi: 10.1016/B978-0-12-822778-7.00021-3.

J. Dowdell, M. Erwin, T. Choma, A. Vaccaro, J. Iatridis, and S. K. Cho, “Intervertebral Disk Degeneration and Repair,” Neurosurgery, vol. 80, no. 3S, pp. S46–S54, Mar. 2017, doi: 10.1093/neuros/nyw078.

M. Teraguchi et al., “Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study,” Osteoarthritis Cartilage, vol. 22, no. 1, pp. 104–110, Jan. 2014, doi: 10.1016/j.joca.2013.10.019.

R. M. Amin, N. S. Andrade, and B. J. Neuman, “Lumbar Disc Herniation,” Curr Rev Musculoskelet Med, vol. 10, no. 4, pp. 507–516, Dec. 2017, doi: 10.1007/s12178-017-9441-4.

M. L. Ferreira et al., “Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021,” Lancet Rheumatol, vol. 5, no. 6, pp. e316–e329, Jun. 2023, doi: 10.1016/S2665-9913(23)00098-X.

R. J. Mobbs, K. Phan, G. Malham, K. Seex, and P. J. Rao, “Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF.,” J Spine Surg, vol. 1, no. 1, pp. 2–18, Dec. 2015, doi: 10.3978/j.issn.2414-469X.2015.10.05.

M. J. Lee, J. Mok, and P. Patel, “Transforaminal Lumbar Interbody Fusion: Traditional Open Versus Minimally Invasive Techniques,” Journal of the American Academy of Orthopaedic Surgeons, vol. 26, no. 4, pp. 124–131, Feb. 2018, doi: 10.5435/JAAOS-D-15-00756.

G.-X. Lin et al., “Comparing Outcomes of Banana-Shaped and Straight Cages in Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis,” Neurospine, Jan. 2024, doi: 10.14245/ns.2347078.539.

S. Wu et al., “Porous Titanium‐6 Aluminum‐4 Vanadium Cage Has Better Osseointegration and Less Micromotion Than a Poly‐Ether‐Ether‐Ketone Cage in Sheep Vertebral Fusion,” Artif Organs, vol. 37, no. 12, Dec. 2013, doi: 10.1111/aor.12153.

A-SPINE Asia, “Combo Lumbar Disc Cage.”

K.-M. Lim, T.-H. Park, S.-J. Lee, and S.-J. Park, “Design and Biomechanical Verification of Additive Manufactured Composite Spinal Cage Composed of Porous Titanium Cover and PEEK Body,” Applied Sci-ences, vol. 9, no. 20, p. 4258, Oct. 2019, doi: 10.3390/app9204258.

A. Faadhila et al., “Design of a Transforaminal Lumbar Interbody Fusion (TLIF) Spine Cage,” International Journal of Technology, vol. 13, no. 8, p. 1663, Dec. 2022, doi: 10.14716/ijtech.v13i8.6152.