Calcium-phosphate ceramics in spine surgery: features of regeneration and use

Abstract

The review is based on the analysis of 53 literature sources from PubMed, Google, Google Scholar, and Cochrane Library. Among the substitutes for autogenous bone grafts in spine surgery, ceramic biomaterials are the largest studied group, among which certain niche is occupied by calcium phosphate ceramics (CPCs). Hydroxylapatite, tricalcium phosphate and biphasic ceramics with all parts of hydroxylapatite and tricalcium phosphate are widely used in spine surgery. The advantage of using CPCs is their biocompatibility, osteoconductivity, osteoinductivity, osteoimmunomodulation and the ability to stimulate angiogenesis — the main components that ensure bone regeneration. In the given review, the peculiarities of regeneration in the interface “ceramic material — bone tissue” depending on the composition, surface structure, and crystallinity of the material are noted. The positive results of the experimental studies led to the use of CPCs in the clinic. CPCs with autogenous bone grafts are successfully used in posterior and posterolateral lumbar spondylodesis, which allows reducing significantly the volume of autologous bone. A new direction is the development of non-metallic combined cages, which are used to perform anterior cervical discectomy and spondylodesis. The composition of these cages includes various polymers in combination with CPCs and bone autogenous graft to ensure high-quality spondylodesis, reduce of stress-shielding and subsidence of the cage. A special approach requires the study of degradation and resorption by osteoclasts of various CPCs in order to control and synchronize the process of “resorption — bone formation”. Among the issues for the further research, the molecular mechanisms of osteoimunomodulation and factors that stimulate osseointegration and osteoinduction in the management of reparative osteogenesis should be further explored.