DESIGN STRATEGY OF THREE-DIMENSIONAL PRINTED CAGES TO REDUCE IMPACT-INDUCED DEBRIS ALONG THE LOAD-TRANSFERRING PATH

Abstract

Peri-implant debris certainly lead to osteolysis, necrosis, pseudotumor formation, tissue granulation, fibrous capsule contractions, and even implant failure. For the three-dimensional (3D) printed cage, impaction during cage insertion is one of the most potential sources of fracture debris. A finite-element study was carried out to reduce the impact-induced debris of the 3D-printed cage. This study focused on the design strategy of solid and cellular structures along the load-transferring path. Using the finite-element method, the cellular structure of the transforaminal lumbar interbody fusion (TLIF) cage was systematically modified in the following four variations: a noncellular cage (NC), a fully cellular (FC) cage, a solid cage with a cellular structure in the middle concave (MC) zone, and a strengthened cage (SC) in the MC zone. Three comparison indices were considered: the stresses at the cage-instrument interfaces, in the MC zone, and along the specific load-transferring path. The NC and FC were the least and most highly stressed variations at the cage-instrument interfaces and in the MC zone, respectively. Along the entirely load-transferring path, the FC was still the most highly stressed variation. It showed a higher risk of stress fracture for the FC cage. For the MC and SC, the MC zone was consistently more stressed than the directly impacted zone. The further strengthened design of the SC had a lower peak stress (approximately 29.2%) in the MC zone compared with the MC. Prior to 3D printing, the load-transferring path from the cage-instrument interfaces to the cage-tissue interfaces should be determined. The cage-instrument interfaces should be printed as a solid structure to avoid impact-induced fracture. The other stress-concentrated zones should be cautiously designed to optimize the coexistence strategy of the solid and cellular structures.