Endplate Deformation Due to Open and Strutted Intervertebral Devices.

BACKGROUND: There is an absence of work on vertebral endplate response to peripheral loading following disc removal and interbody placement. Endplate deflection into the interbody space may impart beneficial strain on the developing fusion mass, influencing bone formation and remodeling. The aim of this study was to verify endplate deformation due to peripheral loading using a custom transducer and to investigate whether endplate motion is inhibited by implant design.
METHODS: A total of 14 porcine (L4, L5) vertebrae were assigned to open or strutted implant designs. A custom transducer was placed on the endplate while 500 N was applied to the implant at 1 Hz for 500 cycles. Endplate motion was acquired for each time point and averaged among specimens of the same design. The rates and magnitudes of endplate deformation were compared between implant designs using unpaired t tests.
RESULTS: Peripheral loading of both implant designs resulted in endplate deflection into the interbody space. The open implant design demonstrated an increased rate and magnitude of endplate deformation when compared with strutted implants.
CONCLUSION: Interbody cage design directly influences the dynamic motion of the vertebral endplate during cyclic loading. A larger, faster deflection of the endplate could increase the strain rate, duration, and magnitude on the developing interbody fusion mass. These parameters of dynamic strain have been correlated with increased bone formation and remodeling. CLINICAL RELEVANCE: Unimpeded endplate deformation in an open cage design could impart a strain pattern on the developing fusion mass that increases bone formation and remodeling, ultimately leading to a faster and stronger fusion. ©International Society for the Advancement of Spine Surgery 2019.