Lordosis Depuy Bengal Stackable Cage System Biomaterials BIOL

Lordosis (Depuy Bengal® Stackable Cage System) Biomaterials (BIOL 1120) Professor Beth Zielinski Professor Jeffrey R. Scott Jacqueline Chang Timothy Chou

The Human Spine �Spine made up �Five regions: ◦ ◦ ◦ of 33 vertebrae Cervical Vertebrae Thoracic Vertebrae Lumbar Vertebrae Sacrum Coccyx �Intervertebral Disc ◦ Spongy, cartilaginous �Natural curve in the spine helps distribute stress

Pathophysiology of Lordosis � Background ◦ Inward curvature of the lumbar and cervical vertebrae (swayback appearance) ◦ Anterior pelvic tilt, when the pelvis tips forward when resting on top of the femurs ◦ Can cause herniated disc � Symptoms ◦ Severe lower back pain ◦ Exaggerated Posture � Diagnosis ◦ Physical Examination ◦ MRI/CT Scan � Who is at risk? ◦ ◦ ◦ Discitis Spondylolisthesis Kyphosis Osteoporosis Obesity

Treatment Methods �Drugs ◦ Nonsteroidal antiinflammatory drugs ◦ Prevent discomfort and swelling �Physical Therapy ◦ Strengthening of muscles ◦ Improving posture ◦ Reducing body weight �Brace ◦ Lordactiv™ lumbar belt �Surgery ◦ Depuy Bengal® Stackable Cage System

Product �Used to treat �Materials vertebrae T 1 -L 5 ◦ Carbon Fiber Reinforced Polymer (CFRP) ◦ Titanium Rods ◦ Tantalum Beads �Versatile ◦ Adjustable height and angles options �Stackable Cage System ◦ Replace excised vertebral tissue ◦ Used singularly or stacked ◦ Similar in dimension to normal vertebrae

Advantages over other Methods �Structure supports loads with modulus of elasticity close to that of cortical bone �Ridges and teeth resist rotation and migration �Cavities accept bone graft �Radiolucent so healing can be assessed by normal radiographic methods

Costs �Cost is dependent on size ◦ ~$1800 for 18 mm ◦ $6190 for 66 mm �Disectomy costs can vary from $15, 000 to $75, 000 �Corpectomy can range between $25, 000 and $40, 000 �Hospitals sometimes have contract rates �Insurance coverage is dependent on individual insurance companies

Surgical Protocol � Disectomy ◦ Removes the herniated or affected disc ◦ Incision down the center of the back, muscles and nerves moved aside and problematic disc is removed and device is implanted ◦ Suture or metal staples are used to close up � Corpectomy ◦ Removes multiple vertebrae, more invasive ◦ Device implanted in the removed area ◦ Suture or metal staples are used to close up � Caliper to determine defect height � Fluorscopy to determine lordotic angle

Recovery After Surgery � Most patients go home 1 -2 days (disectomy) or 4 -5 days (corpectomy) later � 1 -4 weeks recovery time. � 8 -12 weeks recovery needed for more labor intensive jobs � Surgical tape to affix suture, keep wound dry and clean � Narcotic medication may be taken for pain for 2 -4 weeks (not more because addictive) � Physical therapy recommended � Do not sit for long periods of time or drive for the first 2 -4 weeks

Possible Complications �Potential ◦ ◦ Complications of Surgery Haematoma Skin necrosis outside operation region Deep infection around implantation Thrombosis �Osteoporosis patients may encounter problems with device fixation �Obesity (too much stress)

Improvements after Procedure � 80 -90% of patients show good results �Better sitting posture �Improved sagittal balance �Reduced pain �Optimized fusion environment

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