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

2. The Human Spine Spine made up of 33 vertebrae Five regions:
Cervical Vertebrae
Thoracic Vertebrae
Lumbar Vertebrae
Sacrum
Coccyx
Intervertebral Disc
Spongy, cartilaginous
Natural curve in the
spine helps distribute
stress
-Cervical (7), Thoracic (12), Lumbar (5/6), Sacrum (5 fused), Coccyx (3)

3. 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
Significant lordotic curves are most often discovered by a physical exam. X-ray or spinal MRI imaging will usually be performed to determine the exact extent of the curvature. MRI or CT scan will also show any neurological effects that the curve is producing.
Discitis – inflammation of disc space
Spondylolisthesis – vertebrae slips forward
Kyphosis – abnormally rounded upper back
Osteoporosis – bones become fragile and
may fracture
Obesity – excess belly fat can cause
imbalance in muscle strength

4. Treatment Methods Drugs Physical Therapy Brace Surgery
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
-Treatment method rarely required usually condition just needs to be monitored. Severe conditions will cause compression on nerves and cause pain.
-Drugs: over-the-counter, if more severe then doctors prescribe more stuff
-Physical Therapy: Exercises may be used to strengthen muscles and increase range of motion. You may also be taught how to maintain a correct posture.
-Brace: Used with younger children to prevent worsening of condition. Study show that it helps improve balance
-Surgery: Spine straightened, sometimes involves using bone graft to promote new growth and stability

5. Product Used to treat vertebrae T1-L5 Materials Versatile
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
Thoracic and Lumbar vertebral bones
CFRP: densities and electrical conductivity/resistivity properties close to bone with strengths much higher than metals on a per-weight basis, increased osteoconductivity in study on rats
Tantalum is a metal, corrosion resistant, elasticity prevents stress shielding (Stress shielding refers to the reduction in bone density (osteopenia) as a result of removal of normal stress from the bone by an implant)

6. 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

7. Costs Cost is dependent on size
~$1800 for 18mm
$6190 for 66mm
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

8. Surgical Protocol Disectomy Corpectomy
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
Caliper to determine defect height
Fluorscopy to determine lordotic
angle
"Discectomy" means "remove the disc". A discectomy relieves the pressure on a nerve root by removing the herniated disc causing the pressure.
The discectomy procedure is performed through an incision down the center of the back over the area of the herniated disc. The muscles are moved to the side so that the surgeon can see the back of the vertebrae. X-rays may be required during surgery to make sure the correct vertebra is located. The surgeon cuts a small opening through the lamina (lam-in-ah) bone on the back of the spinal column. This procedure, called "laminotomy," is used to give the doctor room to see and work inside the spinal canal.
The nerve roots are moved out of the way. Upon locating the problem disc, the surgeon removes it, easing pressure and irritation on the nerves of the spine. Small instruments that fit inside the disc are used to remove as much of the nucleus as possible. This prevents the remaining disc material from herniating in the future.
After the discectomy, the muscles of the back are returned to their normal position around the spine. The skin incision is repaired with sutures or metal staples. In some cases, a discectomy may be combined with a spinal fusion, where the two vertebrae above and below the removed disc are joined together or fused.

9. 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

10. 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)
1. Use of these systems is contraindicated when there is active systemic infection, infection localized to the site of the proposed implantation, or when the patient has demonstrated allergy or foreign body sensitivity to any of the implant materials. 2. Severe osteoporosis may prevent adequate fixation and thus preclude the use of this or any other orthopaedic implant. 3. Conditions that may place excessive stresses on bone and implants, such as severe obesity or degenerative diseases, are relative contraindications. The decision whether to use these devices in such conditions must be made by the physician taking into account the risks versus the benefits to the patient.

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

12. Sources
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disorders
Lordosis.aspx
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