**4. Conclusion**

The concept of reconstruction of the lumbar and cervical disc is not new, as clinical experimentation goes back to the early 1950's. Since then, the scientific and clinical community has sought to improve upon the selection of available biomaterials for use in the disc arthroplasty arenas. The mainstay of these materials has been ceramics, metal alloys and polymers, in large part due to the history gained form their use in total joint reconstruction. Currently there is no universal material that is considered the ultimate biomaterial, and an in-depth knowledge of a given material is important in understanding and predicting its response when used in an application as demanding as an implantable biomaterial. Knowledge can be gained by not only performing the appropriate testing on the bulk properties of the material, but also proper preclinical testing of the constructed device. More importantly, adroit interpretation of these results is fundamental to the clinical success of the device (Fraser, 2004; Kurtz, 2009). The use of PEEK in spinal arthroplasty represents a new application of this material. Although the history of PEEK suggests that it has the necessary material properties to serve as a long-term implantable arthroplasty material, it's use in the form of any arthroplasty device has not been diligently explored. Therefore, a battery of preclinical testing was performed, and the interpretation of the results for both a cervical disc arthroplasty device and lumbar nucleus replacement device have allowed for successful advancement to the clinical usage. The results of these

The Use of PEEK in Spine Arthroplasty 233

Guyer, R.; Shellock, J & MacLennan, B. (2011). Early failure of metal-on-metal artificial disc

Kurtz, S. & Devine J. (2007). PEEK biomaterials in trauma, orthropedic and spinal implants. *Biomaterials*, Vol. 28, No. 32, (November, 2007) pp. 4845-4869 ISSN 0142-9612 Kurtz, S. MacDonald, D. & Ianuzzi, A. (1976). The natural history of polyethylene oxidation

Licina, P. & Thorpe P. (1948). Osteolysis and complications associated with artificial disc

Lowe, T.; Hashim, S. & Wilson, L. (1976). A biomechanical study of regional endplate

Moroney, S. Schultz, A. & Miller J. (1988). Analysis and measurement of neck loads. *J Ortho* 

Murrey D.; Janssen M & Delamarter R. (2009). Results of the Prospective, Randomized,

*Res*, Vol. 6, No. 5, (September, 1988) pp. 713-720 ISSN 1554-527X

2436

0362-2436

620X

2436

0362-2436

prostheses associated with lymphocytic reaction: diagnosis and treatment experience in four cases. *Spine*, Vol. 36, No. 7, (April, 2001) E492-497 ISSN 0362-

in total disc replacment. *Spine*, Vol. 15, No. 34, (October, 2009) pp. 2369-2377 ISSN

replacement. *J Bone Joint Surg,* Vol. 86-B, Suppl IV (2004) pp. 460-461 ISSN 0301-

strength and cage morphology as it relates to structural interbody support. *Spine*, Vol. 1, No. 29, (Novermber, 2004) pp. 2389-2394 ISSN 0362-

Controlled Multicenter Food and Drug Administration Investigational Device Exemption Study of the ProDisc-C Total Disc Replacement Versus Anterior Discectiomy and Fusion for the Treatment of 1-level Symptomatic Cervical Disc Disease. *The Spine Journal,* Vol.9, No. 4, (April, 2009) pp. 275-286 ISSN 1529-9430 Nechtow, W.; Hinter, M. & Bushelow M. IVD Replacement Mechanical Performance Depends Stronlgy on Input Parameters. Trans 52nd ORS (2006) p0118. Niedzwiecki, S.; Klapperich, C, & Short J. (2001). Comparison of three joint simulator wear

debris isolation techniques: acid digestion, base digestion, and enzyme cleavage. *J* 

Movement in the Lumbar Spine. *Spine*, Vol. 9, No. 3 (April, 1984) pp.294-297 ISSN

Spine as Shown by Three Dimensional Load Displacement Curves. *Spine*, Vol. 26,

(PEEK) with emphasis on the large compressive strain response. *Polymer* Vol. 48,

Extension in Asymptomatic Individuals. *Spine*, Vol. 29, No. 24 (December, 2004)

intervertebral lumbar segments: the Wallis system. *Eur Spine J* Vol. 11, Suppl 2

*Biomed Mater Res* Vol. 56, No. 2, (August, 2001) pp. 245-249 ISSN 1549-3296 Pearcy, M.; Portek, I. & Shepherd J. (1976). Three-Dimensional X-ray Analysis of Normal

Panjabi, M.; Crisco, J. & Vasavada A. (2001) Mechanical Properties of the Human Cervical

Przybyla A.; Skrzypeic, D. & Pollintine, P. Strength of the cervical spine in compression and bending. *Spine*, Vol. 32, No. 15, (July, 2007), pp. 1612-1620 ISSN 0362-2436 Rae, P.; Brown, E. & Orler, E. (1960). The mechanical properties of poly(ether-ether-ketone)

Reitman, C.; Mauro, K. & Nguyen. L. (2004). Intervertebral Motion Between Flexion and

Senegas, J. (2002). Mechanical supplementation by non-rigid fixation in degenerative

No. 24 (December, 2001) pp. 2692-2700 ISSN 0362-2436

No. 2 (January, 2007) pp.598-615 ISSN 0032-3861

(October, 2002) pp. S164-169 ISSN 0940-6719

pp. 2832-2843 ISSN 0362-2436

combined preclinical studies described can be used in an ongoing basis to further analyze the use of PEEK in arthroplasty applications. Long term clinical follow up is needed to further support the preclinical results.
