PMC7732662_01
X-ray double level EIT CIF cage C4C5 and C5C6 2 years postop. Arrow indicates symptomatic level.
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F1
The patient (male, 70 yrs old) had a double level (C4/C5, C5/C6) ACDF using EIT Cellular Titanium  cervical cages and no plate for 2 years before renewed symptomatology of the level below occurred (Figures 1, 2).
MRI double level EIT CIF cage 2 years postop Arrow indicates spinal stenosis C6/C7.
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F2
The patient (male, 70 yrs old) had a double level (C4/C5, C5/C6) ACDF using EIT Cellular Titanium  cervical cages and no plate for 2 years before renewed symptomatology of the level below occurred (Figures 1, 2).
(A) EIT cervical cage. (B) Retrieved cervical cage specimen. The red line indicates the intersection line from which the histological sections were cut.
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F3
HE stained specimen, 20x magnification: This overview shows direct mature bone apposition onto the titanium struts (black spots), also present in the middle of the cage, indicating that the mechanical stimulation is transferred through the total cage.
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F4
In the HE stained specimen lamellar bone was found in close contact with the titanium surface and the bone extended throughout the cage from endplate to endplate (Figure 4).
(A-C) HE stained specimen: Higher magnification from the cage middle and surface area. The lamellar bone has a mature, vivid appearance without any fibrous tissue intervening between the titanium and the bone. Healthy bone marrow can be observed throughout the scaffold. (D-F) HE stained specimen: Higher magnification from the posterior 1/3th of the cage. Dense collagen fibers are directed in a cranial to caudal trajectory, attaching to the titanium struts.
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F5
No fibrous tissue interface was found between the newly formed bone and the titanium struts (Figures 5A-C). The posterior part of the cage was infiltrated with dense fibrous tissue, demonstrating caudal-cranial directed collagen fibers (Figures 5D-F).
Masson Goldner Trichrome stained specimen, 20x magnification: In this staining the lamellar bone is colored light blue and young woven bone and osteoid has a red appearance.
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F6
The Masson's Goldner Trichrome staining showed active bone remodeling in various areas throughout the section with patterns of adaptive reactivity and no appearance of signs of overloading (Figures 6, 7A-C).
(A-C) Higher magnification of the cage central part; the bone (light blue) is remodeling, demonstrating adaptive reactivity. The red lining is osteoid, indicating active bone apposition by osteoblasts. No signs of inflammation are present. The whitisch bullous tissue is healthy bone marrow.
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F7
The Masson's Goldner Trichrome staining showed active bone remodeling in various areas throughout the section with patterns of adaptive reactivity and no appearance of signs of overloading (Figures 6, 7A-C).