Advancing spinal fusion: Interbody stabilization by in situ foaming of a chemically modified polycaprolactone

Spinal fusion (SF) surgery relies on medical hardware such as screws, cages and rods, complemented by bone graft or substitute, to stabilize the interventioned spine and achieve adequate bone ingrowth. SF is technically demanding, lengthy and expensive. Advances in material science and processing technologies, proposed herein, allowed the development of an adhesive polymeric foam with the potential to dismiss the need for invasive hardware in SF. Herein, 3D foams of polycaprolactone doped with polydopamine and polymethacrylic acid (PCL pDA pMAA) were created. For immediate bone stabilization, in situ hardening of the foam is required; therefore, a portable high-pressure device was developed to allow CO₂ foaming within bone defects. Foams were characterized by scanning electron microscopy, Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. Adhesive properties of PCL pDA pMAA outperformed PCL when tested using glass surfaces (p < 0.001) or spinal plugs (p < 0.05). No cytotoxicity was observed, and bioactivity was confirmed by the CaP layer formed upon 7 days immersion in simulated body fluid. As proof of concept, PCL pDA pMAA was extruded in-between ex vivo porcine vertebrae, and micro-computed tomography revealed similar properties to those of trabecular bone. This novel system presents great promise for instrumentation-free interbody fusion.