Exploring the mechanical strength, antimicrobial performance, and bioactivity of 3D-printed silicon nitride-PEEK composites in cervical spinal cages.

In this study, our goal was to assess the suitability of a polyether-ether-ketone (PEEK) and silicon nitride (Si₃N₄) polymer composite for antimicrobial three-dimensional (3D)-printed cervical cages. Generic cage designs (PEEK and 15 vol.% Si₃N₄-PEEK) were 3D-printed, including solid and porous cage designs. Cages were tested in static compression, compression shear, and torsion per ASTM F2077. For antibacterial testing, virgin and composite filament samples were inoculated with Staphylococcus epidermidis and Escherichia coli. In vitro cell testing was conducted using MC3T3-E1 mouse preosteoblasts, where cell proliferation, cumulative mineralization, and osteogenic activity were measured. The 3D-printed PEEK and Si₃N₄-PEEK cages exhibited adequate mechanical strength for all designs, exceeding 14.7 kN in compression and 6.9 kN in compression shear. Si₃N₄-PEEK exhibited significantly lower bacterial adhesion levels, with a 93.9% reduction (1.21 log), and enhanced cell proliferation when compared to PEEK. Si₃N₄-PEEK would allow for custom fabrication of 3D-printed spinal implants that reduce the risk of infection compared to unfilled PEEK or metallic alloys.