Outcome of Ti/PEEK Versus PEEK Cages in Minimally Invasive Transforaminal Lumbar Interbody Fusion

Overview

Journal Global Spine J

Publisher Sage Publications

Date 2021 Mar 18

PMID 33733888

Citations 7

Authors

Yu-Cheng Yao

Po-Hsin Chou

Hsi-Hsien Lin

Shih-Tien Wang

Ming-Chau Chang

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective case-control study.

Objectives: This study aims to present the clinical and radiographical outcomes of the titanium-polyetheretherketone (Ti/PEEK) composite cage compared to those of the standard PEEK cage in patients receiving minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Methods: Patients receiving 1 level MI-TLIF between October 2015 and October 2017 were included with a minimum of 2-year follow-up. The patients were segregated into 2 groups; Ti/PEEK group and PEEK group. Each patient was propensity-matched using preoperative age, sex, and body mass index. Early fusion rate was evaluated by computed tomography at postoperative 6 months. Clinical outcomes were assessed using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores.

Results: After matching, there were 27 patients included in each group. The demographics, diagnosis, and surgical details were not significantly different between the 2 groups. The 6-month rate was 88.9% in Ti/PEEK group. The fusion rate and cage subsidence rate had no difference between the 2 groups. The complication rate in the Ti/PEEK group was comparable to that in the PEEK group. There was no difference in VAS and ODI scores during a 2-year follow-up period.

Conclusions: The use of Ti/PEEK composite cage was as safe and effective as the use of PEEK cage in MI-TLIF. The 6-month fusion rate was 88.9%. Our finding revealed comparable clinical results for surgeons using Ti/PEEK composite cages in MI-TLIF compared to those using the PEEK cage.

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References

Price J, Dawson J, Schwender J, Schellhas K . Clinical and Radiologic Comparison of Minimally Invasive Surgery With Traditional Open Transforaminal Lumbar Interbody Fusion: A Review of 452 Patients From a Single Center. Clin Spine Surg. 2017; 31(2):E121-E126. DOI: 10.1097/BSD.0000000000000581. View

Weiss H, Garcia R, Hopkins B, Shlobin N, Dahdaleh N . A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion. Curr Rev Musculoskelet Med. 2019; :328-339. PMC: 6684700. DOI: 10.1007/s12178-019-09574-2. View

Landham P, Don A, Robertson P . Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction. Eur Spine J. 2017; 26(11):2843-2850. DOI: 10.1007/s00586-017-5170-z. View

Miller L, Bhattacharyya S, Pracyk J . Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Single-Level Degenerative Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. World Neurosurg. 2019; 133:358-365.e4. DOI: 10.1016/j.wneu.2019.08.162. View

Mobbs R, Phan K, Assem Y, Pelletier M, Walsh W . Combination Ti/PEEK ALIF cage for anterior lumbar interbody fusion: Early clinical and radiological results. J Clin Neurosci. 2016; 34:94-99. DOI: 10.1016/j.jocn.2016.05.028. View

Fogel G, Toohey J, Neidre A, Brantigan J . Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: X-ray films and helical computed tomography scans compared with surgical exploration of fusion. Spine J. 2007; 8(4):570-7. DOI: 10.1016/j.spinee.2007.03.013. View

Lee M, Mok J, Patel P . Transforaminal Lumbar Interbody Fusion: Traditional Open Versus Minimally Invasive Techniques. J Am Acad Orthop Surg. 2018; 26(4):124-131. DOI: 10.5435/JAAOS-D-15-00756. View

Ito Z, Imagama S, Kanemura T, Satake K, Ando K, Kobayashi K . Volumetric change in interbody bone graft after posterior lumbar interbody fusion (PLIF): a prospective study. Eur Spine J. 2014; 23(10):2144-9. DOI: 10.1007/s00586-014-3410-z. View

Assem Y, Mobbs R, Pelletier M, Phan K, Walsh W . Radiological and clinical outcomes of novel Ti/PEEK combined spinal fusion cages: a systematic review and preclinical evaluation. Eur Spine J. 2015; 26(3):593-605. DOI: 10.1007/s00586-015-4353-8. View

10.

Warburton A, Girdler S, Mikhail C, Ahn A, Cho S . Biomaterials in Spinal Implants: A Review. Neurospine. 2019; 17(1):101-110. PMC: 7136103. DOI: 10.14245/ns.1938296.148. View

11.

Yao Y, Lin H, Chou P, Wang S, Chang M . Differences in the interbody bone graft area and fusion rate between minimally invasive and traditional open transforaminal lumbar interbody fusion: a retrospective short-term image analysis. Eur Spine J. 2019; 28(9):2095-2102. DOI: 10.1007/s00586-019-06002-4. View

12.

Chong E, Mobbs R, Pelletier M, Walsh W . Titanium/Polyetheretherketone Cages for Cervical Arthrodesis with Degenerative and Traumatic Pathologies: Early Clinical Outcomes and Fusion Rates. Orthop Surg. 2016; 8(1):19-26. PMC: 6584396. DOI: 10.1111/os.12221. View

13.

Ge D, Stekas N, Varlotta C, Fischer C, Petrizzo A, Protopsaltis T . Comparative Analysis of Two Transforaminal Lumbar Interbody Fusion Techniques: Open TLIF Versus Wiltse MIS TLIF. Spine (Phila Pa 1976). 2018; 44(9):E555-E560. DOI: 10.1097/BRS.0000000000002903. View

14.

Liu S, Wang Y, Liang Z, Zhou M, Chen C . Comparative Clinical Effectiveness and Safety of Bone Morphogenetic Protein Versus Autologous Iliac Crest Bone Graft in Lumbar Fusion: A Meta-analysis and Systematic Review. Spine (Phila Pa 1976). 2020; 45(12):E729-E741. PMC: 7282484. DOI: 10.1097/BRS.0000000000003372. View

15.

Lee J, Lee J, Park J, Lee H . Fusion rates of a morselized local bone graft in polyetheretherketone cages in posterior lumbar interbody fusion by quantitative analysis using consecutive three-dimensional computed tomography scans. Spine J. 2011; 11(7):647-53. DOI: 10.1016/j.spinee.2011.04.029. View

16.

Makanji H, Schoenfeld A, Bhalla A, Bono C . Critical analysis of trends in lumbar fusion for degenerative disorders revisited: influence of technique on fusion rate and clinical outcomes. Eur Spine J. 2018; 27(8):1868-1876. DOI: 10.1007/s00586-018-5544-x. View

17.

Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U . Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results. Eur Spine J. 2005; 14(6):551-8. PMC: 3489237. DOI: 10.1007/s00586-004-0830-1. View

18.

McGilvray K, Waldorff E, Easley J, Seim H, Zhang N, Linovitz R . Evaluation of a polyetheretherketone (PEEK) titanium composite interbody spacer in an ovine lumbar interbody fusion model: biomechanical, microcomputed tomographic, and histologic analyses. Spine J. 2017; 17(12):1907-1916. DOI: 10.1016/j.spinee.2017.06.034. View

19.

Formica M, Vallerga D, Zanirato A, Cavagnaro L, Basso M, Divano S . Fusion rate and influence of surgery-related factors in lumbar interbody arthrodesis for degenerative spine diseases: a meta-analysis and systematic review. Musculoskelet Surg. 2020; 104(1):1-15. DOI: 10.1007/s12306-019-00634-x. View

20.

Park Y, Ha J, Lee Y, Sung N . The effect of a radiographic solid fusion on clinical outcomes after minimally invasive transforaminal lumbar interbody fusion. Spine J. 2011; 11(3):205-12. DOI: 10.1016/j.spinee.2011.01.023. View