Biomechanical Comparison of Polyetheretherketone Rods and Titanium Alloy Rods in Transforaminal Lumbar Interbody Fusion: a Finite Element Analysis

Background: Whether polyetheretherketone (PEEK) rods have potential as an alternative to titanium alloy (Ti) rods in transforaminal lumbar interbody fusion (TLIF) remains unclear, especially in cases with insufficient anterior support due to the absence of a cage. The purpose of this study was to investigate biomechanical differences between PEEK rods and Ti rods in TLIF with and without a cage.

Methods: An intact L1-L5 lumbar finite element model was constructed and validated. Accordingly, four TLIF models were developed: (1) Ti rods with a cage; (2) PEEK rods with a cage; (3) Ti rods without a cage; and (4) PEEK rods without a cage. The biomechanical properties were then compared among the four TLIF constructs.

Results: With or without a cage, no obvious differences were found in the effect of PEEK rods and Ti rods on the range of motion, adjacent disc stress, and adjacent facet joint force. Compared to Ti rods, PEEK rods increase the average bone graft strain (270.8-6055.2 µE vs. 319.0-8751.6 µE). Moreover, PEEK rods reduced the stresses on the screw-rod system (23.1-96.0 MPa vs. 7.2-48.4 MPa) but increased the stresses on the cage (4.6-35.2 MPa vs. 5.6-40.9 MPa) and endplates (5.7-32.5 MPa vs. 6.6-37.6 MPa).

Conclusions: Regardless of whether a cage was used for TLIF, PEEK rods theoretically have the potential to serve as an alternative to Ti rods because they may provide certain stability, increase the bone graft strain, and reduce the posterior instrumentation stress, which might promote bony fusion and decrease instrumentation failure.