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Study Design. A multicenter, randomized, open-label, parallel-group trial. Objective. To investigate interbody bone fusion rates in titanium-coated polyetheretherketone (TiPEEK) and polyetheretherketone (PEEK) cages after posterior lumbar interbody fusion (PLIF) surgery. Summary of Background Data. Previous clinical studies have not revealed any significant difference in bone fusion rates between TiPEEK and PEEK cages. Methods. During one-level PLIF surgery, 149 patients (84 men, 65 women, mean age 67 yr) were randomly allocated to use either a TiPEEK cage (n = 69) or PEEK cage (n = 80). Blinded radiographic evaluations were performed using computed tomography and assessed by modified intention-to-treat analysis in 149 cases and per-protocol analysis in 143 cases who were followed for 12 months. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and the Oswestry Disability Index. Results. The interbody union rate at 12 months after surgery was 45% owing to a very strict definition of bone fusion. The rates of bone fusion were significantly higher at 4 and 6 months after surgery in the TiPEEK group than in the PEEK group in the unadjusted modified intention-to-treat analysis and were significantly higher at 6 months in the unadjusted per-protocol analysis. Binary logistic regression analysis adjusted for sex, age, body mass index, bone mineral density, and surgical level showed that using a TiPEEK cage (odds ratio, 2.27; 95% confidence interval: 1.09–4.74; P = 0.03) was independently associated with bone fusion at 6 months after surgery. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Oswestry Disability Index results improved postoperatively in both groups. Conclusion. Using the TiPEEK cage for PLIF enabled the maintenance of better bone fusion to the endplate than using the PEEK cage at 6 months after the surgery. Our findings suggest the possibility of an earlier return to rigorous work or sports by the use of TiPEEK cage. Level of Evidence: 1

OBJECTIVEMany complications are likely to occur in patients with malnutrition. The prognostic nutritional index (PNI) is often used when evaluating a patient’s nutritional condition. However, no studies have investigated the association between nutritional status and postoperative medical complications or prognosis by using the PNI in the field of spinal surgery. The purpose of this retrospective study was to investigate postoperative medical complications and prognoses of patients who had undergone adult spinal deformity (ASD) surgery, according to their preoperative nutritional status.METHODSAll patients aged ≥ 40 years who had undergone scheduled ASD surgery in the authors’ hospital between March 2010 and June 2017 were eligible for study inclusion and were divided into groups according to their PNI (< 50, group L; ≥ 50, group H). Medical complications diagnosed within 30 days postoperatively were evaluated; however, surgical site infection and death were evaluated until 1 and 5 years after surgery, respectively.RESULTSAmong the 285 eligible patients, groups L and H consisted of 118 and 167 patients, whose mean ages were 68.6 and 68.3 years, respectively. There was a significant difference in body mass index (22 vs 24 mg/kg2, respectively, p = 0.000), PNI (46 vs 55, p = 0.000), comorbidity of osteoporosis (50% vs 32%, p = 0.005) and autoimmune disease (13% vs 5%, p = 0.036), medical history of malignant disorder (17% vs 6%, p = 0.007), and medical complications (49% vs 23%, p = 0.000) between groups L and H. Multiple logistic regression analysis suggested that significant risk factors for postoperative medical complications were male sex (p = 0.000, OR 3.5, 95% CI 1.78–6.96), PNI < 50 (p = 0.000, OR 2.9, 95% CI 1.69–4.93), and days to ambulation (p = 0.003, OR 1.1, 95% CI 1.02–1.09).CONCLUSIONSMedical complication rates are significantly higher in patients with PNI < 50, those with delayed ambulation, and male patients. In malnourished patients scheduled for ASD surgery, improvement of preoperative nutritional status and postoperative early ambulation are important to avoid medical complications.