Biomechanical Rationale for Using Polyetheretherketone (PEEK) Spacers for Lumbar Interbody Fusion–A Finite Element Study

Vadapalli, Sasidhar; Sairyo, Koichi; Goel, Vijay K.; Robon, Matt; Biyani, Ashok; Khandha, Ashutosh; Ebraheim, Nabil A.

doi:10.1097/01.brs.0000250177.84168.ba

Cited by 220 publications

(130 citation statements)

References 3 publications

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“…Rather, late-onset settling was found to correlate with cage material, as all patients in the segment S group received a PEEK cage. According to Vadapalli et al 17) , PEEK cages have a modulus of elasticity closely resembling that of cortical bone. They described how PEEK spacers reduce the stresses in the adjacent endplates as well as subsidence, and facilitate bony fusion.…”

Section: Discussionmentioning

confidence: 99%

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Satake

Kanemura

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Introduction: Few studies have investigated the influence of cage subsidence patterns (intraoperative endplate injury or late-onset cage settling) on bony fusion and clinical outcomes in lateral interbody fusion (LIF). This retrospective study was performed to compare the fusion rate and clinical outcomes of cage subsidence patterns in LIF at one year after surgery.Methods: Participants included 93 patients (aged 69.0±0.8 years; 184 segments) who underwent LIF with bilateral pedicle screw fixation. All segments were evaluated by computed tomography and classified into three groups: Segment E (intraoperative endplate injury, identified immediately postoperatively); Segment S (late-onset settling, identified at 3 months or later); or Segment N (no subsidence). We compared patient characteristics, surgical parameters and fusion status at 1 year for the three subsidence groups. Patients were classified into four groups: Group E (at least one Segment E), Group S (at least one Segment S), Group ES (both Segments E and S), or Group N (Segment N alone). Visual analog scales (VASs) and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared for the four patient groups.Results: 184 segments were classified: 31 as Segment E (16.8%), 21 as Segment S (11.4%), and 132 as Segment N (71.7%). Segment E demonstrated significantly lower bone mineral density (-1.7 SD of T-score, p=0.003). Segment S demonstrated a significantly higher rate of polyetheretherketone (PEEK) cages (100%, p=0.03) and a significantly lower fusion rate (23.8%, p=0.01). There were no significant differences in VAS or in any of the JOABPEQ domains among the four patient groups.Conclusions: Intraoperative endplate injury was significantly related to bone quality, and late-onset settling was related to PEEK cages. Late-onset settling demonstrated a worse fusion rate. However, there were no significant differences in clinical outcomes among the subsidence patterns.

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Section: Discussionmentioning

confidence: 99%

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Satake

Kanemura

Nakashima

et al. 2017

Spine Surg Relat Res

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“…For an accurate prediction of the subsidence, taking into account such phenomena is definitely a requirement [8]. However, most FE models investigating intersomatic stabilization ignored this issue [4,19,20,32,33], while others considered in a simplified manner [18].…”

Section: Discussionmentioning

confidence: 99%

“…Since the cage had the same height of the intervertebral space, no distraction due to cage insertion was modeled. Surface-to-surface contact having friction coefficient 0.5, similar to previous studies aimed to simulate the immediate post-operative time [4,20,33], was employed to model the cage-endplate interaction.…”

Section: Stabilization With a Stand Alone Cagementioning

confidence: 99%

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Lumbar interbody fusion: a parametric investigation of a novel cage design with and without posterior instrumentation

2011

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“…The characteristics of PEEK include high strength, rigidity, and durability, with a modulus of elasticity similar to that of cancellous bone. The difference in strain magnitude is also less between cortical bone and a PEEK cage compared with the difference between cortical bone and titanium alloy ; in general, PEEK cages are considered to be not as prone to subsidence 7 . The purpose of our study was to examine, by cage type, the outcome of unilateral TLIF using pedicle screw PS xation to treat lumbar foraminal stenosis.…”

Section: Originalmentioning

confidence: 99%

Treatment Outcome of Transforaminal Lumbar Interbody Fusion (TLIF) Using Unilateral Pedicle Screw Fixation for Lumbar Foraminal Stenosis

Ozawa

Toyone

Shirahata

et al. 2016

Showa Univ J Med Sci

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: Transforaminal lumbar interbody fusion TLIF for both anterior / posterior and superior / inferior decompression of foramina can be indicated. The purpose of this study was to examine the outcome of unilateral TLIF and pedicle screw PS fixation for lumbar foraminal stenosis. The subjects were 24 consecutive patients who underwent monosegmental fusion for lumbar foraminal stenosis ; there were 14 men and 10 women. All subjects underwent fusion at L5-S for unilateral L5 radiculopathy. A titanium cage was used in 10 subjects titanium group and a carbon or polyetheretherketone PEEK cage was used in 14 subjects carbon / PEEK group . Clinical conditions and radiological findings were examined preand postoperatively, and at the nal follow-up. The mean Roland and Morris Disability index improved from 8.5 preoperatively to 3.8 points. Excellent and good patient satisfaction was obtained in 2 / 3 of the patients. The mean disc height was increased by 2.0 mm immediately after surgery and by 1.1 mm at the nal followup compared with the height before surgery. Subsidence of the cage of more than 3.0 mm was observed in 60 patients of the titanium group and in 14 patients of the carbon / PEEK group P 0.05 . Unilateral TLIF and PS fixation was demonstrated to be less invasive for paravertebral muscles with a lower incidence of adjacent lumbar foraminal stenosis, resulting in a good outcome. Although there was no signi cant difference in clinical outcomes, subsidence of the cage was 4-fold higher in the titanium cage group than in patients receiving the carbon / PEEK cages. These ndings indicate that unilateral TLIF and PS xation are useful procedures.

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Biomechanical Rationale for Using Polyetheretherketone (PEEK) Spacers for Lumbar Interbody Fusion–A Finite Element Study

Cited by 220 publications

References 3 publications

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Lumbar interbody fusion: a parametric investigation of a novel cage design with and without posterior instrumentation

Treatment Outcome of Transforaminal Lumbar Interbody Fusion (TLIF) Using Unilateral Pedicle Screw Fixation for Lumbar Foraminal Stenosis

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