PEEK-Halo effect in interbody fusion

Phan, Kevin; Hogan, Jarred; Assem, Yusuf; Mobbs, Ralph J.

doi:10.1016/j.jocn.2015.07.017

Cited by 65 publications

(54 citation statements)

References 21 publications

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“…Another animal study comparing fusion for PEEK cages versus titanium cages, both with iliac autograft, found slower fusion and less bony ingrowth for the PEEK cages [58]. A paper with a pair of human case reports and an animal model study describes a “halo” effect around PEEK implants on CT-imaging, which reflects lack of bony ongrowth to the implant, even when sufficient bony bridging across and around the implant was clearly apparent [59]. The results of our clinical trial also suggest that PEEK as a material may be better suited for other applications where bony ongrowth is not desired, such as arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter “PIERCE-PEEK” study

et al. 2017

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BackgroundAnterior cervical diskectomy and fusion (ACDF) is a well-established surgical treatment for radiculopathy and myelopathy. Previous studies showed that empty PEEK cages have lower radiographic fusion rates, but the clinical relevance remains unclear. This paper’s aim is to provide high-quality evidence on the outcomes of ACDF with empty PEEK cages and on the relevance of radiographic fusion for clinical outcomes.MethodsThis large prospective multicenter clinical trial performed single-level ACDF with empty PEEK cages on patients with cervical radiculopathy or myelopathy. The main clinical outcomes were VAS (0–10) for pain and NDI (0–100) for functioning. Radiographic fusion was evaluated by two investigators for three different aspects.ResultsThe median (range) improvement of the VAS pain score was: 3 (1–6) at 6 months, 3 (2–8) at 12 months, and 4 (2–8) at 18 months. The median (range) improvement of the NDI score was: 12 (2–34) at 6 months, 18 (4–46) at 12 months, and 22 (2–44) at 18 months. Complete radiographic fusion was reached by 126 patients (43%) at 6 months, 214 patients (73%) at 12 months, and 241 patients (83%) at 18 months. Radiographic fusion was a highly significant (p < 0.001) predictor of the improvement of VAS and NDI scores.ConclusionThis study provides strong evidence that ACDF is effective treatment, but the overall rate of radiographic fusion with empty PEEK cages is slow and insufficient. Lack of complete radiographic fusion leads to less improvement of pain and disability. We recommend against using empty uncoated pure PEEK cages in ACDF.Trial registration ISRCTN42774128. Retrospectively registered 14 April 2009.

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Section: Discussionmentioning

confidence: 99%

Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter “PIERCE-PEEK” study

et al. 2017

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“…This undesirable property has been recently reported in studies finding that conventional smooth PEEK implants have limited osteoconductive properties and limited bone fixation at the implant interface [29,37]. For example, Phan et al described a case in which a patient underwent anterior lumbar interbody fusion (ALIF) with a PEEK implant [38]. The authors found evidence of poor integration between the implant and surrounding bone causing the "halo-effect" on CT scans.…”

Section: Synthetics: Polyetheretherketone (Peek) Cagesmentioning

confidence: 99%

“…Animal studies have demonstrated fibrous tissue growth and lack of osseointegration related to the use of PEEK implants. In a technical note, Phan et al described PEEK's poor integration with the surrounding bone, producing a "PEEK-Halo" effect [38]. This phenomenon is represented by a halo appearance between the implant and bone graft on a CT scan.…”

Section: Pre-clinical Literature Review: In Vivo Modelsmentioning

confidence: 99%

Allograft Structural Interbody Spacers Compared to PEEK Cages in Cervical Fusion: Benchtop and Clinical Evidence

Carter¹,

Gianulis²,

Moore³

2021

Clinical Implementation of Bone Regeneration and Maintenance

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Cervical degenerative disc disease (CDDD) can lead to radiculopathy and myelopathy, resulting in pain, lack of function, and immobility. Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment modality for advanced CDDD. ACDF involves removal of the affected disc(s) followed by replacement with a bone or synthetic graft. Historically, autograft has been considered the gold standard for interbody fusion. However, it is often associated with limitations, including donor site morbidity and limited quality and supply, prompting surgeons to seek alternatives. Two of the most common alternatives are structural bone allografts and polyetheretherketone (PEEK) synthetic cages. Both, advantageously, have similar mechanical properties to autologous bone, with comparable elastic modulus values. However, a lack of osseointegration of PEEK cages has been reported both pre-clinically and clinically. Reported fusion rates assessed radiographically are higher with the use of structural bone allografts compared to PEEK cages, while having a lower incidence of pseudarthrosis. This book chapter will discuss in detail the pre-clinical and clinical performance of structural allografts in comparison to conventional PEEK cages.

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“…Porous scaffolds and spacers made of titanium alloy and poly[aryl‐ether‐ether‐ketone] (PEEK) have been widely used in trauma and vertebrae surgeries (Kurtz & Devine, 2007; Lethaus et al, 2012; Wu, Liu, Yeung, Liu, & Yang, 2014). However, these metallic and polymeric implants do not promote osteoblast differentiation or bone tissue formation (Chaudhari et al, 2011; Phan, Hogan, Assem, & Mobbs, 2016). The ultimate goal of using polymer or metal is to fill the space while introducing minimal toxicity due to accumulation of metal ions or polymer degradation products.…”

Section: Introductionmentioning

confidence: 99%

Synthesis and characterization of porous bioactiveSiCtissue engineering scaffold

El‐Ghannam

Greenier

Johnson

et al. 2020

J Biomedical Materials Res

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Silicon carbide (SiC) is an inert material with excellent biocompatibility properties. A major issue that limits its use as a medical device is the difficult processing technique that requires hot pressing at a temperature (>2,000oC) and pressure (1,000–2,000 atm). In the present study, we developed a protocol to synthesize a porous SiC scaffold by pressing the powder at 50 MPa and heating at 900oC/2 hr. The surface of SiC was chemically modified by NaOH to facilitate sintering and induce bioactivity. Porous discs with 51.51 ± 3.17% porosity and interconnected pores in the size range from 1 to 1,000 μm were prepared using 40% PEG. The average compressive strength and Young's modulus of the scaffolds were 1.94 ± 0.70 and 169.2 ± 0.08 MPa, respectively. FTIR analysis confirmed the formation of biomimetic hydroxyapatite layer after 2 hr of immersion in simulated body fluid. The Ca/P ratio was dependent on the concentration of the silanol groups created on the material surface. Increasing the atomic % of silicon on the SiC surface from 33.27 ± 9.53% to 45.13 ± 4.74% resulted in a 76% increase in the osteocalcin expression by MC3T3‐E1 cells seeded on the material after 7 days. The cells colonized the entire thickness of the template and filled the pores with mineralized extracellular matrix after 14 days. Taken all together, the porous SiC scaffolds can serve as a bone graft for tissue reconstruction and cell delivery in trauma surgery.

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PEEK-Halo effect in interbody fusion

Cited by 65 publications

References 21 publications

Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter “PIERCE-PEEK” study

Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter “PIERCE-PEEK” study

Allograft Structural Interbody Spacers Compared to PEEK Cages in Cervical Fusion: Benchtop and Clinical Evidence

Synthesis and characterization of porous bioactiveSiCtissue engineering scaffold

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