PEEK versus metal cages in posterior lumbar interbody fusion: a clinical and radiological comparative study

Cuzzocrea, Fabrizio; Ivone, Alessandro; Jannelli, Eugenio; Fioruzzi, Alberto; Ferranti, Enrico; Vanelli, R.; Benazzo, Francesco

doi:10.1007/s12306-018-0580-6

Cited by 30 publications

(39 citation statements)

References 17 publications

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“…Eight singlecenter studies were retrospective, observational, and 3 singlecenter studies were prospective studies of which, 1 study was a randomized clinical pilot study. Four studies were carried out in Germany, 17,20,27,28 4 studies in Japan, 13,16,18,19 1 study in Italy, 12 1 study in China, 15 1 study in the United Kingdom (Table 1). 14 The data of 1,094 patients was analyzed in this meta-analysis, of which 673 (61.5%) had lumbar interbody fusion using a Ti Full-text articles excluded, with reasons (n = 56)…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Lumbar fusion was performed for a total of 1,094 patients (Ti-421, PEEK-673). PLIF was performed in 5 studies 13,15,18,27,28 for 390 patients (35.64%) (Ti-165, PEEK-225) and transforaminal interbody fusion (TLIF) in 6 studies 12,14,16,17,19,20,29 for 704 patients (64.36%) (Ti-256, PEEK-448). The different types of interbody cages used were summarized in Table 1, revealing 3 studies us-ing Ti-coated PEEK cages.…”

Section: Posterior Lumbar Fusionmentioning

confidence: 99%

“…Subsidence rates were successfully extracted from 6 studies 12,[15][16][17][18]27 at a follow-up range (6-24 months). Four studies used CT Fig.…”

Section: Subsidence Ratementioning

confidence: 99%

“…www.e-neurospine.org 131 scans, 12,15,18,27 1 study used MPR-CT scan, 16 and 1 study used Xray. 17 The definition of subsidence used in the studies is summarized in Table 3.…”

Section: Subsidence Ratementioning

confidence: 99%

“…8,9 Despite that, PEEK is chemically inert with limited cell adhesion and fixation to bone. 10 The characteristics and clinical outcomes of Ti and PEEK cages for lumbar spinal fusion were explored in several studies, [11][12][13][14][15][16][17][18][19][20] but the findings were largely inconsistent regarding fusion and subsidence rates. Hence, this study presents a systematic review and meta-analysis to evaluate the clinical outcomes of interbody cages in posterior lumbar fusion surgery.…”

Section: Introductionmentioning

confidence: 99%

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Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

et al. 2020

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Objective: Lumbar fusion with implantation of interbody cage is a common procedure for treatment of lumbar degenerative disease. This study aims to compare the fusion and subsidence rates of titanium (Ti) versus polyetheretherketone (PEEK) interbody cages after posterior lumbar interbody fusion and investigate the effect of clinical and radiological outcomes following fusion on patient-reported outcomes. Methods: A systematic search strategy of 4 electronic databases (MEDLINE, Embase, Web of Science, and Cochrane) was conducted using different MeSH (medical subject headings) terms until January 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using fixed and random-effect models based upon the heterogeneity (I 2 ) to estimate the association between interbody cages and the measured outcomes. Results: A total of 1,094 patients from 11 studies were reviewed. The final analysis included 421 patients (38.5%) who had lumbar surgery using a Ti and/or a Ti-coated interbody cage and 673 patient (61.5%) who had lumbar surgery using a PEEK cage. Overall, PEEK interbody devices were associated with a significantly lower fusion rate compared with Ti interbody devices (OR, 0.62; 95% CI, 0.41-0.93; p = 0.02). There was no difference in subsidence rates between Ti and PEEK groups (OR, 0.91; 95% CI, 0.54-1.52; p = 0.71). Also, there were no statistically significant differences in visual analogue scale (VAS)-low back pain (p = 0.14) and Japanese Orthopedic Association scale (p = 0.86) between the 2 groups. However, the PEEK group had lower odds of leg pain after surgery compared to the Ti group (OR [VAS-leg], 0.61; 95% CI, 0.28-0.94; p = 0.003). Conclusion: Ti and Ti-coated PEEK cages used for posterior lumbar interbody fusion are associated with similar rates of subsidence, but a higher rate of fusion compared to PEEK interbody cages. Randomized controlled trials are needed to better assess the effect of cage materials and potential factors that could influence the outcomes of interbody lumbar fusion.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Posterior Lumbar Fusionmentioning

confidence: 99%

“…Subsidence rates were successfully extracted from 6 studies 12,[15][16][17][18]27 at a follow-up range (6-24 months). Four studies used CT Fig.…”

Section: Subsidence Ratementioning

confidence: 99%

“…www.e-neurospine.org 131 scans, 12,15,18,27 1 study used MPR-CT scan, 16 and 1 study used Xray. 17 The definition of subsidence used in the studies is summarized in Table 3.…”

Section: Subsidence Ratementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

et al. 2020

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Clinical application of 3D‐printed biodegradable lumbar interbody cage (polycaprolactone/β‐tricalcium phosphate) for posterior lumbar interbody fusion

Liu

Bao

et al. 2023

J Biomed Mater Res

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A novel 3D‐printed biodegradable cage composed of polycaprolactone (PCL) and beta‐tricalcium phosphate (β‐TCP) in a mass ratio of 50:50, with stable resorption patterns and mechanical strength has been developed for lumbar interbody fusion. This is a prospective cohort study to evaluate the short‐ and mid‐term safety and efficacy of this biodegradable cage in posterior lumbar interbody fusion (PLIF) surgery. This was a prospective single‐arm pilot clinical trial in 22 patients with a follow‐up time of 1, 3, 6, and 12 months, postoperatively. Clinical outcomes were assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Visual analogue scale (VAS) for leg pain and low back pain. Radiological examination included X‐ray, CT scan, and three‐dimensional reconstruction to evaluate surgical indications, intervertebral space height (ISH), intervertebral bone fusion and cage degradation. A total of 22 patients was included, with an average age of 53.5 years. Among 22 patients, one patient lost to follow‐up and one patient withdrew from the clinical trial because of cage retropulsion. The remaining 20 patients showed significant improvement in clinical and imaging outcomes compared to the preoperative period. The overall mean VAS for back decreased from 5.85 ± 0.99 preoperatively to 1.15 ± 0.86 at the 12‐month follow‐up (p < .001); the VAS for leg decreased from 5.75 ± 1.11 to 1.05 ± 0.76 (p < .001); the JOA score improved from 13.8 ± 2.64 to 26.45 ± 2.46 (p < .001). The mean intervertebral space height (ISH) increased from 11.01 ± 1.75 mm preoperatively to 12.67 ± 1.89 mm at the 12‐month follow‐up and the bone fusion reached 95.2% (20/21 disc segments). Partial resorption (inferior to 50% compared with the initial cage size) were found in all cages (21/21). The clinical and radiological assessments showed that the application of 3D‐printed biodegradable PCL/β‐TCP cages in PLIF yielded satisfactory results at the 12‐month follow‐up. In the future, long‐term clinical observations and controlled clinical trials are required to further validate the safety and efficacy of this novel cage.

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Titanium (Ti) cages may be superior to polyetheretherketone (PEEK) cages in lumbar interbody fusion: a systematic review and meta-analysis of clinical and radiological outcomes of spinal interbody fusions using Ti versus PEEK cages

2021

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Aim Interbody cages are commonly used to augment interbody fusion. Commonly used materials include titanium (Ti) and polyetheretherketone (PEEK), with their inherent differences. The aim of this study is to perform a systematic review and meta-analysis to compare between the various clinical and radiological outcomes of Ti and PEEK interbody spinal cages. Methods A systematic review and meta-analysis comparing clinical and radiological outcomes between Ti and PEEK interbody cages in patients undergoing spinal fusion was performed. PubMed, Scopus, Web of Science, Embase, and Cochrane Central Register of Controlled Trials database were searched. All studies that compared the clinical and radiological outcomes of patients who underwent Ti and PEEK cages were included. Subgroup analyses was performed to differentiate between patients who had cervical and lumbar interbody fusion. Results A total of 11 articles were identified, with a total of 743 patients. Spinal fusion rates at final follow-up did not differ between Ti and PEEK cages (OR 1.50, 95% CI 0.57-3.94, P = 0.41), although in patients undergoing lumbar fusion, Ti cages demonstrated superior fusion (OR 2.12, 95% CI 1.05-4.28, P = 0.04). In patients with non-infective etiologies, Ti cages had a higher rate of cage subsidence (RR 2.17, 95% CI 1.13-4.16, P = 0.02). Both types of cages had similar operating time, postoperative hematoma formation, neuropathic pain, segmental angle correction and postoperative clinical outcome improvement. ConclusionIn non-infective lumbar spine conditions, Ti cage may be the superior option due to the higher fusion rate. Level of evidence III.

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PEEK versus metal cages in posterior lumbar interbody fusion: a clinical and radiological comparative study

Cited by 30 publications

References 17 publications

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

Clinical application of 3D‐printed biodegradable lumbar interbody cage (polycaprolactone/β‐tricalcium phosphate) for posterior lumbar interbody fusion

Titanium (Ti) cages may be superior to polyetheretherketone (PEEK) cages in lumbar interbody fusion: a systematic review and meta-analysis of clinical and radiological outcomes of spinal interbody fusions using Ti versus PEEK cages

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