The Titanium-coated PEEK Cage Maintains Better Bone Fusion With the Endplate Than the PEEK Cage 6 Months After PLIF Surgery

Abstract

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

Impact of Early Intervertebral Osseous Union After Posterior Lumbar Interbody Fusion on Health-Related Quality of Life

“…23 In our first report using a randomized controlled trial, titanium-coated PEEK cages significantly increased early complete union ratios compared with PEEK cages. 8 Our findings commensurate with previous in vitro studies. 22 The current study defined union outcome as completed osseous union, which was a very strict definition compared to previous clinical studies.…”

“…In our first report using a multicenter, randomized, open-label, and parallel-group trial, the titanium-coated polyetheretherketone (PEEK) cage maintained better bone fusion with the endplate than the PEEK cage 6 months after PLIF; however, there was no difference in clinical outcomes related to HRQOL. 8 Therefore, we analyzed this discrepancy in our second report. We hypothesized that early intervertebral osseous union could improve HRQOL, and the present study aimed to retrospectively investigate the influence of early intervertebral osseous union after PLIF on HRQOL.…”

Immunomodulatory Properties and Osteogenic Activity of Polyetheretherketone Coated with Titanate Nanonetwork Structures

“…However, these methods of surface morphology modification are time-consuming and require large machines or high costs, making their clinical application difficult. In recent years, titanium (Ti) coating on the surface of PEEK has become a highly feasible and widely used surface topography modification method [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. Ti exhibits high bone conductivity, and the Ti coating can be given a special porous nanostructure morphology in multiple simple ways.…”

A Nomogram for Predicting Screw Loosening after Single-Level Posterior Lumbar Interbody Fusion utilizing Cortical Bone Trajectory Screw: A Minimum 2-year Follow-up Study

“…Bone fusion was graded according to Bridwell classi cation into three grades based on lumbar CT scan 19 Grade I, complete fusion with bridging bone bonding with both adjacent vertebral bodies; Grade II, incomplete fusion with bridging bone bonding with either superior or inferior vertebral bodies; Grade III, failed fusion with incomplete bony bridging. Bone fusion was assessed by CT scan slices selected from the center of the cage or the largest bone grafting 20 . Oswestry Disability Index (ODI) was used to evaluate back pain preoperatively and at postoperative time point of 6 month and nal follow-up.…”