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Wang Z, Zhang D, Zhang Z, Miao J. The postoperative clinical effects of utilizing 3D printed (Ti6Al4V) interbody fusion cages in posterior lumbar fusion: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e38431. [PMID: 38905365 PMCID: PMC11191957 DOI: 10.1097/md.0000000000038431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/10/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND The research focused on the postoperative effect of using interbody fusion cage in lumbar posterior lamina decompression and interbody fusion with pedicle screw by comparing the postoperative effect of using 3D printing (Ti6Al4V) and PEEK material interbody fusion cage. METHODS Ninety-one patients with lumbar degenerative diseases from the Department of Spine Surgery of Tianjin Hospital were included in the study cohort. They were divided into 3D group (n = 39) and PEEK group (n = 52) according to the use of interbody fusion cage. The imaging data of the patients were collected and the postoperative data of the 2 groups were compared to evaluate patients' health status and the recovery of lumbar structure and function after operation. RESULTS Combined with the degree of fusion, the clinical effect of 3D printing titanium alloy interbody fusion cage was comprehensively judged. At the last follow-up, the JOA score, ODI index, VAS, prolo function score, and SF-36 scale of the 2 groups showed that the clinical symptoms were better than those before operation (P < .05). The height of intervertebral disc, the area of intervertebral foramen and the physiological curvature of lumbar vertebrae increased in varying degrees after operation (P < .05). At the last follow-up, the vertebral cage fusion rates were as high as 89.13% and 90.91% in the 3D and PEEK groups, with collapse rates of 6.5% and 4.5%, respectively. There were 10 cases of cage displacement in 3D group and 7 cases of cage displacement in PEEK group. There was no significant difference between the 2 groups (P > .05). CONCLUSIONS In conclusion, 3D printed (Ti6Al4V) interbody fusion cage can obtain good clinical effect in the surgical treatment of lumbar degenerative diseases. Posterior lumbar lamina decompression, bilateral pedicle screw fixation combined with 3D printed cage interbody fusion is excellent in rebuilding the stability of lumbar vertebrae. 3D printed interbody fusion cage can be an ideal substitute material for intervertebral bone grafting. The stable fusion time of interbody fusion cage after lumbar fusion is mostly from 3 months to half a year after operation.
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Affiliation(s)
- Zi Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Dongzhe Zhang
- Department of Spine Surgery, Cangzhou Hospital of Integrated TCM-WM, Cangzhou, China
| | - Zepei Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
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Fernandes RJR, Gee A, Kanawati AJ, Siddiqi F, Rasoulinejad P, Zdero R, Bailey CS. Biomechanical Comparison of Subsidence Between Patient-Specific and Non-Patient-Specific Lumbar Interbody Fusion Cages. Global Spine J 2024; 14:1155-1163. [PMID: 36259252 DOI: 10.1177/21925682221134913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Biomechanical study. OBJECTIVES Several strategies to improve the surface of contact between an interbody device and the endplate have been employed to attenuate the risk of cage subsidence. 3D-printed patient-specific cages have been presented as a promising alternative to help mitigate that risk, but there is a lack of biomechanical evidence supporting their use. We aim to evaluate the biomechanical performance of 3D printed patient-specific lumbar interbody fusion cages in relation to commercial cages in preventing subsidence. METHODS A cadaveric model is used to investigate the possible advantage of 3D printed patient-specific cages matching the endplate contour using CT-scan imaging in preventing subsidence in relation to commercially available cages (Medtronic Fuse and Capstone). Peak failure force and stiffness were analyzed outcomes for both comparison groups. RESULTS PS cages resulted in significantly higher construct stiffness when compared to both commercial cages tested (>59%). PS cage peak failure force was 64% higher when compared to Fuse cage (P < .001) and 18% higher when compared to Capstone cage (P = .086). CONCLUSIONS Patient-specific cages required higher compression forces to produce failure and increased the cage-endplate construct' stiffness, decreasing subsidence risk.
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Affiliation(s)
- Renan J R Fernandes
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Aaron Gee
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Andrew J Kanawati
- Department of Orthopaedic Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Fawaz Siddiqi
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
| | - Parham Rasoulinejad
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Radovan Zdero
- Lawson Health Research Institute, London, ON, Canada
| | - Christopher S Bailey
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Drossopoulos PN, Ononogbu-uche FC, Tabarestani TQ, Huang CC, Paturu M, Bardeesi A, Ray WZ, Shaffrey CI, Goodwin CR, Erickson M, Chi JH, Abd-El-Barr MM. Evolution of the Transforaminal Lumbar Interbody Fusion (TLIF): From Open to Percutaneous to Patient-Specific. J Clin Med 2024; 13:2271. [PMID: 38673544 PMCID: PMC11051479 DOI: 10.3390/jcm13082271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The transforaminal lumbar interbody fusion (TLIF) has seen significant evolution since its early inception, reflecting advancements in surgical techniques, patient safety, and outcomes. Originally described as an improvement over the posterior lumbar interbody fusion (PLIF), the TLIF began as an open surgical procedure, that notably reduced the need for the extensive neural retractation that hindered the PLIF. In line with the broader practice of surgery, trending toward minimally invasive access, the TLIF was followed by the development of the minimally invasive TLIF (MIS-TLIF), a technique that further decreased tissue trauma and postoperative complications. Subsequent advancements, including Trans-Kambin's Triangle TLIF (percLIF) and transfacet LIF, have continued to refine surgical access, minimize surgical footprint, and reduce the risk of injury to the patient. The latest evolution, as we will describe it, the patient-specific TLIF, is a culmination of the aforementioned adaptations and incorporates advanced imaging and segmentation technologies into perioperative planning, allowing surgeons to tailor approaches based on individual patient anatomy and pathology. These developments signify a shift towards more precise methods in spine surgery. The ongoing evolution of the TLIF technique illustrates the dynamic nature of surgery and emphasizes the need for continued adaptation and refinement.
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Affiliation(s)
- Peter N. Drossopoulos
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
| | - Favour C. Ononogbu-uche
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
| | - Troy Q. Tabarestani
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
| | - Chuan-Ching Huang
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
| | - Mounica Paturu
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
| | - Anas Bardeesi
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University, St Louis, MO 63110, USA
| | - Christopher I. Shaffrey
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
| | - C. Rory Goodwin
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
| | - Melissa Erickson
- Division of Spine, Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - John H. Chi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (T.Q.T.); (M.M.A.-E.-B.)
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Shih CM, Lee CH, Chen KH, Pan CC, Yen YC, Wang CH, Su KC. Optimizing Spinal Fusion Cage Design to Improve Bone Substitute Filling on Varying Disc Heights: A 3D Printing Study. Bioengineering (Basel) 2023; 10:1250. [PMID: 38002375 PMCID: PMC10669701 DOI: 10.3390/bioengineering10111250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
The success of spinal fusion surgery relies on the precise placement of bone grafts and minimizing scatter. This study aims to optimize cage design and bone substitute filling methods to enhance surgical outcomes. A 3D printed lumbar spine model was utilized to implant 3D printed cages of different heights (8 mm, 10 mm, 12 mm, and 14 mm) filled with BICERA® Bone Graft Substitute mixed with saline. Two filling methods, SG cage (side hole for grafting group, a specially designed innovative cage with side hole, post-implantation filling) and FP cage (finger-packing group, pre-implantation finger packing, traditional cage), were compared based on the weight of the implanted bone substitute. The results showed a significantly higher amount of bone substitute implanted in the SG cage group compared to the FP cage group. The quantity of bone substitute filled in the SG cage group increased with the height of the cage. However, in the FP cage group, no significant difference was observed between the 12 mm and 14 mm subgroups. Utilizing oblique lumbar interbody fusion cages with side holes for bone substitute filling after implantation offers several advantages. It reduces scatter and increases the amount of implanted bone substitute. Additionally, it effectively addresses the challenge of insufficient fusion surface area caused by gaps between the cage and endplates. The use of cages with side holes facilitates greater bone substitute implantation, ultimately enhancing the success of fusion. This study provides valuable insights for future advancements in oblique lumbar interbody fusion cage design, highlighting the effectiveness of using cages with side holes for bone substitute filling after implantation.
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Affiliation(s)
- Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-M.S.); (C.-H.L.); (K.-H.C.); (C.-C.P.)
- Department of Physical Therapy, Hungkuang University, Taichung 433, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-M.S.); (C.-H.L.); (K.-H.C.); (C.-C.P.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-M.S.); (C.-H.L.); (K.-H.C.); (C.-C.P.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-M.S.); (C.-H.L.); (K.-H.C.); (C.-C.P.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
| | - Yu-Chun Yen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan; (Y.-C.Y.); (C.-H.W.)
| | - Chun-Hsiang Wang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan; (Y.-C.Y.); (C.-H.W.)
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan; (Y.-C.Y.); (C.-H.W.)
- Department of Biomedical Engineering, HungKuang University, Taichung 433, Taiwan
- Department of Chemical and Materials Engineering, Tunghai University, Taichung 407, Taiwan
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