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Lee JJ, Jacome FP, Hiltzik DM, Pagadala MS, Hsu WK. Evolution of Titanium Interbody Cages and Current Uses of 3D Printed Titanium in Spine Fusion Surgery. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09912-z. [PMID: 39003679 DOI: 10.1007/s12178-024-09912-z] [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] [Accepted: 06/20/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE OF REVIEW To summarize the history of titanium implants in spine fusion surgery and its evolution over time. RECENT FINDINGS Titanium interbody cages used in spine fusion surgery have evolved from solid metal blocks to porous structures with varying shapes and sizes in order to provide stability while minimizing adverse side effects. Advancements in technology, especially 3D printing, have allowed for the creation of highly customizable spinal implants to fit patient specific needs. Recent evidence suggests that customizing shape and density of the implants may improve patient outcomes compared to current industry standards. Future work is warranted to determine the practical feasibility and long-term clinical outcomes of patients using 3D printed spine fusion implants. Outcomes in spine fusion surgery have improved greatly due to technological advancements. 3D printed spinal implants, in particular, may improve outcomes in patients undergoing spine fusion surgery when compared to current industry standards. Long term follow up and direct comparison between implant characteristics is required for the adoption of 3D printed implants as the standard of care.
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Affiliation(s)
- Justin J Lee
- Northwestern University, Simpson Querrey Institute (SQI), 808 N Cleveland Ave. 901, Chicago, IL, 60610, USA.
| | - Freddy P Jacome
- Northwestern University, Simpson Querrey Institute (SQI), 808 N Cleveland Ave. 901, Chicago, IL, 60610, USA
| | - David M Hiltzik
- Northwestern University, Simpson Querrey Institute (SQI), 808 N Cleveland Ave. 901, Chicago, IL, 60610, USA
| | - Manasa S Pagadala
- Northwestern University, Simpson Querrey Institute (SQI), 808 N Cleveland Ave. 901, Chicago, IL, 60610, USA
| | - Wellington K Hsu
- Northwestern University, Simpson Querrey Institute (SQI), 808 N Cleveland Ave. 901, Chicago, IL, 60610, USA
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, USA
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Pairojboriboon S, Niruthisard S, Chandhanayingyong C, Monsereenusorn C, Poopan S, Lo SFL. A comparison of transforaminal lumbar interbody fusion (TLIF) cage material on fusion rates: A systematic review and network meta-analysis. World Neurosurg X 2024; 23:100392. [PMID: 38884030 PMCID: PMC11176927 DOI: 10.1016/j.wnsx.2024.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/29/2024] [Indexed: 06/18/2024] Open
Abstract
Background A wide variety of materials are used for lumbar interbody fusion, but there is no unified consensus on the superiority of one material over another. The aim of this systematic review and network meta-analysis (NMA) is to compare and rank the various TLIF interbody materials based on fusion rates. Methods We queried PubMed, EMBASE and Scopus from inception until August 2023, in which 2135 studies were identified. Inclusion criteria were applied based on the PRISMA guidelines. The fusion assessment employed the Bridwell's criteria with a length of follow-up of at least 12 months. The NMA was conducted to compare multiple approaches from multiple studies using the frequentist framework with STATA16. Results In total, 13 TLIF studies involving 1919 patients with 1981 lumbar interbody levels fulfilled our eligibility criteria. Seven different cage materials were utilized: polyetheretherketone (PEEK, as the reference), allograft, autograft, PEEK with titanium coating (TiPEEK), titanium, carbon/carbon fiber reinforced polymer (CFRP) and 3D-printed titanium. The average patient age was 60.9 (SD = 7.5) years old. When compared to PEEK, the other six materials did not have a significantly different rate of lumbar fusion. However, the SUCRA number of the 3D-printed titanium, TiPEEK, Ti, allograft, autograft, CFRP, and PEEK were 0.8, 0.6, 0.5, 0.5, 0.4, 0.4, and 0.3 consecutively. Conclusions Based on a network meta-analysis within the confines of our clinical study, 3D-printed titanium interbody cage may promote the highest success rate of fusion while PEEK may be the material with the least success rate of fusion in TLIF.
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Affiliation(s)
- Sutipat Pairojboriboon
- Department of Orthopaedic Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Supranee Niruthisard
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Chalinee Monsereenusorn
- Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Siwaporn Poopan
- Faculty of Social Sciences and Humanities, Mahidol University, Thailand
| | - Sheng-Fu Larry Lo
- Deparment of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
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Lee SB, Yoon J, Park SJ, Chae DS. Expandable Cages for Lumbar Interbody Fusion: A Narrative Review. J Clin Med 2024; 13:2889. [PMID: 38792431 PMCID: PMC11122612 DOI: 10.3390/jcm13102889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Lumbar fusion surgery for treating degenerative spinal diseases has undergone significant advancements in recent years. In addition to posterior instrumentation, anterior interbody fusion techniques have been developed along with various cages for interbody fusion. Recently, expandable cages capable of altering height, lordotic angle, and footprint within the disc space have garnered significant attention. In this manuscript, we review the current status, clinical outcomes, and future prospects of expandable cages for lumbar interbody fusion based on the existing literature. Expandable cages are suitable for minimally invasive spinal surgeries. Small-sized cages can be inserted and subsequently expanded to a larger size within the disc space. While expandable cages generally demonstrate superior clinical outcomes compared to static cages, some studies have suggested comparable or even poorer outcomes with expandable cages than static cages. Careful interpretation through additional long-term follow-ups is required to assess the utility of expandable cages. If these shortcomings are addressed and the advantages are further developed, expandable cages could become suitable surgical instruments for minimally invasive spinal surgeries.
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Affiliation(s)
- Soo-Bin Lee
- Department of Orthopedic Surgery, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Republic of Korea;
| | - Jonghun Yoon
- Department of Mechanical Engineering, Hanyang University, Ansan 15588, Republic of Korea
| | - Sung-Jun Park
- School of Mechanical, Automotive and Aeronautical Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
| | - Dong-Sik Chae
- Department of Orthopedic Surgery, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Republic of Korea;
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Donaldson C, Santro T, Awad M, Morokoff A. 3D-printed titanium alloy cage in anterior and lateral lumbar interbody fusion for degenerative lumbar spine disease. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:22-29. [PMID: 38567003 PMCID: PMC10982926 DOI: 10.21037/jss-23-120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024]
Abstract
Background The most commonly used cages for intervertebral disc replacement in lumbar fusion procedures are made predominantly from polyetheretherketone (PEEK). There is sufficient data studying their subsidence and failure rates from a variety of approaches. A novel implant is now available for commercial use, 3D-printed porous titanium (3DppTi) alloy cages, which have recently become available for use in spinal procedures. They have been shown in ovine models to have superior efficacy and fusion rates compared to traditional cages. However, there is limited data on their use in clinical practice and long-term outcomes associated with them. Methods A retrospective chart review was performed, of all patients in a single institution who underwent lumbar spine fusion surgery via an anterior or lateral approach with a 3D-printed titanium alloy cage, between January 2020 and February 2021. Clinic letters, imaging and operation reports were independently reviewed to assess for fusion, or evidence of subsidence on follow-up. Results Fifty patients were identified as meeting inclusion criteria, with a total of 66 operative levels. Of these operative levels, 32 were via an anterior approach and 34 via a lateral approach. One patient demonstrated a Marchi grade 0 subsidence, with recurrence of radiculopathy 2 months after an anterior approach, requiring posterior decompression and stabilization. A second patient demonstrated a Marchi grade 1 subsidence after a lateral approach, but did not require further surgery as they were asymptomatic at 2 years of follow-up. This study demonstrated an overall subsidence rate of 3.03%. There was a median follow-up time of 11.3 months for all patients. Conclusions 3D-printed titanium alloy cages demonstrate a lower subsidence rate compared to historically published rates for alternative intervertebral cages, in anterior and lateral lumbar spine fusion surgery.
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Affiliation(s)
- Christopher Donaldson
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
| | - Tomislav Santro
- Department of Radiology, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
| | - Mohammed Awad
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
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Duan Y, Feng D, Li T, Wang Y, Jiang L, Huang Y. Comparison of Lumbar Interbody Fusion with 3D-Printed Porous Titanium Cage Versus Polyetheretherketone Cage in Treating Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 183:144-156. [PMID: 38145654 DOI: 10.1016/j.wneu.2023.12.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To compare the safety and radiological effectiveness of lumbar interbody fusion with a 3D-printed porous titanium (3D-PPT) cage versus a polyetheretherketone (PEEK) cage for the treatment of lumbar degenerative disease. METHODS This study was registered at PROSPERO (CRD42023461511). We systematically searched the PubMed, Embase, and Web of Science databases for related studies from inception to September 3, 2023. Review Manager 5.3 was used to conduct this meta-analysis. The reoperation rate, complication rate, fusion rate, and subsidence rate were assessed using relative risk and 95% confidence intervals. RESULTS Ten articles reporting 9 studies comparing lumbar interbody fusion with 3D-PPT cages versus PEEK cages for the treatment of lumbar degenerative disease were included. The subsidence rate at the 1-year follow-up in the 3D-PPT cage was significantly lower than that in the PEEK cage. The fusion rate in the 3D-PPT cage was significantly higher than that in the PEEK cage at the 6-month follow-up. No significant difference was identified between the 2 groups at the 12-month follow-up. No significant difference was identified between the 2 groups in terms of the complication rate and reoperation rate. There was a trend toward a lower complication rate and reoperation rate with the 3D-PPT cage. CONCLUSIONS Compared with the PEEK cage, the 3D-PPT cage may be a safer implant. The 3D-PPT cage was associated with a higher fusion rate and lower subsidence rate. The 3D-PPT cage may accelerate the intervertebral fusion process, improve the quality of fusion and prevent the occurrence of subsidence.
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Affiliation(s)
- Yuchen Duan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Dagang Feng
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Tong Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yiran Wang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Leiming Jiang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
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Ryu S, Yoon SJ, Lee CK, Yi S, Kim KN, Ha Y, Shin DA. The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching. Neurospine 2023; 20:1186-1192. [PMID: 38171287 PMCID: PMC10762388 DOI: 10.14245/ns.2346702.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/05/2023] [Accepted: 08/28/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor kappa B ligand (RANKL), hinders osteoblast differentiation and function. Therefore, this study aimed to observe the combined effect of the local application of rhBMP-2 in a lumbar cage and systemic RANKL inhibition on postoperative spinal fusion in patients with bone density loss undergoing posterior lumbar interbody fusion (PLIF). METHODS This retrospective observational study included 251 consecutive patients with spinal stenosis who underwent PLIF at a single center between 2017 and 2021. Clinical outcomes were assessed, and radiographic evaluations included lumbar flexion, extension, range of motion, and subsidence. Statistical analyses were conducted to identify the combined effect of the treatment and the subsidence and spinal fusion status. RESULTS One hundred patients were included in the final analysis. Denosumab treatment significantly reduced the rate of osteolysis (p = 0.013). When denosumab was administered in combination with rhBMP-2, the fusion status remained similar; however, the incidences of postoperative osteolysis and postoperative oozing day decreased. CONCLUSION The combined use of rhBMP-2 and RANKL inhibition in patients with bone density loss can enhance bone formation after PLIF with fewer complications than rhBMP-2 alone.
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Affiliation(s)
- Seungjun Ryu
- Department of Neurosurgery, Daejeon Eulji University Hospital, School of Medicine, Eulji University, Daejeon, Korea
| | - Seon-Jin Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Kyu Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keung-Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Pholprajug P, Kotheeranurak V, Liu Y, Kim JS. The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective. Neurospine 2023; 20:1224-1245. [PMID: 38171291 PMCID: PMC10762387 DOI: 10.14245/ns.2346888.444] [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: 08/27/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
Lumbar interbody fusion stands as a preferred surgical solution for degenerative lumbar spine diseases. The procedure primarily aims to establish lumbar segment stability, directly addressing patient symptoms associated with spinal complications. Traditional open surgery, though effective, is linked with notable morbidities and extended recovery time. To mitigate these concerns, minimally invasive surgery (MIS) has garnered significant popularity, presenting an appealing alternative with numerous benefits such as reduced soft tissue trauma, decreased blood loss, and expedited recovery. Among MIS procedures, full endoscopic spinal surgery, characterized by its minimal invasiveness, holds the potential to further minimize morbidities while enhancing surgical outcomes. Endoscopic lumbar interbody fusion, a novel procedure within this paradigm, has gained attention for offering advantages comparable to those of minimally invasive transforaminal lumbar interbody fusion. However, the safety, efficacy, and associated surgical techniques and instrument design of this method continue to be subjects of ongoing debate. This paper critically reviews current evidence on the safety, efficacy, and advantages of endoscopic lumbar spinal interbody fusion, examining whether it could indeed supersede existing mainstream techniques.
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Affiliation(s)
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee S, Jung JW, Lee SW, Kim KT, Kwon HD, Lee S, Ko YS, Kim P, Cho DC. Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study. Neurospine 2023; 20:1205-1216. [PMID: 38171289 PMCID: PMC10762405 DOI: 10.14245/ns.2347032.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Although several studies have reported successful fusion rates after oblique lumbar interbody fusion (OLIF) using allografts or dimerized bone matrix (DBM) instead of autografts, whether OLIF can achieve satisfactory solid fusion without the use of autografts remains unclear. This study investigated the real fusion rates after OLIF using allografts and DBM, which were evaluated using both dynamic radiographs and computed tomography scans. METHODS We enrolled 79 consecutive patients who underwent minimally invasive OLIF followed by percutaneous pedicle screw fixation. All patients were treated with OLIF between L2 and L5 and underwent radiographic and clinical follow-ups at 12, 18, and 24 months after surgery. Radiographic assessment of fusion was performed using the modified BrantigaSteffee-Fraser (mBSF) scale, which was categorized as follows: grades I (radiographic pseudoarthrosis), II (indeterminate fusion), and III (solid radiographic fusion). Other radiologic and clinical outcomes were evaluated using the following parameters: vertebral slippage distance, disc height, subsidence, Oswestry Disability Index (ODI), and visual analogue scale (VAS). RESULTS Clinical outcomes demonstrated significant improvements in the VAS scores for back pain, leg pain, and ODI after surgery. Subsidence was present in 34 cases (35.4%) at 12 months postoperatively, which increased to 47.9% and reached 50.0% at 1.5 years and 2 years after surgery, respectively. The solid fusion rate after OLIF was 32.3% at 1 year, increased to 58.3% at 1.5 years, and reached 72.9% at 2 years. Radiographic pseudoarthrosis was 24.0% at 1 year, which decreased to 6.3% at 1.5 years and 3.1% at 2 years. CONCLUSION OLIF is a safe and effective surgical procedure for the treatment of degenerative lumbar diseases. The mBSF scale, which simultaneously evaluates both dynamic angles and bone bridge formation, offers great reliability for the radiological assessment of fusion. Moreover, OLIF using allografts and DBM, which is performed on one or 2 levels at L2-5, can achieve satisfactory fusion rates within 2 years after surgery.
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Affiliation(s)
- Sangseok Lee
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Woo Jung
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang-Woo Lee
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Heum-Dai Kwon
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young San Ko
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Pius Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Deng Z, Zou Q, Wang L, Wang L, Xiu P, Feng G, Song Y, Yang X. Comparison between Three-Dimensional Printed Titanium and PEEK Cages for Cervical and Lumbar Interbody Fusion: A Prospective Controlled Trial. Orthop Surg 2023; 15:2889-2900. [PMID: 37771127 PMCID: PMC10622287 DOI: 10.1111/os.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES The three-dimensional printing titanium (3DPT) cage with excellent biomechanical properties and osseointegration capabilities has been initially used in spinal fusion, while the polyetheretherketone (PEEK) cage, a bioinert material device, has been a widely used for decades with relatively excellent clinical outcomes. This study was performed to investigate the early radiographic and clinical outcomes of 3DPT cage versus PEEK cage in patients undergoing anterior cervical discectomy and fusion (ACDF) and transforaminal lumbar interbody fusion (TLIF). METHODS This prospective controlled trial, from December 2019 to June 2022, included patients undergoing ACDF and TLIF with 3DPT cages and compared them to patients using PEEK cages for treating spinal degenerative disorders. The outcome measures included radiographic parameters (intervertebral height [IH], subsidence, fusion status, and bone-cage interface contact) and clinical outcomes (Japanese Orthopaedic Association [JOA], Neck Disability Index [NDI], Oswestry Disability Index [ODI], Short Form 12-Item Survey [SF-12], Visual Analog Scale [VAS], and Odom's criteria). Student's independent samples t test and Pearson's chi-square test were used to compare the outcome measures between the two groups before surgery and at 1 week, 3 and 6 months after surgery. RESULTS For the patients undergoing ACDF, the 3DPT (18 patients/[26 segments]) and PEEK groups (18 patients/[26 segments]) had similar fusion rates at 3 months and 6 months follow-up (3 months: 96.2% vs. 83.3%, p = 0.182; 6 months: 100% vs. 91.7%, p = 0.225). The subsidence in the 3DPT group was significantly lower than that in the PEEK group (3 months: 0.4 ± 0.2 mm vs. 0.9 ± 0.7 mm p = 0.004; 6 months: 0.7 ± 0.3 mm vs. 1.5 ± 0.8 mm, p < 0.001). 3DPT and PEEK cage all achieved sufficient contact with the cervical endplates. For the patients undergoing TLIF, the 3DPT (20 patients/[26 segments]) and PEEK groups (20 patients/[24 segments]) had no statistical difference in fusion rate (3 months: 84.6% vs. 58.3%, p = 0.059; 6 months: 92.3% vs. 75%, p = 0.132). The subsidence was lower than that in the PEEK group without significantly difference (3 months: 0.9 ± 0.7 mm vs.1.2 ± 0.9 mm p = 0.136; 6 months: 1.6 ± 1.0 mm vs. 2.0 ± 1.0 mm, p = 0.200). At the 3-month follow-up, the bone-cage interface contact of the 3DPT cage was significantly better than that of the PEEK cage (poor contact: 15.4% vs. 75%, p < 0.001). The values of UAR were higher in the 3DPT group than in the PEEK group during the follow-up in cervical and lumbar fusion, there were more statistical differences in lumbar fusion. There were no significant differences in the clinical assessment between 3DPT or PEEK cage in spinal fusion. CONCLUSION The 3DPT cage and PEEK cage can achieve excellent clinical outcomes in cervical and lumbar fusion. The 3DPT cage has advantage in fusion quality, subsidence severity, and bone-cage interface contact than PEEK cage.
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Affiliation(s)
- Zhipeng Deng
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Qiang Zou
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Department of OrthopedicsThe First People's Hospital of Shuangliu DistrictChengduChina
| | - Lei Wang
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Liang Wang
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Peng Xiu
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Ganjun Feng
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Xi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Sultana T, Hossain M, Jeong JH, Im S. Comparative Analysis of Radiologic Outcomes Between Polyetheretherketone and Three-Dimensional-Printed Titanium Cages After Transforaminal Lumbar Interbody Fusion. World Neurosurg 2023; 179:e241-e255. [PMID: 37611804 DOI: 10.1016/j.wneu.2023.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Transforaminal lumbar interbody fusion (TLIF) is performed worldwide with polyetheretherketone (PEEK) and titanium (Ti) cages for the treatment of degenerative lumbar diseases. The aim of this study was to compare radiologic outcomes between a PEEK and three-dimensional-printed titanium (3DP-Ti) cage after TLIF with >1 year of follow-up. METHODS A total of 140 patients with degenerative lumbar diseases who underwent TLIF operation were included in this study. Intervertebral disc height and whole lumbar lordosis were measured and evaluated from the preoperative stage to the final follow-up. Subsidence of the cage was indicated if the cage sunk into the adjacent vertebral body or if there was a reduction in height of the fused segment by ≥3 mm during the postoperative follow-up. Migration of the cage was determined as the displacement of the interbody cage by ≥2 mm during the postoperative period. Fusion status was assessed at the 1 year and final follow-up using standard methods. RESULTS Both disc height and lumbar lordosis were well maintained throughout the study period, and no significant differences were observed between PEEK and 3DP-Ti groups. Both PEEK and 3DP-Ti cages demonstrated low rates of cage subsidence, with no significant difference was noted. A significant cage migration rate was observed in the PEEK group and the revision operation was required for 2 patients. The fusion rate of this study was not found to be statistically significant, although the 3DP-Ti cage was known to have an improved fusion rate than PEEK cage after lumbar interbody fusion. CONCLUSIONS Radiologic results suggest that the 3DP-Ti cage may be a better interbody cage for TLIF than is the PEEK cage.
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Affiliation(s)
- Tamima Sultana
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Mosharraf Hossain
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Soobin Im
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea.
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Lee DH, Lee DG, Park CK, Jang JW, Hwang JS, Kim JY, Cho YE, Lee SW, Lee DC, Han BS, Han SY. Saving Stabilizing Structure Treatment With Bilateral-Contralateral Decompression for Spinal Stenosis in Degenerative Spondylolisthesis Using Unilateral Biportal Endoscopy. Neurospine 2023; 20:931-939. [PMID: 37798987 PMCID: PMC10562235 DOI: 10.14245/ns.2346504.252] [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: 05/06/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the treatment of spinal stenosis with spondylolisthesis using bilateral-contralateral unilateral biportal endoscopic (UBE) decompression to minimize facet joint damage. METHODS We retrospectively evaluated 42 patients with grade 1 spondylolisthesis who underwent bilateral-contralateral UBE decompression between July 2018 and September 2019. To identify segmental instability, static and dynamic images from preoperative and postoperative procedures and final follow-up radiographs were reviewed. Lateral radiograph slippage ratio, sagittal motion, and facet joint preservation were evaluated. Clinical assessments were conducted using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. RESULTS The average final follow-up period was 26.5 ± 1.3 months. The average preoperative slip percentage was 15.70% ± 5.25%, which worsened to 18.80% ± 5.41% at the final follow-up (p < 0.005). The facet joint preservation rate was 95.6% ± 4.1% on the contralateral side. Improvements in the VAS scores (leg pain: from 7.9 ± 2.2 to 3.1 ± 0.7; p < 0.005; back pain: from 7.2 ± 3.0 to 2.8 ± 1.0; p < 0.005) were observed at the final follow-up. The mean preoperative ODI was 26.19 ± 3.42, which improved to 9.6 ± 1.0 (p < 0.005). Thirteen patients exhibited delayed focal segmental instability following decompression. Despite the absence of symptoms or improvement with conservative treatment in the majority of patients with delayed instability, two patients required fusion surgery to address the instability. Additionally, 2 patients developed facet synovial cysts, while 2 experienced spinous process fractures. CONCLUSION Bilateral decompression with a contralateral UBE approach could be an effective and alternative treatment method to reduce instability in spinal stenosis with grade 1 spondylolisthesis.
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Affiliation(s)
- Dong Hyun Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Dong-Geun Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Choon Keun Park
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jae-Won Jang
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jin Sub Hwang
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jun Yong Kim
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Sang Won Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Dong Chan Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Bang Sang Han
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Sang Yeop Han
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
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Liu Y, Suvithayasiri S, Kim JS. Commentary on "Three-Dimensional-Printed Titanium Versus Polyetheretherketone Cages for Lumbar Interbody Fusion: A Systematic Review of Comparative In Vitro, Animal, and Human Studies". Neurospine 2023; 20:464-466. [PMID: 37401064 DOI: 10.14245/ns.2346488.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Siravich Suvithayasiri
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wu PH, Lau ETC, Kim HS, Grasso G, Jang IT. Spinal Canal Remodeling and Indirect Decompression of Contralateral Foraminal Stenosis After Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion. Neurospine 2023; 20:99-109. [PMID: 37016858 PMCID: PMC10080438 DOI: 10.14245/ns.2346132.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: There is a lack of literature on indirect decompression in uniportal endoscopic posterolateral transforaminal lumbar interbody fusion (EPTLIF). Our aim is to evaluate the dimensions of the spinal canal and contralateral foramen before and after EPTLIF.Methods: This is a retrospective study of patients who underwent EPTLIF in a tertiary spine centre over a 2-year period. The cross-sectional area of the spinal canal and the contralateral foramen at the level of fusion were measured on magnetic resonance imaging scan at 1-day postoperation and at the final follow-up. Patients were grouped according to the decompression performed as per the clinician’s judgement.Results: One hundred fifty-two levels of fusion were performed in 120 patients. There was a statistically significant clinical improvement in visual analogue scale and Oswestry Disability Index scores postoperation. The measurements of the spinal canal area were 106.0 mm<sup>2</sup>, 138.8 mm<sup>2</sup>, and 195.5 mm<sup>2</sup>; while contralateral foraminal area were 73.2 mm<sup>2</sup>, 104.4 mm<sup>2</sup>, and 120.7 mm<sup>2</sup> at preoperation, 1-day postoperation, and at the final follow-up, respectively (p < 0.001). For the subgroup analyses, spinal canal area measurements for the bilateral decompression cohort (n = 35) were 57.0 mm<sup>2</sup>, 123.9 mm<sup>2</sup>, and 191.8 mm<sup>2</sup>; for the ipsilateral decompression cohort (n = 42) were 89.3 mm<sup>2</sup>, 128.9 mm<sup>2</sup>, 183.3 mm<sup>2</sup>; and for the cohort without any decompression and only cage inserted (n = 75) were 138.3 mm<sup>2</sup>, 151.2 mm<sup>2</sup>, and 204.1 mm<sup>2</sup> (p < 0.001). Contralateral foraminal area measurements were 73.3 mm<sup>2</sup>, 106.4 mm<sup>2</sup> and 120.4 mm<sup>2</sup> in the bilateral decompression cohort; 69.5 mm<sup>2</sup>, 99.0 mm<sup>2</sup>, 116.9 mm<sup>2</sup> in the ipsilateral decompression cohort; and 75.1 mm<sup>2</sup>, 106.5 mm<sup>2</sup>, 122.9 mm<sup>2</sup> in the cohort without any decompression (p < 0.001).Conclusion: Indirect decompression of both the spinal canal and the contralateral foramen can be achieved via EPTLIF. Decompression on an asymptomatic contralateral side is not necessary.
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Affiliation(s)
- Pang Hung Wu
- National University Health System, Juronghealth Campus, Department of Orthopaedic Surgery, Singapore
| | - Eugene Tze-Chun Lau
- National University Health System, Juronghealth Campus, Department of Orthopaedic Surgery, Singapore
| | - Hyeun-Sung Kim
- Neurosurgical Clinic, Department of Biomedicine, Neurosciences and Advanced Diagnostics University for Palermo, Palermo, Italy
- Corresponding Author Hyeun-Sung Kim Department of Neurosurgery, Nanoori Hospital Gangnam, 731 Eonju-ro, Gangnam-gu, Seoul 06048, Korea ,
| | - Giovanni Grasso
- Neurosurgical Clinic, Department of Biomedicine, Neurosciences and Advanced Diagnostics University for Palermo, Palermo, Italy
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Korea
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Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation. J Clin Med 2023; 12:jcm12020564. [PMID: 36675493 PMCID: PMC9861750 DOI: 10.3390/jcm12020564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
(1) Background: The choice of surgical access for 4-level degenerative cervical myelopathy (DCM) remains controversial, and the clinical and radiological outcomes of anterior surgery using a low-profile cage (Low-P) versus posterior surgery using cervical pedicle screw fixation (CPS) have not been compared. (2) Methods: This is a retrospective controlled study conducted between January 2019 and June 2021 of 72 patients with 4-level DCM who underwent ACDF using a low-profile cage (n = 39) or laminectomy and instrument fusion using CPS (n = 33). The minimum follow-up time was 12 months. The outcomes were C2−7Cobb angle, C2−7sagittal vertical axis (SVA) fusion rate, the Japanese Orthopedic Association (JOA) score, pain visual analog scale (VAS), neck disability index (NDI), and complications. (3) Results: Both anterior and posterior procedures significantly improved the patients’ quality-of-life parameters. Anterior cervical convexity and SVA significantly increased in both groups, but the SVA was greater in the posterior group than in the anterior group (p < 0.001). The C2−7 Cobb angle significantly improved in both groups postoperatively, and at the final follow-up, there was a slight but nonsignificant reduction in cervical lordosis in both groups (p = 0.567). There was a longer operative time, less intraoperative blood loss, and reduced mean hospital stay in the anterior group compared to the posterior group, with two cases of postoperative hematoma requiring a second operation, two cases of axial pain (AP), five cases of dysphagia, two cases of c5 palsy in the anterior group, and four cases of axial pain, and three cases of c5 palsy in the posterior group. According to Bridwell fusion grade, anterior fusion reached grade I in 28 cases (71.8%) and grade II in 10 cases (25.6%) in the anterior group, and posterior fusion reached grade I in 25 cases (75.8%) and grade II in 8 cases (24.2%) in the posterior group. (4) Conclusions: There was no difference between the anterior and posterior surgical approaches for MDCM in terms of improvement in neurological function. Posterior surgery using CPS achieved similar recovery of cervical anterior convexity as anterior surgery with a shorter operative time but was more invasive and had a greater increase in SVA. The use of Low-P in anterior surgery reduced the incidence of dysphagia and cage subsidence and was less invasive, but with a longer operative time.
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Concentration-Dependent Efficacy of Recombinant Human Bone Morphogenetic Protein-2 Using a HA/β-TCP Hydrogel Carrier in a Mini-Pig Vertebral Oblique Lateral Interbody Fusion Model. Int J Mol Sci 2023; 24:ijms24010892. [PMID: 36614335 PMCID: PMC9821164 DOI: 10.3390/ijms24010892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Bone morphogenetic protein-2 (BMP-2) is used in the treatment of degenerative spinal disease and vertebral fractures, spine fusion, dental surgery, and facial surgery. However, high doses are associated with side effects such as inflammation and osteophytes. In this study, we performed spinal fusion surgery on mini-pigs using BMP-2 and a HA/β-TCP hydrogel carrier, and evaluated the degree of fusion and osteophyte growth according to time and dosage. Increasing the dose of BMP-2 led to a significantly higher fusion rate than was observed in the control group, and there was no significant difference between the 8-week and 16-week samples. We also found that the HA + β-TCP hydrogel combination helped maintain the rate of BMP-2 release. In conclusion, the BMP-2-loaded HA/β-TCP hydrogel carrier used in this study overcame the drawback of potentially causing side effects when used at high concentrations by enabling the sustained release of BMP-2. This method is also highly efficient, since it provides mineral matter to accelerate the fusion rate of the spine and improve bone quality.
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