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Published in: European Spine Journal 1/2024

22-09-2023 | Back Pain | Original Article

Clinical and radiological results of TLIF surgery with titanium-coated PEEK or uncoated PEEK cages: a prospective single-centre randomised study

Authors: P. Vanek, N. Svoboda, O. Bradac, J. Malik, R. Kaiser, D. Netuka

Published in: European Spine Journal | Issue 1/2024

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Abstract

Background

A comparison of fusion rates and clinical outcomes of instrumented transforaminal interbody fusion (TLIF) between polyetheretherketone (PEEK) and titanium-coated PEEK (Ti-PEEK) cages is not well documented.

Methods

A single-centre, prospective, randomised study included patients who underwent one-level TLIF between L3-S1 segments. Patients were randomised into one of two groups: TLIF surgery with the PEEK cage and TLIF surgery with the Ti-PEEK cage. Clinical results were measured. All patients were assessed by repeated X-rays and 3D CT scans. Cage integration was assessed using a modified Bridwell classification. The impact of obesity and smoking on fusion quality was also analysed. Patients in both groups were followed up for 2 years.

Results

Altogether 87 patients were included in the study: of these 87 patients, 81 (93.1%) completed the 2-year follow-up. A significant improvement in clinical outcome was found in the two measurements scales in both groups (RM: p = 0.257, VAS: p = 0.229). There was an increase in CobbS and CobbL angle in both groups (p = 0.172 for CobbS and p = 0.403for CobbL). Bony fusion was achieved in 37 of 40 (92.5%) patients in the TiPEEK group and 35 of 41 (85.4%) in the PEEK group (p = 0.157). Cage subsided in 2 of 40 patients (5%) in the TiPEEK group and 11 of 41 (26.8%) in the PEEK group (p = 0.007). Body mass index > 30 and smoking were not predictive factors of bony fusion achievement.

Conclusion

There is no significant advantage of TiPEEK cages over PEEK cages in clinical outcome and fusion rate 2 years after surgery.
Literature
1.
go back to reference Briggs H, Keats S (1947) Laminectomy and foraminotomy with chip fusion; operative treatment for the relief of low-back pain and sciatic pain associated with spondylolisthesis. J Bone Joint Surg Am 29:328–334PubMed Briggs H, Keats S (1947) Laminectomy and foraminotomy with chip fusion; operative treatment for the relief of low-back pain and sciatic pain associated with spondylolisthesis. J Bone Joint Surg Am 29:328–334PubMed
2.
go back to reference Agazzi S, Reverdin A, May D (1999) Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg 91:186–192PubMed Agazzi S, Reverdin A, May D (1999) Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg 91:186–192PubMed
3.
go back to reference Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study G (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: A prospective multicenter randomized study from the swedish lumbar spine study group. Spine 27:1131–1141CrossRefPubMed Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study G (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: A prospective multicenter randomized study from the swedish lumbar spine study group. Spine 27:1131–1141CrossRefPubMed
4.
go back to reference Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ (2015) Lumbar interbody fusion: Techniques, indications and comparison of interbody fusion options including plif, tlif, mi-tlif, olif/atp, llif and alif. J Spine Surg 1:2–18PubMedPubMedCentral Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ (2015) Lumbar interbody fusion: Techniques, indications and comparison of interbody fusion options including plif, tlif, mi-tlif, olif/atp, llif and alif. J Spine Surg 1:2–18PubMedPubMedCentral
5.
go back to reference Hsieh PC, Koski TR, O’Shaughnessy BA, Sugrue P, Salehi S, Ondra S et al (2007) Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 7:379–386CrossRefPubMed Hsieh PC, Koski TR, O’Shaughnessy BA, Sugrue P, Salehi S, Ondra S et al (2007) Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 7:379–386CrossRefPubMed
6.
go back to reference De Bartolo L, Morelli S, Bader A, Drioli E (2001) The influence of polymeric membrane surface free energy on cell metabolic functions. J Mater Sci Mater Med 12:959–963CrossRefPubMed De Bartolo L, Morelli S, Bader A, Drioli E (2001) The influence of polymeric membrane surface free energy on cell metabolic functions. J Mater Sci Mater Med 12:959–963CrossRefPubMed
7.
go back to reference Gittens RA, Olivares-Navarrete R, Schwartz Z, Boyan BD (2014) Implant osseointegration and the role of microroughness and nanostructures: Lessons for spine implants. Acta Biomater 10:3363–3371CrossRefPubMedPubMedCentral Gittens RA, Olivares-Navarrete R, Schwartz Z, Boyan BD (2014) Implant osseointegration and the role of microroughness and nanostructures: Lessons for spine implants. Acta Biomater 10:3363–3371CrossRefPubMedPubMedCentral
8.
go back to reference Fujibayashi S, Takemoto M, Neo M, Matsushita T, Kokubo T, Doi K et al (2011) A novel synthetic material for spinal fusion: a prospective clinical trial of porous bioactive titanium metal for lumbar interbody fusion. Eur Spine J 20:1486–1495CrossRefPubMedPubMedCentral Fujibayashi S, Takemoto M, Neo M, Matsushita T, Kokubo T, Doi K et al (2011) A novel synthetic material for spinal fusion: a prospective clinical trial of porous bioactive titanium metal for lumbar interbody fusion. Eur Spine J 20:1486–1495CrossRefPubMedPubMedCentral
9.
go back to reference Vadapalli S, Sairyo K, Goel VK, Robon M, Biyani A, Khandha A et al (2006) Biomechanical rationale for using polyetheretherketone (peek) spacers for lumbar interbody fusion-a finite element study. Spine 31:E992-998CrossRefPubMed Vadapalli S, Sairyo K, Goel VK, Robon M, Biyani A, Khandha A et al (2006) Biomechanical rationale for using polyetheretherketone (peek) spacers for lumbar interbody fusion-a finite element study. Spine 31:E992-998CrossRefPubMed
10.
go back to reference Massaad E, Fatima N, Kiapour A, Hadzipasic M, Shankar GM, Shin JH (2020) Polyetheretherketone versus titanium cages for posterior lumbar interbody fusion: meta-analysis and review of the literature. Neurospine 17:473CrossRefPubMedPubMedCentral Massaad E, Fatima N, Kiapour A, Hadzipasic M, Shankar GM, Shin JH (2020) Polyetheretherketone versus titanium cages for posterior lumbar interbody fusion: meta-analysis and review of the literature. Neurospine 17:473CrossRefPubMedPubMedCentral
11.
go back to reference Hasegawa T, Ushirozako H, Shigeto E, Ohba T, Oba H, Mukaiyama K et al (2020) The titanium-coated peek cage maintains better bone fusion with the endplate than the peek cage 6 months after plif surgery: a multicenter, prospective, randomized study. Spine 45:E892–E902CrossRefPubMed Hasegawa T, Ushirozako H, Shigeto E, Ohba T, Oba H, Mukaiyama K et al (2020) The titanium-coated peek cage maintains better bone fusion with the endplate than the peek cage 6 months after plif surgery: a multicenter, prospective, randomized study. Spine 45:E892–E902CrossRefPubMed
12.
go back to reference Schnake KJ, Fleiter N, Hoffmann C, Pingel A, Scholz M, Langheinrich A et al (2021) Plif surgery with titanium-coated peek or uncoated peek cages: a prospective randomised clinical and radiological study. Eur Spine J 30:114–121CrossRefPubMed Schnake KJ, Fleiter N, Hoffmann C, Pingel A, Scholz M, Langheinrich A et al (2021) Plif surgery with titanium-coated peek or uncoated peek cages: a prospective randomised clinical and radiological study. Eur Spine J 30:114–121CrossRefPubMed
13.
go back to reference Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine 20:1410–1418CrossRefPubMed Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine 20:1410–1418CrossRefPubMed
14.
go back to reference McAfee PC (1999) Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 81:859–880CrossRefPubMed McAfee PC (1999) Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 81:859–880CrossRefPubMed
15.
go back to reference Abbushi A, Cabraja M, Thomale UW, Woiciechowsky C, Kroppenstedt SN (2009) The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J 18:1621–1628CrossRefPubMedPubMedCentral Abbushi A, Cabraja M, Thomale UW, Woiciechowsky C, Kroppenstedt SN (2009) The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J 18:1621–1628CrossRefPubMedPubMedCentral
16.
go back to reference Phan K, Thayaparan GK, Mobbs RJ (2015) Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion–systematic review and meta-analysis. Br J Neurosurg 29:705–711CrossRefPubMed Phan K, Thayaparan GK, Mobbs RJ (2015) Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion–systematic review and meta-analysis. Br J Neurosurg 29:705–711CrossRefPubMed
17.
go back to reference Seaman S, Kerezoudis P, Bydon M, Torner JC, Hitchon PW (2017) Titanium vs. Polyetheretherketone (peek) interbody fusion: meta-analysis and review of the literature. J Clin Neurosci 44:23–29CrossRefPubMed Seaman S, Kerezoudis P, Bydon M, Torner JC, Hitchon PW (2017) Titanium vs. Polyetheretherketone (peek) interbody fusion: meta-analysis and review of the literature. J Clin Neurosci 44:23–29CrossRefPubMed
18.
19.
go back to reference de Kunder SL, van Kuijk SMJ, Rijkers K, Caelers I, van Hemert WLW, de Bie RA et al (2017) Transforaminal lumbar interbody fusion (tlif) versus posterior lumbar interbody fusion (plif) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J 17:1712–1721CrossRefPubMed de Kunder SL, van Kuijk SMJ, Rijkers K, Caelers I, van Hemert WLW, de Bie RA et al (2017) Transforaminal lumbar interbody fusion (tlif) versus posterior lumbar interbody fusion (plif) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J 17:1712–1721CrossRefPubMed
20.
go back to reference Yao YC, Chou PH, Lin HH, Wang ST, Chang MC (2023) Outcome of ti/peek versus peek cages in minimally invasive transforaminal lumbar interbody fusion. Global Spine J 13:472–478CrossRefPubMed Yao YC, Chou PH, Lin HH, Wang ST, Chang MC (2023) Outcome of ti/peek versus peek cages in minimally invasive transforaminal lumbar interbody fusion. Global Spine J 13:472–478CrossRefPubMed
21.
go back to reference Assem Y, Mobbs RJ, Pelletier MH, Phan K, Walsh WR (2017) Radiological and clinical outcomes of novel ti/peek combined spinal fusion cages: a systematic review and preclinical evaluation. Eur Spine J 26:593–605CrossRefPubMed Assem Y, Mobbs RJ, Pelletier MH, Phan K, Walsh WR (2017) Radiological and clinical outcomes of novel ti/peek combined spinal fusion cages: a systematic review and preclinical evaluation. Eur Spine J 26:593–605CrossRefPubMed
22.
go back to reference Rickert M, Fleege C, Tarhan T, Schreiner S, Makowski MR, Rauschmann M et al (2017) Transforaminal lumbar interbody fusion using polyetheretherketone oblique cages with and without a titanium coating: a randomised clinical pilot study. Bone Joint J. 99-B:1366–1372CrossRefPubMed Rickert M, Fleege C, Tarhan T, Schreiner S, Makowski MR, Rauschmann M et al (2017) Transforaminal lumbar interbody fusion using polyetheretherketone oblique cages with and without a titanium coating: a randomised clinical pilot study. Bone Joint J. 99-B:1366–1372CrossRefPubMed
23.
go back to reference Singhatanadgige W, Tangchitcharoen N, Kerr SJ, Tanasansomboon T, Yingsakmongkol W, Kotheeranurak V et al (2022) A comparison of polyetheretherketone and titanium-coated polyetheretherketone in minimally invasive transforaminal lumbar interbody fusion: a randomized clinical trial. World Neurosurg 168:e471–e479CrossRefPubMed Singhatanadgige W, Tangchitcharoen N, Kerr SJ, Tanasansomboon T, Yingsakmongkol W, Kotheeranurak V et al (2022) A comparison of polyetheretherketone and titanium-coated polyetheretherketone in minimally invasive transforaminal lumbar interbody fusion: a randomized clinical trial. World Neurosurg 168:e471–e479CrossRefPubMed
24.
go back to reference Hoy K, Li H (2018) Editorial on “ transforaminal lumbar interbody fusion using polyetheretherketone oblique cages with and without a titanium coating: a randomised clinical pilot study” . J Spine Surg 4:467–470CrossRefPubMedPubMedCentral Hoy K, Li H (2018) Editorial on “ transforaminal lumbar interbody fusion using polyetheretherketone oblique cages with and without a titanium coating: a randomised clinical pilot study” . J Spine Surg 4:467–470CrossRefPubMedPubMedCentral
25.
go back to reference Nemoto O, Asazuma T, Yato Y, Imabayashi H, Yasuoka H, Fujikawa A (2014) Comparison of fusion rates following transforaminal lumbar interbody fusion using polyetheretherketone cages or titanium cages with transpedicular instrumentation. Eur Spine J 23:2150–2155CrossRefPubMed Nemoto O, Asazuma T, Yato Y, Imabayashi H, Yasuoka H, Fujikawa A (2014) Comparison of fusion rates following transforaminal lumbar interbody fusion using polyetheretherketone cages or titanium cages with transpedicular instrumentation. Eur Spine J 23:2150–2155CrossRefPubMed
26.
go back to reference Massaad E, Fatima N, Kiapour A, Hadzipasic M, Shankar GM, Shin JH (2020) Polyetheretherketone versus titanium cages for posterior lumbar interbody fusion: meta-analysis and review of the literature. Neurospine 17:125–135CrossRefPubMedPubMedCentral Massaad E, Fatima N, Kiapour A, Hadzipasic M, Shankar GM, Shin JH (2020) Polyetheretherketone versus titanium cages for posterior lumbar interbody fusion: meta-analysis and review of the literature. Neurospine 17:125–135CrossRefPubMedPubMedCentral
27.
go back to reference Manabe H, Sakai T, Morimoto M, Tezuka F, Yamashita K, Takata Y et al (2019) Radiological outcomes of posterior lumbar interbody fusion using a titanium-coated peek cage. J Med Invest 66:119–122CrossRefPubMed Manabe H, Sakai T, Morimoto M, Tezuka F, Yamashita K, Takata Y et al (2019) Radiological outcomes of posterior lumbar interbody fusion using a titanium-coated peek cage. J Med Invest 66:119–122CrossRefPubMed
29.
go back to reference Manson NA, Green AJ, Abraham EP (2016) Elevated patient body mass index does not negatively affect self-reported outcomes of thoracolumbar surgery: results of a comparative observational study with minimum 1-year follow-up. Global Spine J 6:108–117CrossRefPubMed Manson NA, Green AJ, Abraham EP (2016) Elevated patient body mass index does not negatively affect self-reported outcomes of thoracolumbar surgery: results of a comparative observational study with minimum 1-year follow-up. Global Spine J 6:108–117CrossRefPubMed
30.
go back to reference Rihn JA, Radcliff K, Hilibrand AS, Anderson DT, Zhao W, Lurie J et al (2012) Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the spine patient outcomes research trial (sport). Spine 37:1933–1946CrossRefPubMedPubMedCentral Rihn JA, Radcliff K, Hilibrand AS, Anderson DT, Zhao W, Lurie J et al (2012) Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the spine patient outcomes research trial (sport). Spine 37:1933–1946CrossRefPubMedPubMedCentral
Metadata
Title
Clinical and radiological results of TLIF surgery with titanium-coated PEEK or uncoated PEEK cages: a prospective single-centre randomised study
Authors
P. Vanek
N. Svoboda
O. Bradac
J. Malik
R. Kaiser
D. Netuka
Publication date
22-09-2023
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 1/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-023-07947-3

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