Top

MUSCULOSKELETAL SURGERY

Published in:

01-12-2019 | Original Article

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

Authors: F. Cuzzocrea, A. Ivone, E. Jannelli, A. Fioruzzi, E. Ferranti, R. Vanelli, F. Benazzo

Published in: MUSCULOSKELETAL SURGERY | Issue 3/2019

Abstract

Background

Low back pain and sciatica represent a common disabling condition with a significant impact on the social, working and economic lives of patients. Transforaminal lumbar interbody fusion (TLIF) is a surgical procedure used in degenerative spine conditions. Several types of cages were used in the TLIF procedure.

Purpose

To determine whether there is a difference in terms of symptomatology improvement, return to daily activities and fusion rate between metal cages and polyetheretherketone (PEEK) cages.

Methods

We have retrospectively reviewed 40 patients who have undergone TLIF from October 2015 to May 2016. All patients were clinically evaluated with questionnaires and were assessed with CT scan and standing X-ray films of the full-length spine.

Results

We found no significant functional differences in the two groups. At 1-year follow-up, osteolysis was present in 50% of cases of the PEEK cages and in 10% cases of the metal cages. The degree of fusion at 1 year was evaluated as complete in 40% cases of the metal cages and 15% cases of the PEEK cages.

Conclusions

We have found a better fusion rate and prevalence of fusion in the group treated with metal cages, reflecting the well-known osteoinductive properties of titanium and tantalum.

Buchbinder R, Underwood M (2012) Prognosis in people with back pain. Can Med Assoc J 184(11):1229–1230. https://doi.org/10.1503/cmaj.120627 CrossRef

Wigfield CC, Nelson RJ (2001) Nonautologous interbody fusion materials in cervical spine surgery: how strong is the evidence to justify their use? Spine (Phila Pa 1976) 26(6):687–694CrossRef

McKenna PJ, Freeman BJC, Mulholland RC, Grevitt MP, Webb JK, Mehdian SH (2005) A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results. Eur Spine J 14(8):727–737. https://doi.org/10.1007/s00586-005-1034-z CrossRefPubMedPubMedCentral

Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM (2000) Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine (Phila Pa 1976) 25(11):1437–1446CrossRef

Cutler AR, Siddiqui S, Mohan AL, Hillard VH, Cerabona F, Das K (2006) Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg Spine 5(6):534–539. https://doi.org/10.3171/spi.2006.5.6.534 CrossRefPubMed

Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S (2012) Anterior cervical discectomy, and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 13(1):172. https://doi.org/10.1186/1471-2474-13-172 CrossRefPubMedPubMedCentral

Chou Y-C, Chen D-C, Hsieh WA et al (2008) Efficacy of anterior cervical fusion: comparison of titanium cages, polyetheretherketone (PEEK) cages, and autogenous bone grafts. J Clin Neurosci 15(11):1240–1245. https://doi.org/10.1016/j.jocn.2007.05.016 CrossRefPubMed

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(10):2150–2155. https://doi.org/10.1007/s00586-014-3466-9 CrossRefPubMed

Christensen FB, Laursen M, Gelineck J, Eiskjaer SP, Thomsen K, Bünger CE (2001) Interobserver and intraobserver agreement of radiograph interpretation with and without pedicle screw implants: the need for a detailed classification system in posterolateral spinal fusion. Spine (Phila Pa 1976) 26(5):538–543CrossRef

10.

Knox CJB, Dai CJM, Orchowski LJ (2011) Osteolysis in transforaminal lumbar interbody fusion with bone morphogenetic protein-2. Spine (Phila Pa 1976) 36(8):672–676. https://doi.org/10.1097/brs.0b013e3181e030e0 CrossRef

11.

Medici A, Meccariello L, Falzarano G (2014) Non-operative vs. percutaneous stabilization in Magerl’s A1 or A2 thoracolumbar spine fracture in adults: is it really advantageous for a good alignment of the spine? Preliminary data from a prospective study. Eur Spine J 23(Suppl 6):677–683. https://doi.org/10.1007/s00586-014-3557-7 CrossRefPubMed

12.

Meccariello L, Muzii VF, Falzarano G, Medici A, Carta S, Fortina M, Ferrata P (2017) Dynamic corset versus three-point brace in the treatment of osteoporotic compression fractures of the thoracic and lumbar spine: a prospective, comparative study. Aging Clin Exp Res 29(3):443–449. https://doi.org/10.1007/s40520-016-0602-x CrossRefPubMed

13.

Vadapalli S, Sairyo K, Goel VK et al (2006) Biomechanical rationale for using polyetheretherketone (PEEK) spacers for lumbar interbody fusion-A finite element study. Spine (Phila Pa 1976) 31(26):E992–E998. https://doi.org/10.1097/01.brs.0000250177.84168.ba CrossRef

14.

Wu S-H, Li Y, Zhang Y-Q et al (2013) Porous titanium-6 aluminum-4 vanadium cage has better osseointegration and less micromotion than a poly-ether-ether-ketone cage in sheep vertebral fusion. Artif Organs 37(12):E191–E201. https://doi.org/10.1111/aor.12153 CrossRefPubMed

15.

Schimmel JJP, Poeschmann MS, Horsting PP, Schönfeld DHW, van Limbeek J, Pavlov PW (2016) PEEK cages in lumbar fusion: mid-term clinical outcome and radiological fusion. J Spinal Disord Technol. https://doi.org/10.1097/bsd.0b013e31826eaf74 CrossRef

16.

Olivares-Navarrete R, Gittens RA, Schneider JM et al (2012) Osteoblasts exhibited a more differentiated phenotype and increased bone morphogenetic protein production on titanium alloy substrates than on poly-ether-ether-ketone. Spine J 12(3):265–272. https://doi.org/10.1016/j.spinee.2012.02.002 CrossRefPubMedPubMedCentral

17.

Cortesi PA, Assietti R, Cuzzocrea F et al (2017) Epidemiologic and economic burden attributable to first spinal fusion surgery. Spine (Phila Pa 1976). https://doi.org/10.1097/brs.0000000000002118 CrossRef

Title: PEEK versus metal cages in posterior lumbar interbody fusion: a clinical and radiological comparative study
Authors: F. Cuzzocrea
A. Ivone
E. Jannelli
A. Fioruzzi
E. Ferranti
R. Vanelli
F. Benazzo
Publication date: 01-12-2019
Publisher: Springer Milan
Published in: MUSCULOSKELETAL SURGERY / Issue 3/2019
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI: https://doi.org/10.1007/s12306-018-0580-6

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2019

Letter to the editor regarding: Intrawound application of vancomycin changes the responsible germ in elective spine surgery without significant effect on the rate of infection: a randomized prospective study

Bilateral unicompartmental knee arthroplasty: one stage or two stages?

Long-term deterioration after one-stage unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction

The clinical outcome of chondrolabral-preserving arthroscopic acetabuloplasty for pincer- or mixed-type femoroacetabular impingement: A systematic review

Single-stage anterior debridement, posterior instrumentation and global fusion in thoracic and thoracolumbar tubercular spondylodiscitis

Systematic review of the outcome of cemented versus uncemented total hip arthroplasty following pelvic irradiation