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

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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.

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References

  1. 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 29:328–334

    CAS  PubMed  Google Scholar 

  2. Agazzi S, Reverdin A, May D (1999) Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg 91:186–192

    CAS  PubMed  Google Scholar 

  3. 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 27:1131–1141

    Article  PubMed  Google Scholar 

  4. 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 1:2–18

    PubMed  PubMed Central  Google Scholar 

  5. 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 7:379–386

    Article  PubMed  Google Scholar 

  6. 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 12:959–963

    Article  PubMed  Google Scholar 

  7. 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 10:3363–3371

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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 20:1486–1495

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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:E992-998

    Article  PubMed  Google Scholar 

  10. 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 17:473

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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–E902

    Article  PubMed  Google Scholar 

  12. 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 30:114–121

    Article  PubMed  Google Scholar 

  13. 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 20:1410–1418

    Article  CAS  PubMed  Google Scholar 

  14. McAfee PC (1999) Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 81:859–880

    Article  CAS  PubMed  Google Scholar 

  15. 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 18:1621–1628

    Article  PubMed  PubMed Central  Google Scholar 

  16. Phan K, Thayaparan GK, Mobbs RJ (2015) Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion–systematic review and meta-analysis. Br J Neurosurg 29:705–711

    Article  PubMed  Google Scholar 

  17. 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 44:23–29

    Article  CAS  PubMed  Google Scholar 

  18. Yan DL, Pei FX, Li J, Soo CL (2008) Comparative study of pilf and tlif treatment in adult degenerative spondylolisthesis. Eur Spine J 17:1311–1316

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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 17:1712–1721

    Article  PubMed  Google Scholar 

  20. 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 13:472–478

    Article  PubMed  Google Scholar 

  21. 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 26:593–605

    Article  PubMed  Google Scholar 

  22. 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:1366–1372

    Article  CAS  PubMed  Google Scholar 

  23. 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–e479

    Article  PubMed  Google Scholar 

  24. 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 4:467–470

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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 23:2150–2155

    Article  PubMed  Google Scholar 

  26. 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 17:125–135

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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 66:119–122

    Article  PubMed  Google Scholar 

  28. Berman D, Oren JH, Bendo J, Spivak J (2017) The effect of smoking on spinal fusion. Int J Spine Surg 11:29

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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 6:108–117

    Article  PubMed  Google Scholar 

  30. 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 37:1933–1946

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Funding was provided by Ministry of Defence and Armed Forces of Czech Republic (Grant Number MO 1012).

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Authors and Affiliations

  1. Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenskénemocnice 1200/2, 16000, Prague 6, Czech Republic

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

Authors
  1. P. Vanek
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  2. N. Svoboda
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  3. O. Bradac
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  4. J. Malik
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  5. R. Kaiser
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  6. D. Netuka
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Corresponding author

Correspondence to N. Svoboda.

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Conflict of interest

The study was supported by grant MO1012.

Ethical approval

The study was performed in accordance with the Helsinki Declaration of 1975 (as revised in 2004 and 2008). Ethics approval was obtained from local institutional review board. All patients provided written informed consent.

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Vanek, P., Svoboda, N., Bradac, O. et al. Clinical and radiological results of TLIF surgery with titanium-coated PEEK or uncoated PEEK cages: a prospective single-centre randomised study. Eur Spine J 33, 332–338 (2024). https://doi.org/10.1007/s00586-023-07947-3

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  • DOI: https://doi.org/10.1007/s00586-023-07947-3

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