3D-printed titanium cages without bone graft outperform PEEK cages with autograft in an animal model

Laratta, Joseph L.; Vivace, Bradley J.; López-Peña, Mónica; Guzon, Fernando M. Muñoz; Gonzalez-Cantalpeidra, Antonio; Jorge-Mora, Alberto; Villar-Liste, Rosa Maria; Pino-Lopez, Laura; Lukyanchuk, Alexandr; Taghizadeh, Erik Arden; Pino, Jesús

doi:10.1016/j.spinee.2021.12.004

Cited by 24 publications

(18 citation statements)

References 31 publications

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“…In an in vivo ovine lumbar model, postoperative 12 week histology slides showed that the 3DPT cage exhibited greater bony growth on the porous wall surface than the PEEK cage and the fibrous tissue gaps that exist between the bone and the implant walls in the PEEK cage 32 . The same phenomena in an in vivo lumbar fusion model were reported by Laratta et al, 26 who found robust osseointegration in a 3DPT cage and negligible osseointegration with localized fibrosis in PEEK implants. The fibrous tissue on the surface of the PEEK cage could be compressed during longitudinal weight; however, the 3DPT cage could provide better support, maintaining better intervertebral height.…”

Section: Discussionsupporting

confidence: 71%

“…This severe elastic modulus mismatch leads to subsidence rates of up to 24.9%–75% in conventional titanium cages after spinal fusion 24,25 . Porous titanium alloy cages manufactured by 3D printing technology can significantly reduce the elasticity modulus to 2–4.6 GPa 17,26 . The cage applied in this study is a non‐homogeneous structure and the elastic modulus measured in our preliminary basic research was approximately 12 GPa.…”

Section: Discussionmentioning

confidence: 86%

“…24,25 Porous titanium alloy cages manufactured by 3D printing technology can significantly reduce the elasticity modulus to 2-4.6 GPa. 17, 26 The cage applied in this study is a non-homogeneous structure and the elastic modulus measured in our preliminary basic research was approximately 12 GPa. A biomechanical analysis showed that compared with the full-density samples, the titanium cage with porous features showed lower stiffness, less mismatch and smoother load transfer to the bone, therefore reducing the risk of subsidence.…”

Section: Discussionmentioning

confidence: 95%

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Comparison between Three‐Dimensional Printed Titanium and PEEK Cages for Cervical and Lumbar Interbody Fusion: A Prospective Controlled Trial

Deng,

Zou,

Wang

et al. 2023

Orthopaedic Surgery

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ObjectivesThe 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).MethodsThis 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.ResultsFor 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.ConclusionThe 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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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 95%

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Comparison between Three‐Dimensional Printed Titanium and PEEK Cages for Cervical and Lumbar Interbody Fusion: A Prospective Controlled Trial

Deng,

Zou,

Wang

et al. 2023

Orthopaedic Surgery

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“…In regards to micropores, when comparing polyetheretherketone (PEEK) interbody cages filled with autologous iliac crest bone graft with 3D-printed titanium cages printed with a porous microstructure without bone graft, the titanium cages showed significantly increased early osseointegration even in the absence of graft. 23 Further research has identified a target range for pore size for bony ingrowth, which seems to fall between 400 and 600 μm, 24–26 although this remains to be conclusively proven. There has been significant interest in triply periodic minimal surfaces (TPMS) as 3D structures with cubic symmetry result in fully interconnected porous networks with a high surface area.…”

Section: Optimizing Implant Designmentioning

confidence: 99%

Use of 3D-Printed Implants in Complex Foot and Ankle Reconstruction

Brown,

Cush,

Adams

2024

Journal of Orthopaedic Trauma

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Summary: Treatment of traumatic critical-sized bone defects remains a challenge for orthopaedic surgeons. Autograft remains the gold standard to address bone loss, but for larger defects, different strategies must be used. The use of 3D-printed implants to address lower extremity trauma and bone loss is discussed with current techniques including bone transport, Masquelet, osteomyocutaneous flaps, and massive allografts. Considerations and future directions of implant design, augmentation, and optimization of the peri-implant environment to maximize patient outcome are reviewed.

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“…Additive manufacturing is convenient for altering the shape parameters and introducing size variations; its usefulness as a means of fabricating spinal devices has been recognized [37,49]. Moreover, approximating the mechanical properties of the cage material to that of trabecular bone will be critical for suppressing bone fracture at the devise/ bone interface (cage subsidence) and stress-shielding [50].…”

Section: Future Perspectivesmentioning

confidence: 99%

Outstanding in vivo mechanical integrity of additively manufactured spinal cages with a novel “honeycomb tree structure” design via guiding bone matrix orientation

Ishimoto¹,

Kobayashi²,

Takahata³

et al. 2022

The Spine Journal

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3D-printed titanium cages without bone graft outperform PEEK cages with autograft in an animal model

Cited by 24 publications

References 31 publications

Comparison between Three‐Dimensional Printed Titanium and PEEK Cages for Cervical and Lumbar Interbody Fusion: A Prospective Controlled Trial

Comparison between Three‐Dimensional Printed Titanium and PEEK Cages for Cervical and Lumbar Interbody Fusion: A Prospective Controlled Trial

Use of 3D-Printed Implants in Complex Foot and Ankle Reconstruction

Outstanding in vivo mechanical integrity of additively manufactured spinal cages with a novel “honeycomb tree structure” design via guiding bone matrix orientation

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