Evaluation of a polyetheretherketone (PEEK) titanium composite interbody spacer in an ovine lumbar interbody fusion model: biomechanical, microcomputed tomographic, and histologic analyses

McGilvray, Kirk C.; Waldorff, Erik I.; Easley, Jeremiah T.; Seim, Howard B.; Zhang, Nianli; Linovitz, Raymond; Ryaby, James T.; Puttlitz, Christian M.

doi:10.1016/j.spinee.2017.06.034

Cited by 71 publications

(72 citation statements)

References 35 publications

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“…36 In this instance, bioactive substances, in particular microstructured Ti, have been shown to improve the biocompatibility of PEEK interbody cages and to increase the rate of bone fusion. 37 Unlike PEEK that has an elastic modulus similar to bone, Ti material has an elastic mismatch that can lead to stress shielding and bone remodeling around the implant. 38,39 In this study, there was no difference in subsidence rates between Ti and PEEK cages.…”

Section: Discussionmentioning

confidence: 99%

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

et al. 2020

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Objective: Lumbar fusion with implantation of interbody cage is a common procedure for treatment of lumbar degenerative disease. This study aims to compare the fusion and subsidence rates of titanium (Ti) versus polyetheretherketone (PEEK) interbody cages after posterior lumbar interbody fusion and investigate the effect of clinical and radiological outcomes following fusion on patient-reported outcomes. Methods: A systematic search strategy of 4 electronic databases (MEDLINE, Embase, Web of Science, and Cochrane) was conducted using different MeSH (medical subject headings) terms until January 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using fixed and random-effect models based upon the heterogeneity (I 2 ) to estimate the association between interbody cages and the measured outcomes. Results: A total of 1,094 patients from 11 studies were reviewed. The final analysis included 421 patients (38.5%) who had lumbar surgery using a Ti and/or a Ti-coated interbody cage and 673 patient (61.5%) who had lumbar surgery using a PEEK cage. Overall, PEEK interbody devices were associated with a significantly lower fusion rate compared with Ti interbody devices (OR, 0.62; 95% CI, 0.41-0.93; p = 0.02). There was no difference in subsidence rates between Ti and PEEK groups (OR, 0.91; 95% CI, 0.54-1.52; p = 0.71). Also, there were no statistically significant differences in visual analogue scale (VAS)-low back pain (p = 0.14) and Japanese Orthopedic Association scale (p = 0.86) between the 2 groups. However, the PEEK group had lower odds of leg pain after surgery compared to the Ti group (OR [VAS-leg], 0.61; 95% CI, 0.28-0.94; p = 0.003). Conclusion: Ti and Ti-coated PEEK cages used for posterior lumbar interbody fusion are associated with similar rates of subsidence, but a higher rate of fusion compared to PEEK interbody cages. Randomized controlled trials are needed to better assess the effect of cage materials and potential factors that could influence the outcomes of interbody lumbar fusion.

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Section: Discussionmentioning

confidence: 99%

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

et al. 2020

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“…Malposition and loosening of pedicle screw are main reasons of failure of internal xation. The reported rate of pedicle screw malposition is 5-41% [15][16][17]. Numerous studies have proved the in uencing factors of the pullout strength [18][19].…”

Section: Discussionmentioning

confidence: 99%

Pullout strength of adjusting pedicle screw with or without self-bone grafting in the previous trajectory using an osteoporotic human vertebral body

Liu¹,

Li²,

Gao³

et al. 2020

Preprint

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Objectives The aim of this study is to explore the pullout strength of adjusting pedicle screw with or without self-bone grafting in the previous trajectory using an osteoporotic human vertebral body. Methods Thirty vertebrae from six cadavers were collected and all of the vertebrae were divided into two groups according to bone mineral density: control group with normal bone mineral density; osteoporosis group with osteoporosis. The osteoporosis group was randomly and evenly divided into five subsamples according to direction of reinsert pedicle screw: the normal angle, sagittal angle, sagittal bone grafting, horizontal angle, horizontal bone grafting. Axial pullout strength testing of the pedicle screw was performed and the maximum axial pullout force (Fmax) was applied to analyse. Result The bone mineral density of the control group was 1.115±0.065 g/cm3, and the bone mineral density of the osteoporosis group was 0.678±0.055 g/cm3, presenting significantly different between the two group (P<0.001). Compared with the control group, the Fmax of the normal angle group was smaller (600.64±43.10 vs 1100.74±49.08 N, P<0.001). Compared with the normal angle group, the Fmax of the sagittal angle group (339.13±38.90 vs 600.64±43.10 N, P<0.001) and the horizontal angle group (342.06±33.01 vs 600.64±43.10 N, P<0.001) were smaller. The Fmax in sagittal bone grafting group was higher than that with non-implanted bone in primary screw canal (492.30±42.06 vs 342.06±33.01 N, P<0.001), and the Fmax of the horizontal bone grafting group was higher than that with non-implanted bone in primary screw canal (502.02± 50.26 vs 342.06±33.01 N, P<0.001). Conclusion The pullout strength of adjusting pedicle screw is seriously decreased in osteoporotic human vertebral body and self-bone grafting in the previous trajectory is an effective remedial measure.

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“…It was concluded that Ti-Peek inter-body devices could potentially lead to a more robust intevertebral fusion relative to a standard PEEK device (Figure 4). 19 On the other hand, we have studies which contradict to a good results of composite spacers. Predominant problem may be wear debris and delamination caused by shear loading.…”

Section: Titanium-polyetheretherketone Composite Cagesmentioning

confidence: 91%

Towards the optimum spinal fusion device

Gorenšek¹,

Jenko²,

Kocjančič³

et al. 2018

Mater. Tehnol.

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Spinal interbody fusion (spondylodesis) remains a gold standard for the treatment of instability, deformity and degenerative disease of the spine. Over the past 40 years surgical techniques and implant-device (cage) technology for spinal fusion have changed significantly. Design and materials have evolved with one common goal, to develop suitable implants that would address all three major issues of the procedure: stability, restoration of lordosis and osteointegration. Historically, two main materials have been utilized in the creation of cages: titanium (Ti) and polyetheretherketone (PEEK). The focus of spinal surgeons is constantly shifting from one material to another, because of the aggressive, commercial drive from the industry. The choice of optimal spinal interbody fusion device was always a matter of controversy. Therefore, this article aims to provide an overview of the different materials and designs from the biomechanical and also clinical aspect. A systematic review of the literature was made. The inadequate available clinical trials and lack of comparisons between different models have prevented definitive conclusions; therefore, further prospective randomized studies are necessary in the future to define one cage as a mainstay of clinical practice. Keywords: spondylodesis, cage, titanium, polyetheretherketone Zatrditev hrbteni~nega segmenta (spondilodeza) predstavlja zlati standard zdravljenja nestabilnosti, deformacij in degenerativnih bolezni hrbtenice. V zadnjih 40 letih so se kirur{ka tehnika in umetni medvreten~ni vsadki (kletke) ob~utno spremenili. Oblika in materiali so se razvijali z enim skupnim ciljem, to je odkriti vsadek, ki bi omogo~al stabilnost hrbteni~nega segmenta, vzdr`evanje lordoze ter osteointegracijo. Zgodovinsko gledano sta bila dva najpogosteje uporabljena materiala titan in polietereterketon. Dandanes med hrbteni~nimi kirurgi ostaja nesoglasje glede optimalne izbire umetnega medvreten~nega vsadka. Namen tega~lanka je predstaviti prednosti in slabosti najpogosteje uporabljenih materialov. Na podlagi aktualne strokovne literature je bila opravljena primerjava biomehanskih in klini~nih rezultatov razli~nih vsadkov. Glede na pomanjkljivost naklju~nih prospektivnih multicentri~nih {tudij ostaja izbira optimalnega umetnega hrbteni~nega vsadka {e naprej problemati~na.

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Evaluation of a polyetheretherketone (PEEK) titanium composite interbody spacer in an ovine lumbar interbody fusion model: biomechanical, microcomputed tomographic, and histologic analyses

Abstract: Overall, the results indicate that PTC interbody devices could potentially lead to a more robust intervertebral fusion relative to a standard PEEK device in a clinical setting.

Cited by 71 publications

References 35 publications

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

Pullout strength of adjusting pedicle screw with or without self-bone grafting in the previous trajectory using an osteoporotic human vertebral body

Towards the optimum spinal fusion device

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