Outcome of Ti/PEEK Versus PEEK Cages in Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract

Study Design: Retrospective case-control study. Objectives: This study aims to present the clinical and radiographical outcomes of the titanium-polyetheretherketone (Ti/PEEK) composite cage compared to those of the standard PEEK cage in patients receiving minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Methods: Patients receiving 1 level MI-TLIF between October 2015 and October 2017 were included with a minimum of 2-year follow-up. The patients were segregated into 2 groups; Ti/PEEK group and PEEK group. Each patient was propensity-matched using preoperative age, sex, and body mass index. Early fusion rate was evaluated by computed tomography at postoperative 6 months. Clinical outcomes were assessed using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Results: After matching, there were 27 patients included in each group. The demographics, diagnosis, and surgical details were not significantly different between the 2 groups. The 6-month rate was 88.9% in Ti/PEEK group. The fusion rate and cage subsidence rate had no difference between the 2 groups. The complication rate in the Ti/PEEK group was comparable to that in the PEEK group. There was no difference in VAS and ODI scores during a 2-year follow-up period. Conclusions: The use of Ti/PEEK composite cage was as safe and effective as the use of PEEK cage in MI-TLIF. The 6-month fusion rate was 88.9%. Our finding revealed comparable clinical results for surgeons using Ti/PEEK composite cages in MI-TLIF compared to those using the PEEK cage.

Comparison of Long‐term Follow‐Up of n‐HA PA66 Cage and PEEK Cage of Lumbar Interbody Fusion in Multi‐level Degenerative Lumbar Diseases: A Stepwise Propensity Score Matching Analysis

“…Commonly used intervertebral fusion cage materials in clinical practice include PEEK, titanium alloy and absorbable polymer materials 12,13 . The PEEK cage is the most widely used fusion material in orthopedic clinics and has achieved a certain curative effect due to its good biocompatibility and biomechanical features 7,14,15,20 . Nevertheless, the PEEK cage use may be incremental to the risk of postoperative nonunion, cage subsidence and ASD during long‐term follow‐up.…”

“…12,13 The PEEK cage is the most widely used fusion material in orthopedic clinics and has achieved a certain curative effect due to its good biocompatibility and biomechanical features. 7,14,15,20 Nevertheless, the PEEK cage use may be incremental to the risk of postoperative nonunion, cage subsidence and ASD during longterm follow-up. The main reasons are related to the low fusion efficacy of PEEK due to its smooth surface, high biological inertness, and inability to provide an environment for osteoblast adhesion.…”

“…12,13 Known for its impressive fracture toughness and resistance to heat, PEEK is a synthetic thermoplastic polymer. 14,15 In contrast, the PEEK cage has similar elastic modulus to natural bone, as well as transmission properties, strength, stiffness, and good biocompatibility, which can compensate the shortcomings of autogenous iliac bone and titanium cages. 16 Therefore, PEEK is currently the preferred clinical material for interbody fusion cage.…”

“…Titanium mesh cages are limited by their radiographic opacity and by the stress shielding effect due to its much higher elastic modulus compared with even cortical bone 12,13 . Known for its impressive fracture toughness and resistance to heat, PEEK is a synthetic thermoplastic polymer 14,15 . In contrast, the PEEK cage has similar elastic modulus to natural bone, as well as transmission properties, strength, stiffness, and good biocompatibility, which can compensate the shortcomings of autogenous iliac bone and titanium cages 16 .…”

Biomechanical analysis of customized cage conforming to the endplate morphology in anterior cervical discectomy fusion: A finite element analysis

“…Optimizing intervertebral fusion devices by changing their material properties and constructing for microporosity are favorable research directions. The advent of the cage in materials like titanium and poly-ether-ether-ketone (PEEK) has gradually replaced autologous bone grafts and become mainstream, owing to the better stability and biocompatibility of titanium alloys; the elastic modulus of PEEK is close to that of cortical bone [ 10 , 11 ]. Wang et al [ 12 ] performed local topological optimization of the unit lattice to obtain a lattice structure filled into the lumbar fusion for microporous fusion, which reduced the weight and showed a more uniform stress distribution.…”