Porous 3D Printed Titanium Cages in Anterior Cervical Discectomy and Fusion are Associated With Less Subsidence, Improved Maintenance of Segmental Lordotic Correction, and Similar Clinical Outcomes as Allograft

Singh, Hardeep; Kukowski, Nathan; Lunati, Matthew P.; Dawes, Alexander; Kim, Chi Heon; Kim, Sungkyu; Rhee, John M.

doi:10.1177/21925682221124527

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…27 A clinical study reported that the subsidence rates at 6 weeks, 6 months, and 12 months were 9.24%, 18.42%, and 31.82%, respectively, with mean subsidence values of 0.79 mm, 1.28 mm, and 1.80 mm, respectively, in ACDF using a 3DPT cage. 16 Another study reported that the mean subsidence after 12 months was 1.2 mm in ACDF. 5 The present study showed that the subsidence in the ACDF of 3DPT group was 0.4 AE 0.2 mm at 3 months postoperatively and 0.9 AE 0.7 mm at 6 months postoperatively, which was lower than that in these two studies.…”

Section: Discussionmentioning

confidence: 98%

“…Fusion was defined as rotation ≤4° and ≤1.25 mm translation on flexion‐extension films in Arts et al’ study. Similarly, in a retrospective study by Singh et al, a relatively low fusion rate (58.0% at 6‐month follow up) in ACDF was obtained with a 3DPT cage assessed with X‐rays 16 . This study used CT to evaluate fusion, thus enabling the visualization of the mature bony trabeculae bridging the interbody space, making the results more reliable.…”

Section: Discussionmentioning

confidence: 98%

“…Fusion was defined as rotation ≤4 and ≤1. 16 This study used CT to evaluate fusion, thus enabling the visualization of the mature bony trabeculae bridging the interbody space, making the results more reliable. Regarding the lumbar fusion rates of 3DPT cage, there were only several reports on the application of this cage.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

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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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“…Additionally, the relatively wide range of cage sizes compared to those of standard allo-bone grafts may lead to better axial load sharing and a low subsidence rate. Comparing patient groups using 3D printed cages and allografts in ACDF, 3DTC yielded similar clinical results and fusion rates to allografts but lower subsidence rates at all times [ 15 ].…”

Section: Anterior Cervical Discectomy and Fusionmentioning

confidence: 99%

Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques

2022

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For patients with cervical radiculopathy, most studies have recommended conservative treatment as the first-line treatment; however, when conventional treatment fails, surgery is considered. A better understanding of the prognosis of cervical radiculopathy is essential to provide accurate information to the patients. If the patients complain of persistent and recurrent arm pain/numbness not respond to conservative treatment, or exhibit neurologic deficits, surgery is performed using anterior or posterior approaches. Anterior cervical discectomy and fusion (ACDF) has historically been widely used and has proven to be safe and effective. To improve surgical outcomes of ACDF surgery, many studies have been conducted on types of spacers, size/height/position of cages, anterior plating, patients’ factors, surgical techniques, and so forth. Cervical disc replacement (CDR) is designed to reduce the incidence of adjacent segment disease during long-term follow-up by maintaining cervical spine motion postoperatively. Many studies on excellent indications for the CDR, proper type/size/shape/height of the implants, and surgical techniques were performed. Posterior cervical foraminotomy is a safe and effective surgical option to avoid complications associated with anterior approach and fusion surgery. Most recent literature demonstrated that all three surgical techniques for patients with cervical radiculopathy have clear advantages and disadvantages and reveal satisfactory surgical outcomes under a proper selection of patients and application of appropriate surgical methods. For this, it is important to fully understand the factors for better surgical outcomes and to adequately practice the operative techniques for patients with cervical radiculopathy.

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“…Several studies have demonstrated that applications of 3D-printed titanium cages in single-level and two-level ACDF can better facilitate interbody fusion and prevent subsidence without increased complications. Yet, based on the authors' knowledge, only a few studies have reported the applications of 3-level ACDF using 3D-printed titanium cages in treating degenerative cervical spondylosis (11,15,16,19). In this study, the clinical and radiological outcomes of patients who underwent 3-level ACDF with a 3D-printed titanium cage were evaluated.…”

mentioning

confidence: 99%

Is 3D-printed Titanium cage a reliable option for 3-level anterior cervical discectomy and fusion in treating degenerative cervical spondylosis?

Wang

Fang²,

Qu³

et al. 2023

Front. Surg.

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BackgroundTo assess the clinical and radiographical outcomes of 3-level anterior cervical discectomy and fusion (ACDF) with a 3D-printed titanium cage in treating degenerative cervical spondylosis.MethodsIn this study, 25 patients with degenerative cervical spondylosis who underwent 3-level ACDF using a 3D-printed titanium cage from March 2019 to June 2021 were retrospectively enrolled. The patient-reported outcome measures (PROMs) were evaluated by visual analog scale (VAS) for the neck (VAS-neck) and arm pain (VAS-arm), Neck Disability Index (NDI) score, Japanese Orthopedic Association (JOA) score, SF-12 concise health survey, and the Odom criteria. The radiographical parameters, including C2-C7 lordosis, segmental angle, segmental height, and subsidence, were assessed. The mean duration of follow-up was 25.6 months.ResultsBony fusion was achieved in all patients (100%). In three patients (12%) mild dysphagia was observed during the follow-up. The VAS-neck, VAS-arm, NDI score, JOA score, SF-12 score, C2-C7 lordosis, and segmental angle improved noticeably at the latest follow-up. Based on the Odom criteria, 22 patients (88%) reported satisfactory (excellent or good). The mean loss of C2-C7 lordosis and segmental angle between the immediate postoperative and the latest follow-up values were 1.6° ± 0.5° and 1.1° ± 0.5°, respectively. The mean subsidence was 0.9 ± 0.6 mm.ConclusionIn patients with multi-level degenerative cervical spondylosis, 3-level ACDF using the 3D-printed titanium cage can effectively relieve the symptoms, stabilize the spine, and restore segmental height and cervical curvature. It is proven to be a reliable option for patients with 3-level degenerative cervical spondylosis. However, a future comparative study involving a larger population and longer follow-up time may be required to further evaluate the safety, efficacy and outcomes of our preliminary results.

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Porous 3D Printed Titanium Cages in Anterior Cervical Discectomy and Fusion are Associated With Less Subsidence, Improved Maintenance of Segmental Lordotic Correction, and Similar Clinical Outcomes as Allograft

Cited by 5 publications

References 29 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

Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques

Is 3D-printed Titanium cage a reliable option for 3-level anterior cervical discectomy and fusion in treating degenerative cervical spondylosis?

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