Risk factors for polyetheretherketone cage subsidence following minimally invasive transforaminal lumbar interbody fusion

Singhatanadgige, Weerasak; Sukthuayat, Amnat; Tanaviriyachai, Terdpong; Kongtharvonskul, Jatupon; Tanasansomboon, Teerachat; Kerr, Stephen J.; Limthongkul, Worawat

doi:10.1007/s00701-021-04923-y

Cited by 35 publications

(34 citation statements)

References 25 publications

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“…There were 15 studies that discussed cage subsidence after LIF [ 20 , 31 , 32 , 34 , 36 , 37 , 40 , 44 , 45 , 49 – 53 , 55 ], with qualities of moderate ( n = 11) and high ( n = 4). For the 2,558 cages pooled across these studies, 705 cages had subsidence (27.6%).…”

Section: Resultsmentioning

confidence: 99%

“…For the 2,558 cages pooled across these studies, 705 cages had subsidence (27.6%). Thresholds for identification of subsidence varied between 2 and 4 mm across studies [ 20 , 31 , 34 , 37 , 40 , 49 , 51 , 53 , 55 ]. Three studies classified subsidence into four grades based on the loss of disc height after LIF (Grade 0: a loss of 0–24% in disc height; Grade I: 25–49%; Grade II: 50–74%; Grade III: 75–100%), with a loss in disc height of 24% indicative of considerable cage subsidence [ 36 , 44 , 52 ].…”

Section: Resultsmentioning

confidence: 99%

“…All included studies provided the age distribution, sixteen of them recorded sex distribution [ 25 , 32 , 34 , 38 , 41 , 42 , 44 , 47 – 50 , 52 , 53 , 55 , 56 , 81 ], seven included body mass index (BMI) [ 32 , 41 , 44 , 49 , 53 , 55 , 56 ], and three accounted for patients with osteoporosis [ 34 , 41 , 48 ]. The details are listed in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

“…Details of fusion levels were provided in 21 of the 29 included articles, describing 7,355 cages [ 20 , 25 , 31 , 32 , 34 – 39 , 41 – 43 , 45 , 47 , 49 , 51 – 53 , 55 , 56 ]. Qualities ranged from low ( n = 1), moderate ( n = 16), and high ( n = 4).…”

Section: Resultsmentioning

confidence: 99%

“…The distribution of fusion levels was as follows: L1/L2: 90 (1.2%); L2/L3, 426 (5.8%); L3/L4: 1,261 (17.1%); L4/L5: 3,852 (52.4%); and L5/S1: 1,681 (22.9%). Cage subsidence was identified in 620 cages, but the fusion level was only provided for 289 of them [ 20 , 32 , 45 , 49 , 52 , 53 , 55 ], with the following distribution: L1/L2, 2 (0.7%); L2/L3, 8 (2.8%); L3/L4, 35 (12.1%); L4/L5, 184 (63.7%); and L5/S1, 60 (20.8%). According to these seven studies, the subsidence rates for cages at distal levels (L4/L5 and L5/S1) ranged from 7.4 to 62.2%, and the total subsidence rate was 27.7%.…”

Section: Resultsmentioning

confidence: 99%

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Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Robinson

Ackland

et al. 2022

J Orthop Surg Res

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Background Lumbar interbody fusion (LIF) is an established surgical intervention for patients with leg and back pain secondary to disc herniation or degeneration. Interbody fusion involves removal of the herniated or degenerated disc and insertion of interbody devices with bone grafts into the remaining cavity. Extensive research has been conducted on operative complications such as a failure of fusion or non-union of the vertebral bodies. Multiple factors including surgical, implant, and patient factors influencing the rate of complications have been identified. Patient factors include age, sex, osteoporosis, and patient anatomy. Complications can also be influenced by the interbody cage design. The geometry of the bony endplates as well as their corresponding material properties guides the design of interbody cages, which vary considerably across patients with spinal disorders. However, studies on the effects of such variations on the rate of complications are limited. Therefore, this study aimed to perform a systematic review of lumbar endplate geometry and material property factors in LIF failure. Methods Search keywords included ‘factor/cause for spinal fusion failure/cage subsidence/cage migration/non-union’, ‘lumbar’, and ‘interbody’ in electronic databases PubMed and Scopus with no limits on year of publication. Results In total, 1341 articles were reviewed, and 29 articles were deemed suitable for inclusion. Adverse events after LIF, such as cage subsidence, cage migration, and non-union, resulted in fusion failure; hence, risk factors for adverse events after LIF, notably those associated with lumbar endplate geometry and material properties, were also associated with fusion failure. Those risk factors were associated with shape, concavity, bone mineral density and stiffness of endplate, segmental disc angle, and intervertebral disc height. Conclusions This review demonstrated that decreased contact areas between the cage and endplate, thin and weak bony endplate as well as spinal diseases such as spondylolisthesis and osteoporosis are important causes of adverse events after LIF. These findings will facilitate the selection and design of LIF cages, including customised implants based on patient endplate properties.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Robinson

Ackland

et al. 2022

J Orthop Surg Res

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Composite Scaffold Materials of Nanocerium Oxide Doped with Allograft Bone: Dual Optimization Based on Anti‐Inflammatory Properties and Promotion of Osteogenic Mineralization

Li,

Huang,

Yang

et al. 2024

Adv Healthcare Materials

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Spinal fusion technique is widely used in the treatment of lumbar degeneration, cervical instability, disc injury, and spinal deformity. However, it is usually accompanied by a high incidence of fusion failure and pseudoarthrosis, placing higher demands on bone implants. Therefore, materials with good biocompatibility, osteoconductivity, and even induce bone ingrowth, which can be used to improve spinal fusion rate and bone regeneration, have become a hot research topic. Here, ultra‐small cerium oxide nanoparticles (CeO2 NPs) are prepared and loaded onto the surface of the homograft bone surface to prepare a composite scaffold AB@PLGA/CeO2. The composite scaffold shows the competitive ability to promote osteoblast differentiation in vitro. In vivo experiments show that AB@PLGA/CeO2 has a good bone enhancement effect. In particular, good biological effects of collagen fiber formation, osteogenic mineralization, and tissue repair are shown in intervertebral implant fusion. Further, transcriptome sequencing confirms that CeO2 NPs promote osteogenic differentiation and mineralization by regulating extracellular matrix (ECM) and collagen formation. Meanwhile, CeO2 NPs can regulate the function of the PI3K‐Akt signaling pathway to exert its ability to promote osteogenic differentiation and mineralization and affect p53 and cell cycle signaling pathway to regulate osteogenic differentiation and mineralization. Hence, the proposed scaffold is a promising strategy for intervertebral fusion in the clinic.

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Research and Application of Medical Polyetheretherketone as Bone Repair Material

Zhang

et al. 2023

Macromolecular Bioscience

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Polyetheretherketone (PEEK) can potentially be used for bone repair because its elastic modulus is similar to that of human natural bone and good biocompatibility and chemical stability. However, its hydrophobicity and biological inertness limit its application in the biomedical field. Inspired by the composition, structure, and function of bone tissue, many strategies are proposed to change the structure and functionality of the PEEK surface. In this review, the applications of PEEK in bone repair and the optimization strategy for PEEK's biological activity are reviewed, which provides a direction for the development of multifunctional bone repair materials in the future.

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Risk factors for polyetheretherketone cage subsidence following minimally invasive transforaminal lumbar interbody fusion

Cited by 35 publications

References 25 publications

Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Composite Scaffold Materials of Nanocerium Oxide Doped with Allograft Bone: Dual Optimization Based on Anti‐Inflammatory Properties and Promotion of Osteogenic Mineralization

Research and Application of Medical Polyetheretherketone as Bone Repair Material

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