The in vitro stabilising effect of polyetheretherketone cages versus a titanium cage of similar design for anterior lumbar interbody fusion

Spruit, Maarten; Falk, R.; Beckmann, Lisa; Steffen, Thomas; Castelein, René M.

doi:10.1007/s00586-005-0961-z

Cited by 45 publications

(16 citation statements)

References 39 publications

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“…However, there are several studies on interbody fusion that have demonstrated contradictory results regarding the superiority of PEEK over titanium as the cage material 18,19) . PEEK cage teeth are reported to be less sharp than those of titanium cages 20) . PEEK implants also tend to have a fibrous connective tissue surface interface, probably due to reduced osteoblastic differentiation of progenitor cells and production of an inflammatory environment that favors cell death via apoptosis and necrosis 21) .…”

Section: Discussionmentioning

confidence: 96%

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Satake

Kanemura

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Introduction: Few studies have investigated the influence of cage subsidence patterns (intraoperative endplate injury or late-onset cage settling) on bony fusion and clinical outcomes in lateral interbody fusion (LIF). This retrospective study was performed to compare the fusion rate and clinical outcomes of cage subsidence patterns in LIF at one year after surgery.Methods: Participants included 93 patients (aged 69.0±0.8 years; 184 segments) who underwent LIF with bilateral pedicle screw fixation. All segments were evaluated by computed tomography and classified into three groups: Segment E (intraoperative endplate injury, identified immediately postoperatively); Segment S (late-onset settling, identified at 3 months or later); or Segment N (no subsidence). We compared patient characteristics, surgical parameters and fusion status at 1 year for the three subsidence groups. Patients were classified into four groups: Group E (at least one Segment E), Group S (at least one Segment S), Group ES (both Segments E and S), or Group N (Segment N alone). Visual analog scales (VASs) and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared for the four patient groups.Results: 184 segments were classified: 31 as Segment E (16.8%), 21 as Segment S (11.4%), and 132 as Segment N (71.7%). Segment E demonstrated significantly lower bone mineral density (-1.7 SD of T-score, p=0.003). Segment S demonstrated a significantly higher rate of polyetheretherketone (PEEK) cages (100%, p=0.03) and a significantly lower fusion rate (23.8%, p=0.01). There were no significant differences in VAS or in any of the JOABPEQ domains among the four patient groups.Conclusions: Intraoperative endplate injury was significantly related to bone quality, and late-onset settling was related to PEEK cages. Late-onset settling demonstrated a worse fusion rate. However, there were no significant differences in clinical outcomes among the subsidence patterns.

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Section: Discussionmentioning

confidence: 96%

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Satake

Kanemura

Nakashima

et al. 2017

Spine Surg Relat Res

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“…Although many papers describe the use of CFR-PEEK for spine implants, the majority of implants involve the use of neat PEEK for both cervical and lumbar spinal cages [11,[140][141][142][143][144][145][146][147]. Because the use of neat PEEK for spine is a relatively recent development, the published literature is generally limited to in vitro biomechanical studies [145][146][147], or shortterm outcomes in animal studies or human clinical trials [11,[140][141][142][143].…”

Section: Spinal Implantsmentioning

confidence: 99%

“…Because the use of neat PEEK for spine is a relatively recent development, the published literature is generally limited to in vitro biomechanical studies [145][146][147], or shortterm outcomes in animal studies or human clinical trials [11,[140][141][142][143]. Recent studies with PEEK cages have looked to improve or accelerate fusion performance by combining the devices with the use of hydroxylapatite [143], 40% β-tricalcium phosphate/60% hydroxylapatite [141], or rhBMP-2 on a collagen sponge [11].…”

Section: Spinal Implantsmentioning

confidence: 99%

PEEK biomaterials in trauma, orthopedic, and spinal implants

Kurtz

Devine²

2007

Biomaterials

2,020

1,518

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Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature.

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“…Metal cages showed good fusion rates [4,5]; however, three problems have been associated with their use. These are subsidence of the cage into the adjacent vertebrae, difficulties in assessing fusion by imaging, and stiffness of the material that reduces the amount of mechanical stimulation to the bone grafts, which might delay the fusion or shielding of the bone graft [6][7][8][9][10][11]. To overcome these shortcomings, polyetheretherketone (PEEK) cages have been introduced.…”

Section: Introductionmentioning

confidence: 99%

Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion

et al. 2020

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Study Design: A retrospective radiographic analysis.Purpose: The aim of the current study is to assess endplate changes after the use of polyetheretherketone (PEEK) cages in posterior lumbar interbody fusion (PLIF).Overview of Literature: A few recent reports had revealed endplate abnormalities due to PEEK cages, which may lead to nonunions.Methods: A retrospective computed tomography (CT)-based analysis of the endplate cavities and fusion status following PLIFs with PEEK cages was conducted by two independent observers. The term “cavity” was used to describe the endplate changes. The vertebral endplate cavities were assessed according to the size, multiplicity, location, and presence or absence of sclerosis.Results: There were 86 fixed levels in 65 consecutive patients, with a mean age of 35.44±19.60 years. The mean follow-up was 16.5±10.1 months (range, 6–57 months). Definite fusion was seen in 56 levels (65.12%) by observer 1 versus 44 levels (51.16) by observer 2. The strength of agreement was moderate. Endplate cavities were observed in 42 levels (48.84%) by observer 1 versus 47 levels (54.65%) by observer 2, with fair agreement. The strengths of agreement for the locations, multiplicity, and size were moderate, fair, and poor, respectively. Neither age, sex, etiology, levels, nor follow-up period was significantly associated with the presence of cavities. With regard to fusions, the nonunions detected by observer 1 were significantly associated with the presence of cavities (p<0.0001). However, those detected by observer 2 were nearly significant (p=0.05).Conclusions: There was a high rate of unfavorable radiographic findings in the form of endplate cavities in PLIF cases with PEEK cages. A more comprehensive classification for the assessment of fusions and endplate cavities should be formulated. We strongly recommend further CT-based studies with larger sample size and longer follow-up periods.

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The in vitro stabilising effect of polyetheretherketone cages versus a titanium cage of similar design for anterior lumbar interbody fusion

Cited by 45 publications

References 39 publications

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

PEEK biomaterials in trauma, orthopedic, and spinal implants

Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion

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