Standalone titanium/polyetheretherketone interbody cage for anterior lumbar interbody fusion: Clinical and radiological results at 24 months
Ralph J Mobbs1, Tajrian Amin1, Kevin Phan1, Darweesh Al Khawaja2, Wen Jie Choy1, William C. H. Parr3, Vedran Lovric4, William R Walsh3
1 Faculty of Medicine, University of New South Wales (UNSW), Nepean, Sydney; Surgical Orthopedic Research Lab (SORL), Prince of Wales Hospital, Randwick, Australia; NeuroSpine Surgery Research Group (NSURG), Nepean, Sydney; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Australia
2 Nepean Neurosurgery, Nepean, Sydney, Australia
3 Faculty of Medicine, University of New South Wales (UNSW), Nepean, Sydney; Surgical Orthopedic Research Lab (SORL), Prince of Wales Hospital, Randwick; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
4 Faculty of Medicine, University of New South Wales (UNSW), Nepean, Sydney; Surgical Orthopedic Research Lab (SORL), Prince of Wales Hospital, Randwick, Australia
Prince of Wales Private Hospital, 320-346 Barker Street, Randwick, NSW 2031, Australia.
Source of Support: None, Conflict of Interest: None
Context: Anterior lumbar interbody fusion (ALIF) is a common procedure for patients suffering degenerative, deformity, or posttraumatic pathologies of the lumbar spine.
Aims: The aim of this study is to evaluate the clinical and radiological outcomes of a combination Titanium/Polyetheretherketone (Ti/PEEK) 3-screw fixation ALIF cage.
Settings and Design: This was a prospective multisurgeon series of 87 patients (105 implants), with a minimum 24-month follow-up. Twelve patients (12/87) were supplemented with posterior percutaneous pedicle screw fixation for additional stability for pars defect spondylolisthesis correction. Radiological follow-up with fine-cut computed tomography (CT) scan occurred at 4–6 months, and again at 18–24 months if no fusion observed on initial CT, was performed to evaluate early and final fusion rates, and integration of the Ti/PEEK cage at the end-plate junction. Clinical follow-up included the subjective measures of pain and functional status and objective wearable device monitoring.
Results: The fusion rate was 85% (97/105 implants) 6 months postoperatively, with no implant-related complications, and 95% at 24 months, based on independent radiological assessment. Patients experienced statistically significant improvement in subjective pain and functional outcomes compared to preoperative status. The objective measures revealed a daily step count with a 27% improvement, and gait velocity with a mean increase from 0.97 m/s to 1.18 m/s, at 3 months postoperatively.
Conclusions: A Ti/PEEK cage, with allograft and bone morphogenetic protein-2 (BMP-2), achieved rapid interbody progression to fusion and is an effective implant for use in anterior lumbar surgery with high early fusion rates and no peri-endplate lucency. Supercritical CO2 allograft provided an osteoconductive scaffold and combined well with BMP-2 to facilitate fusion.