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. 2022 Jan-Mar;13(1):42-47.
doi: 10.4103/jcvjs.jcvjs_133_21. Epub 2022 Mar 9.

Standalone titanium/polyetheretherketone interbody cage for anterior lumbar interbody fusion: Clinical and radiological results at 24 months

Ralph J Mobbs  1   2   3   4 , Tajrian Amin  1   2   3   4 , Kevin Phan  1   2   3   4 , Darweesh Al Khawaja  5 , Wen Jie Choy  1   2   3   4 , William C H Parr  1   2   3 , Vedran Lovric  1   2 , William R Walsh  1   2   3
Affiliations

Standalone titanium/polyetheretherketone interbody cage for anterior lumbar interbody fusion: Clinical and radiological results at 24 months

Ralph J Mobbs et al. J Craniovertebr Junction Spine. 2022 Jan-Mar.

Abstract

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.

Keywords: Anterior lumbar interbody fusion; bone morphogenetic protein-2; integral fixation; polyetheretherketone; supercritical CO2 allograft; titanium.

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Conflict of interest statement

Prof Ralph J. Mobbs is a research and design consultant for A-Spine ASIA. Prof William R. Walsh is a research and design consultant for SeaSpine, USA. Dr William C.H. Parr is founder and director of 3DMorphic Pty Ltd, Sydney, Australia. None of the other authors have any relevant conflicts of interest to declare.

Figures

Figure 1
Figure 1
Titanium/polyetheretherketone Integral fixation 3-screw Anterior Lumbar Interbody Fusion Implant. Porous titanium endplates with Polyetheretherketone forming the body of the implant. ×3 screw integral fixation.(Redmond-L Implant, A-Spine ASIA, Taiwan)
Figure 2
Figure 2
L4/5 Anterior Lumbar Interbody Fusion. (a) Severe degenerative disc disease following multiple microdiscectomy procedures with progressive disc height loss, foraminal stenosis with symptoms of discogenic low back pain and L4 radiculopathy. (b) Preoperative lateral X-ray. (c) L4/5 Anterior Lumbar Interbody Fusion with Titanium/Polyetheretherketone device.(Insert) Intraoperative trial prosthesis
Figure 3
Figure 3
Anterior Lumbar Interbody Fusion with Percutaneous Pedicle Screw Fixation. (a) Intraoperative level check. (b) Trial prosthesis to confirm position and restoration of foraminal volume. (c) Percutaneous fixation to assist with posterior tension band
Figure 4
Figure 4
L4/5 Anterior Lumbar Interbody Fusion. Solid fusion at 6-month postoperative using Allograft and Fibermatt Demineralized-Bone-Matrix graft. (a) Day-1 Postop computer tomography. (b) 6-month Postop Computer Tomography with osseointegration through and behind implant. No halo/lucency at Titanium/bone junction; consistent with Ttanium incorporation into bony endplate. No subsidence
Figure 5
Figure 5
Stand alone Anterior Lumbar Interbody Fusion for Isthmic Spondylolisthesis. (a) Standing X-ray. Degenerative Disc Disease with low-grade spondylolisthesis and pars defect. Insert. Discovertebral uptake on bone scan. (b) 6-month postoperative X-ray and (Insert) computer tomography demonstrating restored disc height, evidence of early graft integration and no subsidence or lucency
See this image and copyright information in PMC

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