Comparison between Two Different Cervical Interbody Fusion Cages in One Level Stand-alone ACDF : Carbon Fiber Composite Frame Cage Versus Polyetheretherketone Cage

Min-Wook Yoo,김기정,Wook Ha Kim,현승재,장태안,김현집 대한척추신경외과학회 2014 Neurospine Vol.11 No.3

Objective: The authors conducted a retrospective study to compare the implantation of carbon fiber composite frame cages (CFCFCs) to the implantation of polyetheretherketone (PEEK) cages after anterior cervical discectomy for cervical degenerative disc disease. In addition, the predictive factors that influenced fusion or subsidence were investigated. Methods: A total of 58 patients with single-level degenerative disc disease were treated with anterior cervical discectomy and implantation of stand-alone cages; CFCFCs were used in 35 patients, and PEEK cages were used in 23 patients. Preoperative and postoperative radiological and clinical assessments were performed. Results: During the mean follow-up period of 41 months, fusion occurred in 43 patients (74.1%), and subsidence developed in 18 patients (31.0%). Pain decreased in all patients, and the patients’ satisfaction rate was 75.9%. Neither fusion nor subsidence was related to the clinical outcome. There were no significant differences in the clinical and radiological outcomes between the CFCFC and the PEEK cage groups. Smoking history (p=0.023) was significantly associated with pseudarthrosis, and cage height (≥7mm) (p=0.037) were significantly associated with subsidence. Conclusion: The clinical and radiological results were similar between the CFCFC and the PEEK cage groups. Fusion or subsidence did not affect the clinical outcomes. Smoking history and cage height (≥7mm) were predictive factors for pseudarthrosis or subsidence in anterior cervical discectomy and fusion with stand-alone cages.

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

Elie Massaad,Nida Fatima,Ali Kiapour,Muhamed Hadzipasic,Ganesh M. Shankar,John H. Shin 대한척추신경외과학회 2020 Neurospine Vol.17 No.1

Objective: Lumbar fusion with implantation of interbody cage is a common procedure for treatment of lumbar degenerative disease. This study aims to compare the fusion and subsidence rates of titanium (Ti) versus polyetheretherketone (PEEK) interbody cages after posterior lumbar interbody fusion and investigate the effect of clinical and radiological outcomes following fusion on patient-reported outcomes. Methods: A systematic search strategy of 4 electronic databases (MEDLINE, Embase, Web of Science, and Cochrane) was conducted using different MeSH (medical subject headings) terms until January 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using fixed and random-effect models based upon the heterogeneity (I2) to estimate the association between interbody cages and the measured outcomes. Results: A total of 1,094 patients from 11 studies were reviewed. The final analysis included 421 patients (38.5%) who had lumbar surgery using a Ti and/or a Ti-coated interbody cage and 673 patient (61.5%) who had lumbar surgery using a PEEK cage. Overall, PEEK interbody devices were associated with a significantly lower fusion rate compared with Ti interbody devices (OR, 0.62; 95% CI, 0.41–0.93; p=0.02). There was no difference in subsidence rates between Ti and PEEK groups (OR, 0.91; 95% CI, 0.54–1.52; p=0.71). Also, there were no statistically significant differences in visual analogue scale (VAS)-low back pain (p=0.14) and Japanese Orthopedic Association scale (p=0.86) between the 2 groups. However, the PEEK group had lower odds of leg pain after surgery compared to the Ti group (OR [VAS-leg], 0.61; 95% CI, 0.28–0.94; p=0.003). Conclusion: Ti and Ti-coated PEEK cages used for posterior lumbar interbody fusion are associated with similar rates of subsidence, but a higher rate of fusion compared to PEEK interbody cages. Randomized controlled trials are needed to better assess the effect of cage materials and potential factors that could influence the outcomes of interbody lumbar fusion.

Vertebral Endplate Cyst Formation in Relation to Properties of Interbody Cages

Manabu Sasaki,Masao Umegaki,Takanori Fukunaga,Yasukazu Hijikata,Yohei Banba,Katsumi Matsumoto,Yasuyoshi Miyao 대한척추신경외과학회 2021 Neurospine Vol.18 No.1

Objective: This retrospective study aimed to compare vertebral endplate cyst formation (VECF), an early predictor for pseudoarthrosis, in different types of interbody cages. Methods: We reviewed 84 cases treated with single-level posterior/transforaminal lumbar interbody fusion. We utilized a polyetheretherketone cage in 20 cases (group P), a titanium cage in 16 cases (group Ti), a titanium-coating polyetheretherketone cage in 13 cases (group TiP) and a porous tantalum cage in 35 cases (group Tn). VECF was evaluated comparing the computed tomography scans taken at day 0 and 6-month postoperation. We defined VECF (+) as enlargement of a pre-existing cyst or de novo formation of a cyst with the diameter over 2 mm. We calculated the adjusted odds ratio (OR) and 95% confidence intervals (CIs) as an indicator of association between different types of cages and VECF using a logistic regression model. Results: VECF was observed in 13 (65%), 7 (44%), 9 (69%), and 8 (23%) cases in groups P, Ti, TiP and Tn, respectively. VECF correlated with the type of cage (p=0.04). In comparison with group P, the proportion of VECF (+) cases was lower in group Tn (OR, 0.16; 95% CI, 0.04–0.60) but not different in group Ti (OR, 0.47; 95% CI, 0.10–2.20) and group TiP (OR, 1.06; 95% CI, 0.21–5.28). No patient underwent additional surgery for the fused spinal level during the follow-up periods (average, 37.9 months; range, 6–76 months). Conclusion: VECF was the least in the porous Tn cage, suggesting its potential superiority for initial stability.

Early Fusion Status after Posterior Lumbar Interbody Fusion with Cortical Bone Trajectory Screw Fixation: A Comparison of Titanium-Coated Polyetheretherketone Cages and Carbon Polyetheretherketone Cages

Hironobu Sakaura,Atsunori Ohnishi,Akira Yamagishi,Tetsuo Ohwada 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2

Study Design: Retrospective cohort study. Purpose: We recently reported that when compared to posterior lumbar interbody fusion (PLIF) using traditional pedicle screw fixation, PLIF with cortical bone trajectory screw fixation (CBT-PLIF) provided favorable clinical outcomes and reduced the incidence of symptomatic adjacent segment pathology, but resulted in relatively lower fusion rates. Since titanium-coated polyetheretherketone (PEEK) cages (TP) could improve and accelerate fusion status after CBT-PLIF, early fusion status was compared between CBT-PLIF using TP and carbon PEEK cages (CP). Overview of Literature: A systematic review demonstrated that clinical studies at this early stage show similar fusion rates for TP compared to PEEK cages. Methods: We studied 36 consecutive patients undergoing CBT-PLIF with TP (TP group) and 92 undergoing CBT-PLIF with CP (CP group). On multiplanar reconstruction computed tomography (MPR-CT) at 6 months postoperatively, vertebral endplate cysts (cyst signs) were evaluated and classified as diffuse or local cysts. Early fusion status was assessed by dynamic plain radiographs and MPR-CT at 1 year postoperatively. Results: The incidences of cyst signs, diffuse cysts, and early fusion rate in the TP and CP groups were 38.9% and 66.3% (p<0.01), 16.7% and 32.6% (p=0.07), and 83.3% and 79.3% (p>0.05), respectively. Combining the two groups, 22 of 36 patients with diffuse cysts had nonunion at 1-year follow-up, compared to only three of 92 patients with local cysts or without cyst signs (p<0.01). Conclusions: Despite having fewer patients with endplate cysts at 6 months (a known risk factor for nonunion), the TP group had the same fusion rate as the CP group at 1-year follow-up. Thus, TP did not accelerate the fusion process after CBT-PLIF.

A Prospective Randomized Clinical Trial Comparing Bone Union Rate Following Anterior Cervical Discectomy and Fusion Using a Polyetheretherketone Cage: Hydroxyapatite/ Β-Tricalcium Phosphate Mixture versus Hydroxyapatite/Demineralized Bone Matrix Mixture

이제민,이건우,남우동,한계영,김명호,강종원,원종화,김성완,노원,염진섭 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1

Study Design: Prospective randomized noninferiority trial. Purpose: To evaluate whether the union rate of anterior cervical discectomy and fusion (ACDF) using a polyetheretherketone (PEEK) cage filled with a mixture of hydroxyapatite (HA) and demineralized bone matrix (DBM) is inferior to that of a mixture of β-tricalcium phosphate (β-TCP) and HA. Overview of Literature: There have been no clinical trials investigating the outcomes of a mixture of HA and DBM in a PEEK cage in ACDF. Methods: Eighty-five eligible patients were randomly assigned to group B (n=43), in which a PEEK cage with a mixture of HA and DBM was used, or group C (n=42), in which a PEEK cage with a mixture of HA and β-TCP was used. The primary study endpoint was the fusion rate, which was assessed with dynamic radiographs and computed tomography (CT) scans. Secondary endpoints included pain intensity using a visual analogue scale, functional outcome using a neck disability index score, laboratory tests of inflammatory profiles, and the infection rate. Results: Seventy-seven patients (38 in group B and 39 in group C) were included in the final analysis. One year postoperatively, bone fusion was achieved in 87% of group B patients and 87% of group C patients on dynamic radiographs, and 87% of group B patients and 72% of group C patients on CT scans (p =1.00 and 0.16, respectively). There were also no between-groups differences with respect to the secondary endpoints. Conclusions: A HA/DBM mixture inside a PEEK cage can provide noninferior outcomes compared to a HA/TCP mixture in ACDF.

국소 자가골을 이용한 경추 전방 유합술

심대무(Dae Moo Shim),김태균(Tae Kyun Kim),오성균(Sung Kyun Oh),국승환(Seung Whan Kuk),장봉준(Bong Jun Jang),최지웅(Ji Woong Choi) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.3

목적: 유합 충전물로서 국소 자가골의 유용성을 알아보고자 하였다. 대상 및 방법: 2006년 6월에서 2009년 9월까지 퇴행성 경추 추간판 탈출증 환자 중 전방 추간판 제거술과 polyetheretherketone 케이지와 국소 자가골편을 이용한 유합술 후 5년 이상 추시한 환자 21명을 대상으로 연구를 실시하였다. 결과: Visual analogue scale 경부통/방사통 점수는 술 전 5.8/7.7점에서 술 후 1년 1.6/2.3점, 술 후 5년 1.8/2.7점이었다. Neck disability index는 술 전 34.3점에서 술 후 1년 6.25점, 술 후 5년 6.51점이었다. 평균 6.4개월에 전 예에서 골유합을 얻었으며, 추체 간격은 1년 추시 평균 6.31 mm, 5년 추시 평균 6.22 mm로 감소하였고, 케이지 종판 내 함몰은 1년 추시 평균 1.28 mm, 5년 추시 평균 1.31 mm 간격 소실을 보였다. 3 mm 이상의 케이지 종판 내 함몰은 1년 추시 1예, 5년 추시 2예에서 나타났다. 수술 후 합병증으로 나사못의 파손이 1예, 나사못 인장이 1예에서 발생하였고, 전 예에서 술 후 감염은 발생하지 않았다. 결론: 유합 충전물로 국소 자가골을 이용하는 것은 장기간의 추시에도 우수한 골유합 및 임상 증상의 호전을 나타내어 효과적인 방법이라고 생각된다. Purpose: The purpose of this study is to determine the usefulness of locally harvested autobone as a filling material for fusion. Materials and Methods: Retrospective study was conducted for 21 patients diagnosed as cervical disc herniation with cervical myelopathy or radiculopathy who underwent anterior cervical fusion using locally harvested autobone and polyetheretherketone solis cage from June 2006 to September 2009, with a follow-up period of longer than 5 years. Radiologic outcomes were evaluated by the rate of bone union, the change of intervertebral height, and the subsidence of the cage. Results: In clinical results, visual analogue scale score was 5.8±0.71/7.7±0.78 at preoperative, 1.6±0.58/2.3±0.97 at 1-year follow-up, 1.8±0.81/2.7±1.28 at 5-year follow-up, and neck disability index score was 34.3±6.2 in preoperative stage, 6.25±3.21 at 1-year follow-up, and 6.51±4.05 at 5-year follow-up. Radiologically intervertebral height was reduced from average 6.31±0.93 mm in 1-year follow-up to average 6.22±0.85 mm in 5-year follow-up. Subsidence of cage was average 1.28±0.41 mm at 1-year follow-up and average 1.31±0.43 mm at 5-year follow-up, with no statistically significant difference (p>0.05). Average subsidence of cage in these cases was 3.25 mm. In postoperative complication, screw breakage occurred in 1 case, screw pull out occurred in 1 case, and there was no postoperative infection. Conclusion: Using locally harvested autobone as filling material for fusion resulted in outstanding bone union and improvement of clinical results. In long term follow-up, there was no significant difference in union rate and complication incidence. Therefore use of locally harvested autobone as a filling material for fusion is considered an effective method.

한국인 요추형상의 해부학적 정보를 고려한 ALIF PEEK Cage 개발에 관한 연구

전창수(C. H. Chon),이재원(J. W. Lee),문종필(J. P. Moon),문영식(Y.S. Moon),고철웅(C. W. Ko),이재협(J. H. Lee),이성재(S. J. Lee),이규인(K.I. Lee) 한국정밀공학회 2009 한국정밀공학회 학술발표대회 논문집 Vol.2009 No.6월

한국인 척추형상을 고려한 PEEK Cage 개발에 관한 연구

전창수(C. H. Chon),유창훈(C. H. Yoo),문영식(Y.S. Moon),이성재(S. J. Lee),이재협(J. H. Lee),이재원(J. W. Lee),문종필(J. P. Moon),고철웅(C. W. Ko) 한국정밀공학회 2008 한국정밀공학회 학술발표대회 논문집 Vol.2008 No.11월

플라즈마 처리된 PEEK 기판 상 RF 스퍼터링에 의한 HA 박막의 형성 연구

송영식,임성철 한국표면공학회 2022 한국표면공학회 학술발표회 초록집 Vol.2022 No.6

Does Subcutaneous Infiltration of Liposomal Bupivacaine Following Single-Level Transforaminal Lumbar Interbody Fusion Surgery Improve Immediate Postoperative Pain Control?

Marko Tomov,Kevin Tou,Rose Winkel,Ross Puffer,Mohamad Bydon,Ahmad Nassr,Paul Huddleston,Michael Yaszemski,Bradford Currier,Brett Freedman 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.1

Study Design: Retrospective case-control study using prospectively collected data. Purpose: Evaluate the impact of liposomal bupivacaine (LB) on postoperative pain management and narcotic use following standardized single-level low lumbar transforaminal lumbar interbody fusion (TLIF). Overview of Literature: Poor pain control after surgery has been linked with decreased pain satisfaction and increased economic burden. Unfortunately, opioids have many limitations and side effects despite being the primary treatment of postoperative pain. LB may be a form of pre-emptive analgesia used to reduce the use of postoperative narcotics as evidence in other studies evaluating its use in single-level microdiskectomies. Methods: The infiltration of LB subcutaneously during wound closure was performed by a single surgeon beginning in July 2014 for all single-level lumbar TLIF spinal surgeries at Landstuhl Regional Medical Center. This cohort was compared against a control cohort of patients who underwent the same surgery by the same surgeon in the preceding 6 months. Statistical analysis was performed on relevant variables including: morphine equivalents of narcotic medication used (primary outcome), length of hospitalization, Visual Analog Scale pain scores, and total time spent on a patient-controlled analgesia (PCA) pump. Results: A total of 30 patients were included in this study; 16 were in the intervention cohort and 14 were in the control cohort. The morphine equivalents of intravenous narcotic use postoperatively were significantly less in the LB cohort from day of surgery to postoperative day 3. Although the differences lost their statistical significance, the trend remained for total (oral and intravenous) narcotic consumption to be lower in the LB group. The patients who received the study intervention required an acute pain service consult less frequently (62.5% in LB cohort vs. 78.6% in control cohort). The amount of time spent on a PCA pump in the LB group was 31 hours versus 47 hours in the control group (p =0.1506). Conclusions: Local infiltration of LB postoperatively to the subcutaneous tissues during closure following TLIF significantly decreased the amount of intravenous narcotic medication required by patients. Well-powered prospective studies are still needed to determine optimal dosing and confirm benefits of LB on total narcotic consumption and other measures of pain control following major spinal surgery.