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

Ralph J Mobbs; Tajrian Amin; Kevin Phan; Darweesh Al Khawaja; Wen Jie Choy; William C H Parr; Vedran Lovric; William R Walsh

doi:10.4103/jcvjs.jcvjs_133_21

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

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

Authors

Ralph J Mobbs^{1

2

3

4}, Tajrian Amin^{1

2

3

4}, Kevin Phan^{1

2

3

4}, Darweesh Al Khawaja⁵, 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

¹ Faculty of Medicine, University of New South Wales (UNSW), Nepean, Sydney.
² Surgical Orthopedic Research Lab (SORL), Prince of Wales Hospital, Randwick, Australia.
³ NeuroSpine Surgery Research Group (NSURG), Randwick, Australia.
⁴ NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Australia.
⁵ Nepean Neurosurgery, Nepean, Sydney.

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.