Follow-up of a new titanium-coated polyetheretherketone cage for the cervical spine

Arregui, R. ; Aso, J. ; Martínez Quiñones, J.V. ; Sebastián, C. ; Consolini, F. ; Aso Vizan, A. (Universidad de Zaragoza)

Resumen: Poly-ether-ether-ketone (PEEK) cages have lower modulus of elasticity when compared with Titanium (TTN) cages. This suggests that PEEK-cages could show a lower rate of subsidence after anterior cervical discectomy-fusion (ACDF) and might lead to a lower loss of correction. We investigated the one to five year-results of standalone PEEK-TTN-porous coated cages in a patient cohort from 2014 to 2017. The patients underwent single-level ACDF for disc herniation and degenerative discopathy. Clinical and radiological outcome were assessed in 50 eligible patients after a mean of 27 months. Results: Solid arthrodesis was found in 84%. Neck disability index (NDI), and visual analogue scale (VAS) of neck and arm show comparable results to the literature. Conclusions: Clinical and radiological outcomes of ACDF with PEEK-body-cages with a porous coated surface show good bony integration. The modulus of elasticity, design, shape, size, cage surface architecture, as well as bone density, endplate preparation, radical microdiscectomy and distraction during surgery should be considered as important factors influencing the clinical results. One main advantage, over titanium cages, is the absence of MRI artifacts, allowing an excellent postoperative follow-up. inferior clinical outcome compared with bone grafts due to a higher elasticity modulus, which could result in cage subsidence.8 Nevertheless, due to structural properties, TTN implants are likely to provide a good osseo-integration9 and several clinical studies demonstrate successful results after implantation of TTN-cages.10-13 PEEKcages have a modulus of elasticity closely resembling that of cortical bone, which might lead to advantages in load sharing and stress distribution. This might reduce the subsidence rate with an improved segmental correction in the long term and a potentially higher fusion rate.14-16 A direct comparison of cervical TTNand PEEKcages in a clinical setting is very rarely found in the literature, 16, 17 and even less studies consequently compare the radiological results.16, 17 The latter studies showed the PEEK-implants being superior in maintaining cervical interspace height and achieving radiographic fusion, 16, 17 even suggesting to cease the application of TTN-cages in cervical spine surgery.16 A solution in-between are newer cages that combine the benefit of both materials: PEEK-body cages plasma-sprayed with a porous titanium surface which is tightly bonded to the PEEK surface.18, 19 On TTN alloy substrates, osteoblasts exhibit a more differentiated phenotype and increased bone morphogenetic protein production than on poly-ether-ether-ketone.20 A group of Japanese surgeons found that TTN-coated PEEK cages exhibit radiographic signs of bone on-growth, as represented by vertebral cancellous condensation around the cage, compared with that around the uncoated PEEK cage.21 Therefore, a TTN-coated PEEK cage may have the potential to promote solid fusion and to improve clinical outcomes in cervical interbody fusion surgery. This keeps the ideal elasticity modulus close to a bonelike elasticity modulus and offers a highly biocompatible surface that is well tolerated by bone and allows its ongrowth to the porous surface. The aim of the present study is to assess clinical and radiological results of CeSpace XP®, a titanium-coated PEEK cage.

Idioma: Inglés

DOI: 10.4081/or.2020.8359

Año: 2020

Publicado en: Orthopedic Reviews 12, 1 (2020), 8359 [7 pp]
ISSN: 2035-8237

Factor impacto SCIMAGO: 0.411 - Orthopedics and Sports Medicine (Q3)

Tipo y forma: Article (Published version)

Área (Departamento): Área Traumatología y Ortopedia (Dpto. Cirugía)