Kashii Masafumi, Kitaguchi Kazuma, Makino Takahiro, Kaito Takashi
Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan; Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan.
J Orthop Sci. 2020 Jul;25(4):565-570. doi: 10.1016/j.jos.2019.07.004. Epub 2019 Jul 30.
Disadvantages of polyetheretherketone (PEEK) cages are their smooth and hydrophobic surfaces and their lack of osteoconductivity. Titanium (Ti) coated PEEK cage has been innovated to overcome these potential concerns. However, few well-designed studies have investigated the efficacy of Ti-coated PEEK cage on interbody fusion in humans. This study aimed to evaluate the efficacy of Ti coating on bone ongrowth at bone-implant surface by simultaneously comparing Ti-coated and uncoated PEEK cages in the same intervertebral space.
This study is a prospective comparative study for the two different cages. Twenty-six subjects who underwent one-level instrumented posterior lumbar interbody fusion (PLIF) were included. Two PEEK cages [a plasma-sprayed Ti-coated (PTC-PEEK) and an uncoated PEEK cage] were inserted in the same intervertebral space. Fusion rates, cage subsidence, and vertebral cancellous condensation (VCC) around the cage, which indicates bone growth on the surface of each cage, were assessed by thin-slice computed tomography (CT) immediately (within 1 week) and at 3 months postoperatively. A functional radiograph was obtained at 3 and 12 months postoperatively.
Twenty-three subjects showed solid fusion at 3 months postoperatively (fusion rate, 88%). Cage subsidence was not observed. VCC was often observed around the PTC-PEEK cage as evaluated by completely synchronized CT images between immediately and at 3 months postoperatively. Quantified VCC around the cage was significantly larger in the PTC-PEEK cage than in the uncoated PEEK cage (P = 0.01).
The Ti-coated PEEK cage exhibits radiographic signs, suggesting bone ongrowth, as represented by VCC around the cage compared with that around the uncoated PEEK cage. The Ti-coated PEEK cage has the potential to promote solid fusion and to improve clinical outcomes in lumbar interbody fusion surgery.
聚醚醚酮（PEEK）椎间融合器的缺点在于其表面光滑且疏水，缺乏骨传导性。为克服这些潜在问题，人们研发了钛（Ti）涂层PEEK椎间融合器。然而，很少有设计良好的研究调查Ti涂层PEEK椎间融合器在人体椎间融合中的疗效。本研究旨在通过在同一椎间隙同时比较Ti涂层和未涂层的PEEK椎间融合器，评估Ti涂层对骨植入物表面骨长入的疗效。
本研究是对两种不同椎间融合器的前瞻性对比研究。纳入26例行单节段后路腰椎椎间融合术（PLIF）的患者。在同一椎间隙植入两个PEEK椎间融合器[一个等离子喷涂Ti涂层（PTC-PEEK）和一个未涂层的PEEK椎间融合器]。分别在术后即刻（1周内）和术后3个月，通过薄层计算机断层扫描（CT）评估融合率、椎间融合器下沉情况以及椎间融合器周围的椎体松质骨凝聚（VCC），VCC表明每个椎间融合器表面的骨生长情况。在术后3个月和12个月拍摄功能位X线片。
23例患者术后3个月显示融合牢固（融合率88%）。未观察到椎间融合器下沉。通过术后即刻和术后3个月完全同步的CT图像评估，PTC-PEEK椎间融合器周围常观察到VCC。椎间融合器周围量化的VCC在PTC-PEEK椎间融合器中显著大于未涂层的PEEK椎间融合器（P = 0.01）。
与未涂层的PEEK椎间融合器相比，Ti涂层PEEK椎间融合器表现出影像学征象，提示骨长入，以椎间融合器周围的VCC为代表。Ti涂层PEEK椎间融合器在腰椎椎间融合手术中具有促进牢固融合和改善临床疗效的潜力。
