Cofano Fabio, Armocida Daniele, Ruffini Livia, Scarlattei Maura, Baldari Giorgio, Di Perna Giuseppe, Pilloni Giulia, Zenga Francesco, Ballante Elena, Garbossa Diego, Tartara Fulvio
Neurosurgery Unit, Department of Neuroscience, University of Turin, 10124 Turin, Italy.
Spine Surgery Unit, Humanitas Gradenigo, 10153 Turin, Italy.
Diagnostics (Basel). 2022 Sep 23;12(10):2296. doi: 10.3390/diagnostics12102296.
Titanium trabecular cages (TTCs) are emerging implants designed to achieve immediate and long-term spinal fixation with early osseointegration. However, a clear radiological and clinical demonstration of their efficacy has not yet been obtained. The purpose of this study was to evaluate the reactive bone activity of adjacent plates after insertion of custom-made titanium trabecular cages for the lumbar interbody with positron emission tomography (PET)/computed tomography (CT) 18F sodium fluoride (18F-NaF). This was an observational clinical study that included patients who underwent surgery for degenerative disease with lumbar interbody fusion performed with custom-made TTCs. Data related to the metabolic-reparative reaction following the surgery and its relationship with clinical follow-up from PET/CT performed at different weeks were evaluated. PET/CTs provided reliable data, such as areas showing abnormally high increases in uptake using a volumetric region of interest (VOI) comprising the upper (UP) and lower (DOWN) limits of the cage. A total of 15 patients was selected for PET examination. Timing of PET/CTs ranged from one week to a maximum of 100 weeks after surgery. The analysis showed a negative correlation between the variables SUVmaxDOWN/time (r = -0.48, = 0.04), ratio-DOWN/time (r = -0.53, = 0.02), and ratio-MEAN/time (r = -0.5, = 0.03). Shapiro-Wilk normality tests showed significant results for the variables ratio-DOWN ( = 0.002), ratio-UP (0.013), and ratio-MEAN (0.002). 18F-NaF PET/CT has proven to be a reliable tool for investigating the metabolic-reparative reaction following implantation of TTCs, demonstrating radiologically how this type of cage can induce reparative osteoblastic activity at the level of the vertebral endplate surface. This study further confirms how electron-beam melting (EBM)-molded titanium trabecular cages represent a promising material for reducing hardware complication rates and promoting fusion.
钛小梁椎间融合器（TTCs）是一种新型植入物，旨在通过早期骨整合实现即刻和长期的脊柱固定。然而，其疗效的明确影像学和临床证据尚未获得。本研究的目的是通过正电子发射断层扫描（PET）/计算机断层扫描（CT）18F氟化钠（18F-NaF）评估定制钛小梁椎间融合器植入腰椎椎间后相邻椎间融合器的反应性骨活性。这是一项观察性临床研究，纳入了因退行性疾病接受定制TTCs腰椎椎间融合手术的患者。评估了手术后代谢修复反应的数据及其与不同周数进行的PET/CT临床随访的关系。PET/CT提供了可靠的数据，例如使用包含椎间融合器上下限的体积感兴趣区（VOI）显示摄取异常高增加的区域。总共选择了15名患者进行PET检查。PET/CT的时间范围为术后1周至多100周。分析显示变量SUVmaxDOWN/时间（r = -0.48，P = 0.04）、比值-DOWN/时间（r = -0.53，P = 0.02）和比值-平均/时间（r = -0.5，P = 0.03）之间呈负相关。Shapiro-Wilk正态性检验显示变量比值-DOWN（P = 0.002）、比值-UP（0.013）和比值-平均（0.002）有显著结果。18F-NaF PET/CT已被证明是研究TTCs植入后代谢修复反应的可靠工具，从影像学上证明了这种类型的椎间融合器如何在椎体终板表面诱导修复性成骨细胞活性。本研究进一步证实了电子束熔化（EBM）成型钛小梁椎间融合器是一种有前景的材料，可降低硬件并发症发生率并促进融合。
