Donaldson Christopher, Santro Tomislav, Awad Mohammed, Morokoff Andrew
Department of Neurosurgery, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia.
Department of Radiology, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia.
J Spine Surg. 2024 Mar 20;10(1):22-29. doi: 10.21037/jss-23-120. Epub 2024 Mar 14.
The most commonly used cages for intervertebral disc replacement in lumbar fusion procedures are made predominantly from polyetheretherketone (PEEK). There is sufficient data studying their subsidence and failure rates from a variety of approaches. A novel implant is now available for commercial use, 3D-printed porous titanium (3DppTi) alloy cages, which have recently become available for use in spinal procedures. They have been shown in ovine models to have superior efficacy and fusion rates compared to traditional cages. However, there is limited data on their use in clinical practice and long-term outcomes associated with them.
A retrospective chart review was performed, of all patients in a single institution who underwent lumbar spine fusion surgery via an anterior or lateral approach with a 3D-printed titanium alloy cage, between January 2020 and February 2021. Clinic letters, imaging and operation reports were independently reviewed to assess for fusion, or evidence of subsidence on follow-up.
Fifty patients were identified as meeting inclusion criteria, with a total of 66 operative levels. Of these operative levels, 32 were via an anterior approach and 34 via a lateral approach. One patient demonstrated a Marchi grade 0 subsidence, with recurrence of radiculopathy 2 months after an anterior approach, requiring posterior decompression and stabilization. A second patient demonstrated a Marchi grade 1 subsidence after a lateral approach, but did not require further surgery as they were asymptomatic at 2 years of follow-up. This study demonstrated an overall subsidence rate of 3.03%. There was a median follow-up time of 11.3 months for all patients.
3D-printed titanium alloy cages demonstrate a lower subsidence rate compared to historically published rates for alternative intervertebral cages, in anterior and lateral lumbar spine fusion surgery.
腰椎融合手术中最常用的椎间盘置换椎间融合器主要由聚醚醚酮（PEEK）制成。有足够的数据从多种方法研究其下沉率和失败率。一种新型植入物现已可供商业使用，即3D打印多孔钛（3DppTi）合金椎间融合器，最近已可用于脊柱手术。在绵羊模型中，它们已被证明与传统椎间融合器相比具有更高的疗效和融合率。然而，关于它们在临床实践中的使用以及与之相关的长期结果的数据有限。
对2020年1月至2021年2月期间在单一机构接受前路或侧路3D打印钛合金椎间融合器腰椎融合手术的所有患者进行回顾性病历审查。独立审查临床信件、影像学和手术报告，以评估融合情况或随访时的下沉证据。
确定50例患者符合纳入标准，共有66个手术节段。在这些手术节段中，32个通过前路，34个通过侧路。1例患者表现为马尔基0级下沉，前路手术后2个月出现神经根病复发，需要后路减压和固定。第2例患者在侧路手术后表现为马尔基1级下沉，但由于在2年随访时无症状，无需进一步手术。本研究显示总体下沉率为3.03%。所有患者的中位随访时间为11.3个月。
在腰椎前路和侧路融合手术中，3D打印钛合金椎间融合器的下沉率低于历史上公布的其他椎间融合器的下沉率。
