Masamoto Kazutaka, Tanida Shimei, Otsuki Bungo, Fujibayashi Shunsuke
Spine Surgery, Shiga General Hospital, Moriyama, JPN.
Orthopaedics, Kyoto University Hospital, Kyoto, JPN.
Cureus. 2025 Jan 15;17(1):e77485. doi: 10.7759/cureus.77485. eCollection 2025 Jan.
Objective This study aimed to compare the fusion rate of polyetheretherketone (PEEK) and titanium-coated PEEK (Ti-PEEK) cages in transforaminal lumbar interbody fusion (TLIF). Methods The patient groups that underwent TLIF using PEEK and Ti-PEEK cages were identified and matched for age, sex, and whether the lumbar spine surgery was performed more than once using propensity scores. The rate of three-month postoperative vertebral endplate cyst sign (VECS), which was reported as a predictor of pseudoarthrosis at one year postoperatively, and the one-year and two-year postoperative fusions between the two groups were statistically compared. Results There were 34 patients (12 men and 22 women) in the PEEK group with a mean age of 69.8 ± 8.2 years and 36 intervertebral discs; there were 30 patients (11 men and 19 women) in the Ti-PEEK group with a mean age of 70.3 ± 9.6 years and 36 intervertebral discs. The operated levels were two discs (5.6%) in L2/3, four (11.1%) in L3/4, 21 (58.3%) in L4/5, and nine (25.0%) in L5/S in the PEEK group and were one (2.8%) in L3/4, 24 (66.7%) in L4/5, and 11 (30.6%) in L5/S in the Ti-PEEK group (P = 0.31). The frequencies of positive VECS at three months postoperatively were four discs (11.1%) in the PEEK group and five (13.9%) in the Ti-PEEK group, with no significant difference (P = 0.72). Bone fusion rates at one year and two years postoperatively were 26 (72.2%) and 28 (77.8%), respectively, in the PEEK group, and 28 (77.8%) and 32 (88.9%), respectively, in the Ti-PEEK group, with no statistically significant difference (P = 0.59 at one year and P = 0.21 at two years). Among the five cases of positive VECS in the Ti-PEEK group, two cases (40%) had bone fusion at one year postoperatively around the cage but not through the cage. Conclusion There was no significant difference in the rate of bone fusion or VECS after TLIF between the PEEK and Ti-PEEK groups. Positive VECS is more appropriate for a finding of no bone fusion through the cage at one year postoperatively than for a finding that predicts pseudoarthrosis.
目的 本研究旨在比较聚醚醚酮（PEEK）椎间融合器和钛涂层聚醚醚酮（Ti-PEEK）椎间融合器在经椎间孔腰椎椎间融合术（TLIF）中的融合率。方法 通过倾向评分法确定接受PEEK和Ti-PEEK椎间融合器TLIF手术的患者组，并在年龄、性别以及腰椎手术是否为再次手术方面进行匹配。对术后三个月椎体终板囊肿征（VECS）的发生率（该指标被报道为术后一年假关节形成的预测指标）以及两组术后一年和两年的融合情况进行统计学比较。结果 PEEK组有34例患者（12例男性和22例女性），平均年龄69.8±8.2岁，共36个椎间盘；Ti-PEEK组有30例患者（11例男性和19例女性），平均年龄70.3±9.6岁，共36个椎间盘。PEEK组手术节段为L2/3节段2个椎间盘（5.6%），L3/4节段4个（11.1%），L4/5节段21个（58.3%），L5/S节段9个（25.0%）；Ti-PEEK组手术节段为L3/4节段1个（2.8%），L4/5节段24个（66.7%），L5/S节段11个（30.6%）（P = 0.31）。术后三个月VECS阳性的频率在PEEK组为4个椎间盘（11.1%），Ti-PEEK组为5个（13.9%），差异无统计学意义（P = 0.72）。PEEK组术后一年和两年的骨融合率分别为26例（72.2%）和28例（77.8%），Ti-PEEK组分别为28例（77.8%）和32例（88.9%），差异无统计学意义（一年时P = 0.59，两年时P = 0.21）。在Ti-PEEK组的5例VECS阳性病例中，有2例（40%）在术后一年时融合发生在椎间融合器周围而非通过椎间融合器。结论 PEEK组和Ti-PEEK组在TLIF术后的骨融合率或VECS发生率方面无显著差异。VECS阳性更适合作为术后一年未通过椎间融合器实现骨融合的表现而非预测假关节形成的表现。
