Vertebral Endplate Concavity in Lateral Lumbar Interbody Fusion: Tapered 3D-Printed Porous Titanium Cage versus Squared PEEK Cage

February 26, 2023

doi: 10.3390/medicina59020372.

Affiliations

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Naoki Segi et al.

Medicina (Kaunas).

2023.

doi: 10.3390/medicina59020372.

Authors

Affiliations

¹ Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan.
² Department of Orthopedic Surgery, Anjo Kosei Hospital, 28 Higashihirokute, Anjo 446-8602, Japan.

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Abstract

Background and Objectives: To prevent postoperative problems in extreme lateral interbody fusion (XLIF), it is critical that the vertebral endplate not be injured. Unintentional endplate injuries may depend on the cage. A novel porous titanium cage for XLIF has improved geometry with a tapered tip and smooth surface. We hypothesized that this new cage should lead to fewer endplate injuries. Materials and Methods: This retrospective study included 32 patients (mean 74.1 ± 6.7 years, 22 females) who underwent anterior and posterior combined surgery with XLIF for lumbar degenerative disease or adult spinal deformity from January 2018 to June 2022. A tapered 3D porous titanium cage (3DTi; 11 patients) and a squared PEEK cage (sPEEK; 21 patients) were used. Spinal alignment values were measured on X-ray images. Vertebral endplate concavity (VEC) was defined as concavity ≥ 1 mm of the endplate on computed tomography (CT) images, which were evaluated preoperatively and at 1 week and 3 months postoperatively. Results: There were no significant differences in the patient demographic data and preoperative and 3-month postoperative spinal alignments between the groups. A 3DTi was used for 25 levels and an sPEEK was used for 38 levels. Preoperative local lordotic angles were 4.3° for 3DTi vs. 4.7° for sPEEK (p = 0.90), which were corrected to 12.3° and 9.1° (p = 0.029), respectively. At 3 months postoperatively, the angles were 11.6° for 3DTi and 8.2° for sPEEK (p = 0.013). VEC was present in 2 levels (8.0%) for 3DTi vs. 17 levels (45%) for sPEEK (p = 0.002). After 3 months postoperatively, none of the 3DTi had VEC progression; however, eight (21%) levels in sPEEK showed VEC progression (p = 0.019). Conclusions: The novel 3DTi cage reduced endplate injuries by reducing the endplate load during cage insertion.

Keywords:

cage subsidence; extreme lateral interbody fusion; lateral lumber interbody fusion; poly-ether-ether-ketone; three-dimensional porous titanium; vertebral endplate injury.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**

Lumbar degenerative spondylolisthesis treated by 3DTi cage and PPS.

**Figure 2**

Flowchart for patients’ selection.

**Figure 3**

Appearance of 3DTi and sPEEK cages. The 3DTi cages are bullet-shaped and have smooth surfaces. The sPEEK cage has angular corners, spikes, and serrations.

**Figure 4**

Intervertebral lordotic angle was defined as the angle formed by the cephalad endplate of the upper vertebra and the caudal endplate of the lower vertebra for each level.

**Figure 5**

Vertebral endplate concavity (VEC) and cage subsidence. Both cages exceeded the end plates by ≥1 mm (VEC-positive) with Marchi classification grade 0.

**Figure 6**

Differences in postoperative changes depending on cage. (A), preoperative degenerated interbody; (B), postoperative VEC caused by the 3DTi cage; (C), no further subsidence after 3 months. (D), preoperative; (E), postoperative VEC caused by the sPEEK cage; (F), cage subsidence and decreased lordosis (11° to 6°) after three months.

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