25. Evaluation of 3D-printed porous titanium alloy versus polyetheretherketone cages in the surgical treatment of multilevel cervical degenerative disease
Taha Khalilullah BS , Ripul R. Panchal DO, FACS , Pratibha Nayak PhD, MBA, MPH
{"title":"25. Evaluation of 3D-printed porous titanium alloy versus polyetheretherketone cages in the surgical treatment of multilevel cervical degenerative disease","authors":"Taha Khalilullah BS , Ripul R. Panchal DO, FACS , Pratibha Nayak PhD, MBA, MPH","doi":"10.1016/j.xnsj.2025.100719","DOIUrl":null,"url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Anterior cervical discectomy and fusion (ACDF) with 3D-printed titanium (TTN) or polyetheretherketone (PEEK) cages is an effective surgery for patients with cervical radiculopathy/myelopathy. The advent of 3D-printed porous TTN cages and its microporous structure has contributed to diminished subsidence and improved osseointegration compared to PEEK. This study compares the long-term outcomes of both implants among patients who underwent a multilevel ACDF procedure.</div></div><div><h3>PURPOSE</h3><div>To compare the long-term clinical and radiographic outcomes of patients who have undergone multilevel ACDF with either 3D-printed TTN or PEEK cages with level-specific analysis.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Single-center retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients who underwent multilevel ACDF procedure with PEEK and 3D Titanium implants.</div></div><div><h3>OUTCOME MEASURES</h3><div>Radiographic outcomes for fusion, cage migration, and subsidence were determined with cervical x-rays and sub-analyzed by the caudal and rostral vertebral level.</div></div><div><h3>METHODS</h3><div>In total, 96 patients underwent multilevel (2, 3, 4) ACDF surgery, of whom 66 and 30 received a PEEK and 3D-printed TTN interbody cage, respectively. Radiographic outcomes for fusion, cage migration, and subsidence were determined with cervical x-rays and analyzed with independent 2-sample T-test and <strong>χ</strong><sup>2</sup> test. Visual analog score (VAS) and Neck Disability Index (NDI) score were examined with repeated measure analysis of variance.</div></div><div><h3>RESULTS</h3><div>Of the 96 patients included, 66 (69%) were in the PEEK group and 30 (31%) in the 3D-printed TTN group. Baseline demographics, including age, osteoporosis, smoking status, and preoperative NDI and VAS scores, were similar between groups. Intraoperative variables, such as blood loss and levels operated, also showed no significant differences. Postoperatively, the 3D-printed TTN group showed a trend of lower NDI and VAS scores at 6 months and 1 year, with significantly improved NDI scores at 1 year (p = .017). Fusion rates were comparable across groups at proximal levels for 2-, 3-, and 4-level ACDFs, with the 3D-printed TTN group demonstrating significantly shorter time to fusion at the distal level of 3-level procedures (p = .011). Complications included dysphagia (15.2% PEEK vs 23.3% TTN), screw loosening, and subsidence, which was more frequent in the 3D-printed TTN group (20% vs 3.33%). Pseudarthrosis was most common at distal levels, but no reoperations occurred in either group. Fusion outcomes were comparable at most levels, but distal-level challenges persisted.</div></div><div><h3>CONCLUSIONS</h3><div>The use of 3D-printed TTN implants enhanced the time to bony fusion at distal levels relative to PEEK cages. Clinically, patients with 3D-printed TTN implants reported diminished NDI scores at 2 years postoperatively. Such findings highlight the difference in outcomes clinically and radiographically for PEEK and 3D-printed TTN implants that need to be considered in optimizing multilevel ACDF procedures.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100719"},"PeriodicalIF":2.5000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"North American Spine Society Journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666548425001398","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
BACKGROUND CONTEXT
Anterior cervical discectomy and fusion (ACDF) with 3D-printed titanium (TTN) or polyetheretherketone (PEEK) cages is an effective surgery for patients with cervical radiculopathy/myelopathy. The advent of 3D-printed porous TTN cages and its microporous structure has contributed to diminished subsidence and improved osseointegration compared to PEEK. This study compares the long-term outcomes of both implants among patients who underwent a multilevel ACDF procedure.
PURPOSE
To compare the long-term clinical and radiographic outcomes of patients who have undergone multilevel ACDF with either 3D-printed TTN or PEEK cages with level-specific analysis.
STUDY DESIGN/SETTING
Single-center retrospective cohort study.
PATIENT SAMPLE
Patients who underwent multilevel ACDF procedure with PEEK and 3D Titanium implants.
OUTCOME MEASURES
Radiographic outcomes for fusion, cage migration, and subsidence were determined with cervical x-rays and sub-analyzed by the caudal and rostral vertebral level.
METHODS
In total, 96 patients underwent multilevel (2, 3, 4) ACDF surgery, of whom 66 and 30 received a PEEK and 3D-printed TTN interbody cage, respectively. Radiographic outcomes for fusion, cage migration, and subsidence were determined with cervical x-rays and analyzed with independent 2-sample T-test and χ2 test. Visual analog score (VAS) and Neck Disability Index (NDI) score were examined with repeated measure analysis of variance.
RESULTS
Of the 96 patients included, 66 (69%) were in the PEEK group and 30 (31%) in the 3D-printed TTN group. Baseline demographics, including age, osteoporosis, smoking status, and preoperative NDI and VAS scores, were similar between groups. Intraoperative variables, such as blood loss and levels operated, also showed no significant differences. Postoperatively, the 3D-printed TTN group showed a trend of lower NDI and VAS scores at 6 months and 1 year, with significantly improved NDI scores at 1 year (p = .017). Fusion rates were comparable across groups at proximal levels for 2-, 3-, and 4-level ACDFs, with the 3D-printed TTN group demonstrating significantly shorter time to fusion at the distal level of 3-level procedures (p = .011). Complications included dysphagia (15.2% PEEK vs 23.3% TTN), screw loosening, and subsidence, which was more frequent in the 3D-printed TTN group (20% vs 3.33%). Pseudarthrosis was most common at distal levels, but no reoperations occurred in either group. Fusion outcomes were comparable at most levels, but distal-level challenges persisted.
CONCLUSIONS
The use of 3D-printed TTN implants enhanced the time to bony fusion at distal levels relative to PEEK cages. Clinically, patients with 3D-printed TTN implants reported diminished NDI scores at 2 years postoperatively. Such findings highlight the difference in outcomes clinically and radiographically for PEEK and 3D-printed TTN implants that need to be considered in optimizing multilevel ACDF procedures.
FDA Device/Drug Status
This abstract does not discuss or include any applicable devices or drugs.