Use of Double Cages for Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: A Comparison of 3-Dimensional-Printed Titanium and Polyetheretherketone Cages.

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2025-08-29 DOI:10.14444/8788

Dong Hyun Lee, Jin Young Lee, Sung Bum Kim, Choon Keun Park, Kang Taek Lim, Dong Chan Lee, Inbo Han, Jae-Won Jang, Dong-Geun Lee, Il-Tae Jang

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引用次数: 0

Abstract

Background: This study aimed to compare a 3-dimensional (3D)-printed titanium cage with a polyetheretherketone (PEEK) cage in biportal endoscopic transforaminal lumbar interbody fusion (BETLIF) using a double cage construct, evaluate differences in fusion stability and subsidence between the 2 cage types, and analyze factors influencing subsidence.

Methods: We retrospectively examined 89 patients who underwent BETLIF using a double cage (3D-printed titanium, 48 levels; PEEK, 46 levels). Fusion status and subsidence were assessed using dynamic plain lateral lumbar spine radiographs and computed tomography images at 6 months and 1 year postoperatively. Fusion was graded according to the Bridwell system, and significant subsidence was defined as ≥2 mm endplate depression on computed tomography. Demographic and clinical variables, including age, sex, body mass index, American Society of Anesthesiologists classification, history of tobacco smoking, diabetes mellitus, bone mineral density measured using dual-energy x-ray absorptiometry, cage length, and cage material, were collected and analyzed as potential risk factors.

Results: At 1-year follow-up, fusion grades were I (75.0%, 36 levels), II (20.8%, 10 levels), and III (4.2%, 2 levels) for 3D-printed titanium and I (53.2%, 25 levels), II (40.4%, 19 levels), and III (6.4%, 3 levels) for PEEK. The overall fusion rate (grades I and II) was similar for both cages (95.8% vs 93.6%, P = 0.629), but grade I was more prevalent with 3D-printed titanium than with PEEK (75.0% vs 53.2%, P = 0.027). No significant differences were observed in subsidence or complications between the 2 cages. Multivariate analysis revealed age as the only variable significantly associated with subsidence in BETLIF.

Conclusions: Both double 3D-printed titanium and PEEK cages demonstrated high fusion rates with no significant differences in overall success. However, double 3D-printed titanium cages showed better early fusion grades and comparable subsidence to that of PEEK cages. Although long-term follow-up is necessary to ascertain efficacy, these findings suggest that 3D-printed titanium cages offer advantages in early fusion quality in BETLIF. Further research is needed to optimize cage arrangement, cage design, and surgical techniques to improve outcomes.

Clinical relevance: The use of double 3D-printed titanium cages is recommended in BETLIF.

Level of evidence: 3:

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双笼在双门静脉内镜下经椎间孔腰椎椎体间融合中的应用：三维打印钛和聚醚醚酮笼的比较。

背景：本研究旨在比较三维（3D）打印钛笼与聚醚醚酮（PEEK）笼在双门静脉内镜下经椎间孔腰椎体间融合（BETLIF）中的应用，评估两种笼型在融合稳定性和沉降方面的差异，并分析影响沉降的因素。方法：我们回顾性分析了89例使用双笼（3d打印钛，48节段；PEEK， 46节段）行BETLIF的患者。术后6个月和1年采用腰椎动态平侧位x线片和计算机断层图像评估融合状态和沉降。根据Bridwell系统对融合进行分级，计算机断层扫描将显著下沉定义为终板凹陷≥2mm。收集人口统计学和临床变量，包括年龄、性别、体重指数、美国麻醉医师学会分类、吸烟史、糖尿病、双能x线骨密度测量、笼子长度和笼子材料，并将其作为潜在危险因素进行分析。结果：在1年的随访中，3d打印钛的融合等级为I（75.0%， 36个水平）、II（20.8%， 10个水平）和III（4.2%， 2个水平），PEEK的融合等级为I（53.2%， 25个水平）、II（40.4%， 19个水平）和III（6.4%， 3个水平）。两种笼体的总体融合率（I级和II级）相似（95.8%对93.6%,P = 0.629），但I级融合率3d打印钛比PEEK更普遍（75.0%对53.2%,P = 0.027）。两种笼间沉降或并发症无显著差异。多变量分析显示，年龄是唯一与BETLIF沉降显著相关的变量。结论：双3d打印钛和PEEK笼均具有高融合率，总体成功率无显著差异。然而，与PEEK笼相比，双3d打印钛笼表现出更好的早期融合等级和相当的下沉。虽然需要长期随访以确定疗效，但这些发现表明3d打印钛笼在BETLIF的早期融合质量方面具有优势。需要进一步的研究来优化笼的布置、笼的设计和手术技术以改善结果。临床相关性：推荐在BETLIF中使用双3d打印钛笼。证据等级：3；

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.