25. 3d打印多孔钛合金与聚醚醚酮笼在多节段宫颈退行性疾病手术治疗中的比较

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100719

Taha Khalilullah BS , Ripul R. Panchal DO, FACS , Pratibha Nayak PhD, MBA, MPH

{"title":"25. 3d打印多孔钛合金与聚醚醚酮笼在多节段宫颈退行性疾病手术治疗中的比较","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":"{\"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}","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

摘要

使用3d打印钛（TTN）或聚醚醚酮（PEEK）笼进行前路颈椎椎间盘切除术和融合（ACDF）是治疗颈椎神经根病/脊髓病患者的有效手术。与PEEK相比，3d打印多孔TTN保持架及其微孔结构的出现有助于减少下沉并改善骨整合。本研究比较了两种植入物在接受多节段ACDF手术的患者中的长期结果。目的比较采用3d打印TTN或PEEK笼进行多节段ACDF的患者的长期临床和影像学结果，并进行水平特异性分析。研究设计/设置：单中心回顾性队列研究。患者样本：采用PEEK和3D钛植入物进行多节段ACDF手术的患者。通过颈椎x线确定融合、椎笼移动和沉降的影像学结果，并通过尾椎和吻侧椎体水平进行亚分析。方法共96例患者行多节段（2、3、4）ACDF手术，其中66例和30例分别接受PEEK和3d打印TTN椎间笼。采用颈椎x线片测定融合、笼内移动和沉降的影像学结果，并采用独立2样本t检验和χ2检验进行分析。采用重复测量方差分析检验视觉模拟评分（VAS）和颈部残疾指数（NDI）评分。结果96例患者中，PEEK组66例（69%），3d打印TTN组30例（31%）。基线人口统计，包括年龄、骨质疏松、吸烟状况、术前NDI和VAS评分，组间相似。术中变量，如出血量和手术水平，也没有显着差异。术后3d打印TTN组患者6个月和1年NDI和VAS评分均有降低趋势，1年NDI评分显著提高（p = .017）。2节段、3节段和4节段ACDFs近节段的融合率在各组间具有可比性，3d打印TTN组在远节段3节段手术的融合时间显著缩短（p = .011）。并发症包括吞咽困难（15.2% PEEK vs 23.3% TTN），螺钉松动和下沉，3d打印TTN组更常见（20% vs 3.33%）。假关节最常见于远节段，但两组均未发生再手术。大多数水平的融合结果具有可比性，但远端水平的挑战仍然存在。结论使用3d打印的TTN种植体相对于PEEK笼可以缩短远节段骨融合时间。临床上，使用3d打印TTN植入物的患者在术后2年报告NDI评分降低。这些发现突出了PEEK和3d打印TTN植入物在临床和影像学上的差异，在优化多节段ACDF手术时需要考虑这些差异。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

25. Evaluation of 3D-printed porous titanium alloy versus polyetheretherketone cages in the surgical treatment of multilevel cervical degenerative disease

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.