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Duan Y, Feng D, Li T, Wang Y, Jiang L, Huang Y. Comparison of Lumbar Interbody Fusion with 3D-Printed Porous Titanium Cage Versus Polyetheretherketone Cage in Treating Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 183:144-156. [PMID: 38145654 DOI: 10.1016/j.wneu.2023.12.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To compare the safety and radiological effectiveness of lumbar interbody fusion with a 3D-printed porous titanium (3D-PPT) cage versus a polyetheretherketone (PEEK) cage for the treatment of lumbar degenerative disease. METHODS This study was registered at PROSPERO (CRD42023461511). We systematically searched the PubMed, Embase, and Web of Science databases for related studies from inception to September 3, 2023. Review Manager 5.3 was used to conduct this meta-analysis. The reoperation rate, complication rate, fusion rate, and subsidence rate were assessed using relative risk and 95% confidence intervals. RESULTS Ten articles reporting 9 studies comparing lumbar interbody fusion with 3D-PPT cages versus PEEK cages for the treatment of lumbar degenerative disease were included. The subsidence rate at the 1-year follow-up in the 3D-PPT cage was significantly lower than that in the PEEK cage. The fusion rate in the 3D-PPT cage was significantly higher than that in the PEEK cage at the 6-month follow-up. No significant difference was identified between the 2 groups at the 12-month follow-up. No significant difference was identified between the 2 groups in terms of the complication rate and reoperation rate. There was a trend toward a lower complication rate and reoperation rate with the 3D-PPT cage. CONCLUSIONS Compared with the PEEK cage, the 3D-PPT cage may be a safer implant. The 3D-PPT cage was associated with a higher fusion rate and lower subsidence rate. The 3D-PPT cage may accelerate the intervertebral fusion process, improve the quality of fusion and prevent the occurrence of subsidence.
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Affiliation(s)
- Yuchen Duan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Dagang Feng
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Tong Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yiran Wang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Leiming Jiang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
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Pereira P, Park Y, Arzoglou V, Charles YP, Krutko A, Senker W, Park SW, Franke J, Fuentes S, Bordon G, Song Y, He S, Vialle E, Mlyavykh S, Varanda P, Hosszu T, Bhagat S, Hong JY, Vanhauwaert D, de la Dehesa P. Anterolateral versus posterior minimally invasive lumbar interbody fusion surgery for spondylolisthesis: comparison of outcomes from a global, multicenter study at 12-months follow-up. Spine J 2023; 23:1494-1505. [PMID: 37236367 DOI: 10.1016/j.spinee.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND CONTEXT Several minimally invasive lumbar interbody fusion techniques may be used as a treatment for spondylolisthesis to alleviate back and leg pain, improve function and provide stability to the spine. Surgeons may choose an anterolateral or posterior approach for the surgery however, there remains a lack of real-world evidence from comparative, prospective studies on effectiveness and safety with relatively large, geographically diverse samples and involving multiple surgical approaches. PURPOSE To test the hypothesis that anterolateral and posterior minimally invasive approaches are equally effective in treating patients with spondylolisthesis affecting one or two segments at 3-months follow-up and to report and compare patient reported outcomes and safety profiles between patients at 12-months post-surgery. DESIGN Prospective, multicenter, international, observational cohort study. PATIENT SAMPLE Patients with degenerative or isthmic spondylolisthesis who underwent 1- or 2-level minimally invasive lumbar interbody fusion. OUTCOME MEASURES Patient reported outcomes assessing disability (ODI), back pain (VAS), leg pain (VAS) and quality of life (EuroQol 5D-3L) at 4-weeks, 3-months and 12-months follow-up; adverse events up to 12-months; and fusion status at 12-months post-surgery using X-ray and/or CT-scan. The primary study outcome is improvement in ODI score at 3-months. METHODS Eligible patients from 26 sites across Europe, Latin America and Asia were consecutively enrolled. Surgeons with experience in minimally invasive lumbar interbody fusion procedures used, according to clinical judgement, either an anterolateral (ie, ALIF, DLIF, OLIF) or posterior (MIDLF, PLIF, TLIF) approach. Mean improvement in disability (ODI) was compared between groups using ANCOVA with baseline ODI score used as a covariate. Paired t-tests were used to examine change from baseline in PRO for both surgical approaches at each timepoint after surgery. A secondary ANCOVA using a propensity score as a covariate was used to test the robustness of conclusions drawn from the between group comparison. RESULTS Participants receiving an anterolateral approach (n=114) compared to those receiving a posterior approach (n=112) were younger (56.9 vs 62.0 years, p <.001), more likely to be employed (49.1% vs 25.0%, p<.001), have isthmic spondylolisthesis (38.6% vs 16.1%, p<.001) and less likely to only have central or lateral recess stenosis (44.9% vs 68.4%, p=.004). There were no statistically significant differences between the groups for gender, BMI, tobacco use, duration of conservative care, grade of spondylolisthesis, or the presence of stenosis. At 3-months follow-up there was no difference in the amount of improvement in ODI between the anterolateral and posterior groups (23.2 ± 21.3 vs 25.8 ± 19.5, p=.521). There were no clinically meaningful differences between the groups on mean improvement for back- and leg-pain, disability, or quality of life until the 12-months follow-up. Fusion rates of those assessed (n=158; 70% of the sample), were equivalent between groups (anterolateral, 72/88 [81.8%] fused vs posterior, 61/70 [87.1%] fused; p=.390). CONCLUSIONS Patients with degenerative lumbar disease and spondylolisthesis who underwent minimally invasive lumbar interbody fusion presented statistically significant and clinically meaningful improvements from baseline up to 12-months follow-up. There were no clinically relevant differences between patients operated on using an anterolateral or posterior approach.
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Affiliation(s)
- Paulo Pereira
- Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Portugal; Department of Neurosurgery, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Rd, Hull HU3 2JZ, United Kingdom.
| | - Yung Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsangdong-gu, Goyang-si, Gyeonggi, 410-719, South Korea
| | - Vasileios Arzoglou
- Department of Neurosurgery, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Rd, Hull HU3 2JZ, United Kingdom
| | - Yann Philippe Charles
- Department of Spine Surgery, Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200 Strasbourg, France
| | - Aleksandr Krutko
- Department of Neurosurgery, Scientific Research Institute of Traumatology and Orthopedics, Academician Baykova house 8, 195427, St. Petersburg, Russia
| | - Wolfgang Senker
- Department of Neurosurgery, Kepler Universitätsklinikum Linz, Hospital Road 9, 4021, Linz, Upper Austria, Austria
| | - Seung Won Park
- Department of Neurological Surgery, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, South Korea
| | - Jörg Franke
- Department of Spine Surgery, Klinikum Magdeburg, Birkenallee 34, 39130 Magdeburg, Saxony-Aanhalt, Germany
| | - Stephane Fuentes
- Service de Neurochirurgie, La Timone, AP-HM, Rue Saint Pierre, 13005 Marseille, Bouches-du-Rhône, France
| | - Gerd Bordon
- Servicio Cirugia Ortopédica y Traumatología, Hospital de Manises, Avenida Generalitat Valenciana 50, 46940 Manises, Valencia, Spain
| | - Yueming Song
- Department of Orthopedics, West China Hospital Sichuan University, No.37 Guoxue Alley, Chengdu, Sichuan Province, PR. China
| | - Shisheng He
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301# Yanchang Road, Shanghai, 200072, PR China
| | - Emiliano Vialle
- Department of Orthopedics, Hospital Universitario Cajuru, Av. São José, 300 - Cristo Rei, Curitiba, PR 80050-350, Brazil
| | - Sergey Mlyavykh
- Trauma and Orthopedics Institute, Volga Research Medical University, Verhne-Voljskaya naberejnaya18, 603155 Nizhnii Novgorod, Russia
| | - Pedro Varanda
- Orthopedics Department, Hospital de Braga, R. das Comunidades Lusíadas 133, Braga, 4710-311 Portugal
| | - Tomáš Hosszu
- Department of Neurosurgery, Fakultní nemocnice Hradec Králové, Sokolská 581, 500 05 Hradec Králové - Nový, Hradec Králové, Czech Republic
| | - Shaishav Bhagat
- Department of Orthopaedic Surgery, East Suffolk and North Essex NHS Foundation Trust, Heath Road, Ipswich, IP4 5PD, Suffolk, United Kingdom
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Gojan Dong, Danwon Gu, Ansan 425-707, South Korea
| | - Dimitri Vanhauwaert
- Department of neurosurgery, AZ Delta Roeselare-Menen-Torhout, Deltalaan 1, 8800 Roeselare, Belgium
| | - Paloma de la Dehesa
- Department of Neurosurgery-Spine Unit, Hospital Marqués de Valdecilla, Av. de Valdecilla, s/n, 39008 Santander, Cantabria, Spain
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