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Schröder J, Kampulz T, Bajaj SK, Hellwig AG, Winking M. PEEK Cages versus Titanium-Coated PEEK Cages in Single-Level Anterior Cervical Fusion: A Randomized Controlled Study. J Neurol Surg A Cent Eur Neurosurg 2024; 85:262-268. [PMID: 37506743 DOI: 10.1055/s-0043-1770694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
BACKGROUND The implantation of a spacer is a common practice after anterior diskectomy in cervical spine. Polyether ether ketone (PEEK) cages have replaced titanium implants due to their better radiologic visibility and appearance in postoperative magnetic resonance imaging (MRI) scans. However, PEEK showed apparently higher nonunion rates than titanium cages. The aim of the study was to evaluate the fusion behavior of plain PEEK cages in comparison to titanium-coated PEEK (TiPEEK) cages. METHOD We randomized 104 patients with single-level cervical radiculopathy or mild myelopathy. They were divided into two groups of 52 patients each, receiving either a PEEK cage or the titanium-coated variant of the same cage type. The 1- and 2-year follow-ups were completed by 43 patients in the PEEK group and by 50 patients in the TiPEEK group. Fusion was determined by plain X-ray and lateral functional X-ray. RESULTS Two years after surgery, a complete fusion was observed in 37 patients of the PEEK group (86%). Six cases were considered as nonunions. In the TiPEEK group, we found 41 fusions (82%) and 9 nonunions at this time. The difference was not considered significant (p = 0.59). The clinical evaluation of the two groups showed no difference in the neurologic examination as well in the pain scores over the time period. CONCLUSIONS Despite some assumptions about an advantage of TiPEEK over PEEK cages for fusion in cervical spine surgery, this prospective randomized controlled study did not find an accelerated or improved fusion using TiPEEK for anterior cervical diskectomy.
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Affiliation(s)
| | - Thomas Kampulz
- ZW-O Zentrum für - Wirbelsäulenchirurgie, Osnabrück, Germany
| | | | | | - Michael Winking
- ZW-O Zentrum für - Wirbelsäulenchirurgie, Osnabrück, Germany
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Jalilvand E, Abollfathi N, Khajehzhadeh M, Hassani-Gangaraj M. Optimization of cervical cage and analysis of its base material: A finite element study. Proc Inst Mech Eng H 2022; 236:1613-1625. [DOI: 10.1177/09544119221128467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nowadays, cervical disorders are common due to human lifestyles. Accordingly, the cage design should be optimized as an essential issue. For an optimal design, an objective function is utilized to calculate the proper geometrical parameters. Additionally, the base material of the cage plays a key role in its functionality and final cost. Novel materials are currently introduced with more compatibility with the bone in terms of mechanical and chemical properties. In this study, a cervical cage was modeled based on PEEK material with three types of tooth designs on its surface. The cervical cage is assumed to be implanted between C6 and C7 vertebrae. The geometric parameters of the cage were optimized to minimize the mass by determining allowable stress and subsidence. The effect of complete cortical removal was investigated as a surgical mistake. Finally, a new composition of PEEK/titanium was introduced as the base material of the cage. Ansys 18.2 was used for FEA. The cage with a straight tooth was chosen due to its lower stress and subsidence compared with other designs. Furthermore, the optimized structures of all three tooth designs were determined. The mass and volume of the optimal cages were reduced by 41.47% and 41.52% respectively. Besides, complete cortical resection should not be carried out during fusion surgery, since it may lead to higher subsidence. The composition of PEEK/titanium was chosen as an appropriate base material due to its better performance compared with PEEK or titanium alone.
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Affiliation(s)
- Elahe Jalilvand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Nabiolah Abollfathi
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Mohsen Khajehzhadeh
- Department of Mechanical Engineering, Amirkabir University of Technology, Tehran, Iran
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Godlewski B, Bebenek A, Dominiak M, Bochniak M, Cieslik P, Pawelczyk T. Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion. J Clin Med 2022; 11:jcm11206066. [PMID: 36294384 PMCID: PMC9605251 DOI: 10.3390/jcm11206066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022] Open
Abstract
Most surgical procedures performed on account of degenerative disease of the cervical spine involve a discectomy and interbody fixation. Bone fusion at the implant placement site is evaluated post-operatively. It is agreed that computed tomography is the best modality for assessing bone union. We evaluated the results obtained with various methods based solely on conventional radiographs in the same group of patients and compared them with results obtained using a method that is a combination of CT and conventional radiography, which we considered the most precise and a reference method. We operated on a total of 170 disc spaces in a group of 104 patients. Fusion was evaluated at 12 months after surgery with five different and popular classifications based on conventional radiographs and then compared with the reference method. Statistical analyses of test accuracy produced the following classification of fusion assessment methods with regard to the degree of consistency with the reference method, in descending order: (1) bone bridging is visible on the anterior and/or posterior edge of the operated disc space on a lateral radiograph; (2) change in the value of Cobb's angle for a motion segment on flexion vs. extension radiographs (threshold for fusion vs. pseudoarthrosis is 2°); (3) change in the interspinous distance between process tips on flexion vs. extension radiographs (threshold of 2 mm); (4) change in the value of Cobb's angle of a motion segment (threshold of 4°); (5) change in the interspinous distance between process bases on flexion vs. extension radiographs (threshold of 2 mm). When bone union is evaluated on the basis on radiographs, without CT evidence, we suggest using the "bone bridging" criterion as the most reliable commonly used approach to assessing bone union.
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Affiliation(s)
- Bartosz Godlewski
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
- Correspondence: ; Tel./Fax: +48-12-3855634
| | - Adam Bebenek
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Marcin Bochniak
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Piotr Cieslik
- Department of Orthopaedics and Traumatology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Tomasz Pawelczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-213 Lodz, Poland
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Godlewski B, Bebenek A, Dominiak M, Karpinski G, Cieslik P, Pawelczyk T. Subsidence following cervical discectomy and implant-to-bone ratio. BMC Musculoskelet Disord 2022; 23:750. [PMID: 35927645 PMCID: PMC9351094 DOI: 10.1186/s12891-022-05698-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Implant subsidence is an undesirable effect after anterior cervical discectomy and fusion (ACDF). We investigated the relation between the rate of implant subsidence and the ratio of the implant surface area to the surface area of the adjacent bone. Methods We operated 170 disc spaces in a group of 104 patients. Two types of implants were used: 1) PEEK (polyetheretherketone) cages and 2) titanium-coated (TC) PEEK cages. Patients were randomised to receive a specific implant using a randomisation table. All implants had a surface area of 1.61 cm2. Based on computed tomography images, bone surface areas were calculated for vertebral bodies immediately adjacent to the interbody implants. The implant-to-bone surface ratio was then calculated for each disc space. Implant subsidence was assessed over 12 months of follow-up, and associations between implant subsidence, the type of implant, and the implant-to-bone surface ratio were investigated. Results Twelve months after the surgery, computed tomography was performed on 86 patients (144 disc spaces). Furthermore, in 166 disc spaces and 102 patients, conventional radiographs were obtained. Subsidence was observed in 21% of the examined intervertebral spaces, and it was more frequently associated with higher values of bone surface area and lower values of the implant-to-bone surface ratio. The type of implant (PEEK vs TC-PEEK cages) did not significantly influence the rate of implant subsidence. Conclusions Implant subsidence was significantly related to the value of a coefficient representing the ratio of the implant's surface area to the bone surface area of the adjacent vertebral bodies, with subsidence occurring significantly more rarely for coefficient values ≥ 0.37.
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Affiliation(s)
- Bartosz Godlewski
- Department of Orthopaedics and Traumatology, With Spinal Surgery Ward. Scanmed St. Raphael Hospital, ul. Adama Bochenka 12, 30-693, Cracow, Poland.
| | - Adam Bebenek
- Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, With Spinal Surgery Ward. Scanmed St. Raphael Hospital, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Grzegorz Karpinski
- Department of Orthopaedics and Traumatology, With Spinal Surgery Ward. Scanmed St. Raphael Hospital, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Piotr Cieslik
- Department of Orthopaedics and Traumatology, Military Institute of Medicine, Warsaw, Poland
| | - Tomasz Pawelczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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Godlewski B, Bebenek A, Dominiak M, Karpinski G, Cieslik P, Pawelczyk T. PEEK versus titanium-coated PEEK cervical cages: fusion rate. Acta Neurochir (Wien) 2022; 164:1501-7. [PMID: 35471708 DOI: 10.1007/s00701-022-05217-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed procedures for degenerative cervical disease. The evaluation of fusion status is still not fully standardized, and a variety of measurement methods are used. This study presents our own evaluation of fusion by comparing two types of implants. METHODS A total of 170 disc spaces were operated on in 104 patients using PEEK (polyetheretherketone) cages and titanium-coated (TC) PEEK cages. Patients were assigned to a specific implant using a randomisation table. Fusion status was evaluated based on functional radiographs and CT scans obtained at 12 months post-surgery. Multivariate mixed-effects logistic regression models were performed to assess the association of type of implant with different fusion rates. RESULTS At 12 months post-surgery, CT scans were performed in 86 patients (a total of 144 disc spaces) and conventional radiographs were obtained in 102 (a total of 166 disc spaces). Complete fusion was demonstrated in 101 cases (71.1%), partial fusion in 43 cases (29.9%). There were no cases of absence of fusion. A total of 85 PEEK cages (59%) and 59 TC-PEEK cages (41%) were implanted. For PEEK cages, complete fusion was seen in 75 (88.2%) disc spaces, compared to 26 (44.1%) achieved with TC-PEEK cages. A significantly higher proportion of complete fusions (B = 15.58; P < 0.0001) after 12 months was observed with PEEK implants compared to TC-PEEK implants. CONCLUSION Complete fusion was noted at 12 months post-surgery significantly more frequently with PEEK implants compared to TC-PEEK implants.
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Guyer RD, Coric D, Nunley PD, Sasso RC, Musacchio M, Bae HW, Peloza JH, Ohnmeiss DD. Single-Level Cervical Disc Replacement Using a PEEK-on-Ceramic Implant: Results of a Multicenter FDA IDE Trial With 24-Month Follow-up. Int J Spine Surg 2021; 15:633-644. [PMID: 34281951 DOI: 10.14444/8084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Many early cervical total disc replacements (TDRs) produced motion through a ball-and-socket action, with metal endplates articulating with a plastic core. Polyetheretherketone (PEEK) is used increasingly for spinal implants due to its mechanical properties and lack of artifacts on imaging. A TDR was designed with titanium-coated PEEK endplates and a ceramic core. The purpose of this study was to compare this TDR with anterior cervical discectomy and fusion (ACDF) to treat single-level cervical disc degeneration. METHODS This was a prospective, nonrandomized, historically controlled, multicenter US Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trial. Patients received the PEEK-on-ceramic Simplify® Cervical Artificial Disc (n = 150). The historic control group included 117 propensity-matched ACDF patients from an earlier IDE trial. The primary outcome was a composite success classification at the 24-month follow-up. Outcome measures included the Neck Disability Index (NDI), neurological status, adverse events, subsequent surgery, a visual analog scale assessing neck and arm pain, and the Dysphagia Handicap Index. Radiographic assessment included flexion/extension range of motion and heterotopic ossification. Facet joints were assessed at 24 months using MRI. RESULTS The success rate was significantly greater in the TDR group vs the ACDF group (93.0% vs 73.6%; P < .001). Mean NDI, neck pain, and arm pain scores improved significantly in both groups at all follow-up points. Mean NDI scores in the TDR group were significantly lower than ACDF scores at all follow-up points. There were no significant differences in the rates of serious adverse events. The range of motion of the TDR level had increased significantly by 3 months and remained so throughout follow-up. Facet joint assessment by MRI in the TDR group showed little change from preoperation. CONCLUSIONS The TDR had an acceptable safety profile and a significantly greater composite success rate than ACDF. These results support that the PEEK-on-ceramic TDR is a viable alternative to ACDF for single-level symptomatic disc degeneration. CLINICAL RELEVANCE This study found that the PEEK-on-ceramic TDR is a viable treatment for symptoms related to cervical disc degeneration and offers similar or superior outcomes compared with fusion. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Richard D Guyer
- Center for Disc Replacement at Texas Back Institute, Plano, Texas
| | - Domagoj Coric
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | | | | | | | - Hyun W Bae
- The Spine Institute, Los Angeles, California
| | | | - Donna D Ohnmeiss
- Center for Disc Replacement at Texas Back Institute, Plano, Texas.,Texas Back Institute Research Foundation, Plano, Texas
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Li W, Wang J, Sang L, Zu Y, Li N, Jian X, Wang F. Effect of
IR
‐laser treatment parameters on surface structure, roughness, wettability and bonding properties of fused deposition modeling‐printed
PEEK
/
CF. J Appl Polym Sci 2021. [DOI: 10.1002/app.51181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Weijie Li
- Department of Polymer Science and Materials, School of Chemical Engineering Dalian University of Technology Dalian China
| | - Jinyan Wang
- Department of Polymer Science and Materials, School of Chemical Engineering Dalian University of Technology Dalian China
- State Key Laboratory of Fine Chemicals Dalian University of Technology Dalian China
| | - Lin Sang
- School of Automotive Engineering Dalian University of Technology Dalian China
| | - Yuan Zu
- Department of Polymer Science and Materials, School of Chemical Engineering Dalian University of Technology Dalian China
| | - Nan Li
- Department of Polymer Science and Materials, School of Chemical Engineering Dalian University of Technology Dalian China
- State Key Laboratory of Fine Chemicals Dalian University of Technology Dalian China
| | - Xigao Jian
- Department of Polymer Science and Materials, School of Chemical Engineering Dalian University of Technology Dalian China
- State Key Laboratory of Fine Chemicals Dalian University of Technology Dalian China
| | - Fei Wang
- School of Opto‐Electronics Engineering Changchun University of Science and Technology Changchun China
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