Titanium cage may be effective alternative to PEEK cage for interbody fusion
Click Here to Manage Email Alerts
Published results showed use of a titanium posterior lumbar cage for interbody fusion may be an effective alternative to polyetheretherketone cages regarding patient-reported outcomes and radiological parameters of surgical success.
Byron F. Stephens II, MD, MSCI, and colleagues assessed patient demographics, disease characteristics, treatment variables, surgical details and all 90-day surgical morbidity among 228 patients who underwent elective lumbar interbody fusion for degenerative disc disease from November 2010 to April 2019. Researchers included a historical PEEK cohort that spanned from the beginning of the enrollment period to the end date, as well as patients who received the Tritanium posterior lumbar cage (Stryker) and were included from 2015 to the end of enrollment in April 2019.
At baseline and at 3 and 12 months postoperatively, researchers assessed patient-reported outcomes, including Oswestry Disability Index (ODI), numeric rating scales (NRS) for low back pain and leg pain, EuroQol-5D. They also assessed return to work, surgery-related readmission or return to the OR. Researchers calculated the direct and indirect costs of the procedures with data from the hospital discharge and billing records for inpatient hospital stay and surgery.
Although no differences between the two groups were found regarding the 3- or 12-month EQ-5D or NRS for leg pain or back pain, results showed patients who received the titanium interbody cage had better ODI scores vs. the PEEK interbody cage group at 3 and 12 months.
Among 200 patients with radiological follow-up within the first year of lumbar interbody fusion, researchers found 90% of patients in the titanium cohort and 73% of patients in the PEEK cohort had intact fusion of the surgical levels with no complications. Researchers also noted 23.5% of patients in the titanium group had incidences of subsidence of the cage compared with 40% of patients in the PEEK group.
The two groups had no statistical differences in the direct cost of surgery and episode of care, according to results. However, researchers found the PEEK group had higher indirect costs for health care resource utilization.
“These data need to be interpreted with caution. It is important to point out that we found no significant difference between the groups with respect to EQ-5D, numeric rating scale back or numeric rating scale leg pain between the groups. There also may be confounding variables that could better explain the differences seen between the titanium and PEEK groups,” Stephens told Healio. “That being said, these data can certainly be interpreted, in my opinion, as saying that the titanium cages are at least not inferior to the PEEK options. The bottom line is that surgeons should use what implant they see fit for the individual patient’s needs and porous, ingrowth titanium cages are an option for lumbar interbody fusion.”
Perspective
Back to Top
The authors report superiority of the Tritanium posterior lumbar device (Stryker) in comparison to PEEK cages in a study of patients undergoing transforaminal lumbar interbody fusion. The authors conclude the Tritanium posterior lumbar device is superior regarding postoperative disability outcomes, fusion and subsidence rates, and total health care costs. Strengths of the study include the sample size of 228 patients and methodology of fusion rate evaluation; however, there are several severe limitations to the conclusions reported. Primarily, this study was non-randomized with an unclear rationale as to how each patient was assigned to Tritanium posterior lumbar or PEEK cohorts. Furthermore, two different varieties of PEEK cages were included. Additionally, no CT evidence of fusion is performed. Lastly, the senior author appears to be a consultant for Stryker with a Stryker research grant, potentially resulting in unintentional bias. The confounding variables make it challenging to draw meaningful conclusions that could potentiate clinical changes in practice.
Reference:
Seaman S, et al. J Clin Neurosci. 2017;doi:10.1016/j.jocn.2017.06.062.
Collapse
Read more about
Click Here to Manage Email Alerts