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Original Articles

Regular Issue

Effect of Cage Material and Size on Fusion Rate and Subsidence Following Biportal Endoscopic Transforaminal Lumbar Interbody Fusion
Ki-Han You, Samuel K. Cho, Jae-Yeun Hwang, Sun-Ho Cha, Min-Seok Kang, Sang-Min Park, Hyun-Jin Park
Neurospine 2024;21(3):973-983.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448244.122

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Effect of Cage Material and Size on Fusion Rate and Subsidence Following Biportal Endoscopic Transforaminal Lumbar Interbody Fusion
Neurospine. 2024;21(3):973-983.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448244.122
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Effect of Cage Material and Size on Fusion Rate and Subsidence Following Biportal Endoscopic Transforaminal Lumbar Interbody Fusion
Neurospine. 2024;21(3):973-983.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448244.122
Close
Objective
Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is an emerging, minimally invasive technique performed under biportal endoscopic guidance. However, concerns regarding cage subsidence and sufficient fusion during BE-TLIF necessitate careful selection of an appropriate interbody cage to improve surgical outcomes. This study compared the fusion rate, subsidence, and other radiographic parameters according to the material and size of the cages used in BE-TLIF.
Methods
In this retrospective cohort study, patients who underwent single-segment BE-TLIF between April 2019 and February 2023 were divided into 3 groups: group A, regular-sized three-dimensionally (3D)-printed titanium cages; group B, regular-sized polyetheretherketone cages; and group C, large-sized 3D-printed titanium cages. Radiographic parameters, including lumbar lordosis, segmental lordosis, anterior and posterior disc heights, disc angle, and foraminal height, were measured before and after surgery. The fusion rate and severity of cage subsidence were compared between the groups.
Results
No significant differences were noted in the demographic data or radiographic parameters between the groups. The fusion rate on 1-year postoperative computed tomography was comparable between the groups. The cage subsidence rate was significantly lower in group C than in group A (41.9% vs. 16.7%, p=0.044). The severity of cage subsidence was significantly lower in group C (0.93±0.83) than in groups A (2.20±1.84, p=0.004) and B (1.79±1.47, p=0.048).
Conclusion
Cage materials did not affect the 1-year postoperative outcomes of BE-TLIF; however, subsidence was markedly reduced in large cages. Larger cages may provide more stable postoperative segments.

Citations

Citations to this article as recorded by  Crossref logo
  • Development and Validation of a Predictive Model and Web-Based Calculator for Cage Subsidence After Midline Lumbar Interbody Fusion (MIDLIF) Surgery
    Mingzheng Zhao, Honghao Yang, Shixuan Guo, Jun Miao, Zepei Zhang, Yangpu Zhang, Kuan Li, Fengqi Cheng, Jing Su, Yaoshen Zhang, Yong Hai, Yuzeng Liu
    Global Spine Journal.2026; 16(3): 1423.     CrossRef
  • Influence of surgical technique, interbody characteristics, and radiographic parameters on fusion rates across the disc space and posterolateral elements following transforaminal lumbar interbody fusion
    Zach Pennington, Abdelrahman Hamouda, Omar Hafz, Anthony L. Mikula, Michelle J. Clarke, William E. Krauss, Brett A. Freedman, Melvin D. Helgeson, Ahmad N. Nassr, Arjun S. Sebastian, Jeremy L. Fogelson, Benjamin D. Elder
    Clinical Neurology and Neurosurgery.2026; 261: 109285.     CrossRef
  • Sagittal Alignment and Clinical Outcomes After Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using a Single Expandable Cage: One Year Follow-up
    Sub-Ri Park, Namhoo Kim, Ji-Won Kwon, Kyung-Soo Suk, Hak-Sun Kim, Seong-Hwan Moon, Si-Young Park, Byung Ho Lee, Jae-Won Shin, Jin-Oh Park
    World Neurosurgery.2026; 205: 124698.     CrossRef
  • Advancements in unilateral biportal endoscopic lumbar interbody fusion: a narrative review
    Penghui Lv, Lu Li, Sichao Cheng, Jincheng Bai, Jianjun Chang
    European Journal of Medical Research.2026;[Epub]     CrossRef
  • A Review of Synthetic Bone Grafts in Lumbar Interbody Fusion
    Jaden Wise, Isabella Merem, Dahlia Wrubluski, Xuanzong Zhang, Ridge Weston, Min Shi, Maohua Lin, Frank D. Vrionis
    Bioengineering.2026; 13(3): 262.     CrossRef
  • Clinical and radiologic outcomes of expandable versus static cages in biportal endoscopic TLIF: focus on endplate injury and subsidence
    Tae Hoon Kang, Geumho Lee, Byungjun Kang, Jeongwoon Han, Hyun-jin Park, Minjoon Cho, Jae Hyup Lee
    Journal of Orthopaedic Surgery and Research.2026;[Epub]     CrossRef
  • En bloc discectomy via anterior lumbar approach: a technical note
    Harmantya Mahadhipta, Amri Muhyi, Muhamad Abdul Harist Fadhlizain, Mitchel Mitchel, Karina Sylvana Gani, Erica Kholinne
    SICOT-J.2026; 12: 19.     CrossRef
  • Clinical outcomes and radiologic parameters of percutaneous endoscopic posterior/transforaminal lumbar interbody fusion using rammed-earth technique
    Qingyang Kang, Zhilin Ge, Jiheng Zhan, Xuzhou Li, Guanwei Huang, Guoyi Su
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • Titanium-coated PEEK versus 3D-Printed Porous Titanium Cages in Transforaminal Lumbar Interbody Fusion: A Meta-analysis
    Youngmin Yu, Thomas Cho, Jiayong Liu
    Journal of Orthopaedics.2026;[Epub]     CrossRef
  • Clinical and radiological outcomes following biportal endoscopic lumbar interbody fusion: A comparative study of three interbody cage strategies
    Ju-Eun Kim, Hee Soo Kim, Daniel K. Park
    World Neurosurgery: X.2026; 31: 100604.     CrossRef
  • Clinical and Radiological Outcomes of Double-Cage Full Endoscopic Transforaminal Lumbar Interbody Fusion Compared with Posterior Lumbar Interbody Fusion : A Retrospective Cohort Study
    Chi Ho Kim, Pius Kim, Chang Il Ju, Jong Hun Seo
    Journal of Korean Neurosurgical Society.2026;[Epub]     CrossRef
  • Risk factors influencing cage retropulsion following lumbar interbody fusion in treating degenerative lumbar diseases: A comprehensive systematic review and meta-analysis
    Yong Liu, Hongyu Chen, Xiaoming Hu, Xiaokun Wu, Xiangui Yu, Hai Chen, Wenxiong Zhang, Limin Du
    Journal of Orthopaedic Science.2025; 30(5): 768.     CrossRef
  • Anterior Lumbar Interbody Fusion (ALIF) Versus Full-Endoscopic/Percutaneous TLIF With a Large-Footprint Interbody Cage: A Comparative Observational Study
    Christian Morgenstern, Francisco Nogueras, Geoffrey Delbos, Rudolf Morgenstern
    Global Spine Journal.2025; 15(6): 2910.     CrossRef
  • Goutallier grading of psoas major and lumbar extensor muscles as a predictor of cage subsidence and reoperation following transforaminal and posterior lumbar interbody fusion
    Frank Vazquez, Alex Tang, Ara Khoylyan, Tan Chen
    The Spine Journal.2025; 25(11): 2514.     CrossRef
  • In vitro comparison of endplate preparation in biportal endoscopic and microscopic tubular transforaminal lumbar interbody fusion procedures
    Min-Seok Kang, Samuel K. Cho, Samuel Q. Li, Fady Y. Hijji, Jun S. Kim, Sang-Min Park, Ki-Han You, Hyun-Jin Park
    The Spine Journal.2025; 25(10): 2326.     CrossRef
  • Development and internal validation of a risk score for subsidence of expandable spacers in transforaminal lumbar interbody fusion (TLIF) surgery
    Martin N. Stienen, Lorenzo Bertulli, Linda Bättig, Yesim Yildiz, Gregor Fischer, Laurin Feuerstein, Francis Kissling, Thomas Schöfl, Felix C. Stengel, Felix Corr, Silvio Heinig, Nader Hejrati, Daniele Gianoli, Stefan Motov, Michael Betz, Benjamin Martens
    Brain and Spine.2025; 5: 104322.     CrossRef
  • Novel Unilateral Biportal Endoscopy-Assisted Lumbar Fusion With Dual Hybrid Cage Insertion: A Technical Note With Case Presentation
    Jisoo Ha, Kuldeep Bansal, Chang-Wook Kim, Do-Hyoung Kim, Shreenidhi Kulkarni, Hee-Don Han
    Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(2): 230.     CrossRef
  • A Novel Switching Portal Technique in Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: Technical Notes and Comparative Outcomes
    Yun-Da Li, Chi-An Luo, Yung-Hsueh Hu, Wen-Chien Chen, Tsung-Ting Tsai, Po-Liang Lai, Tsai-Sheng Fu
    World Neurosurgery.2025; 203: 124511.     CrossRef
  • Biportal Endoscopic Lumbar Interbody Fusion Using the Oblique Lumbar Interbody Fusion Cage: Technical Note and Case Illustration
    Tran Vu Hoang Duong, Phan Quang Son, Le Tan Bao, Luc Dinh Phuong, Phan Dinh Thanh
    Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(2): 303.     CrossRef
  • Anterior Cervical Discectomy and Fusion Using Cages With Different Sized Windows
    Chengkun Zhao, Shijie Wang, Jingjing Zhang, Hegang Niu, Yun Cao, Hui Tao, Cailiang Shen, Yinshun Zhang
    Spine.2025; 50(22): 1556.     CrossRef
  • Comparative Clinical and Radiological Outcomes of Banana-Shaped Versus Straight Cages in Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: A Retrospective Cohort Study
    Nguyen Ngoc Thoi, Nguyen Le Hoang Tuan, Le Tuong Vien, Nguyen Thanh Nhan, Hoang Nguyen Anh Tuan, Nguyen Van Thanh, Tran Nguyen Phuong, Bui Hong Thien Khanh
    Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(2): 172.     CrossRef
  • Radiographic Analysis of Endplate Coverage of a 3-Dimensional-Expandable Transforaminal Lumbar Interbody Fusion (TLIF) Implant Compared to Static TLIF and Anterior Lumbar Interbody Fusion Implants
    Jacob Mazza, Manhal Siddiqi, John Paul G. Kolcun, Dominick Richards, Richard G. Fessler
    Neurospine.2025; 22(4): 891.     CrossRef
  • 9,412 View
  • 227 Download
  • 22 Web of Science
  • 22 Crossref
Biomechanical Effects of Proximal Polyetheretherketone Rod Extension on the Upper Instrumented and Adjacent Levels in a Human Long-Segment Construct: A Cadaveric Model
Bernardo de Andrada Pereira, Jennifer N. Lehrman, Anna G.U. Sawa, Piyanat Wangsawatwong, Jakub Godzik, David S. Xu, Jay D. Turner, Brian P. Kelly, Juan S. Uribe
Neurospine 2022;19(3):828-837.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244146.073

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Biomechanical Effects of Proximal Polyetheretherketone Rod Extension on the Upper Instrumented and Adjacent Levels in a Human Long-Segment Construct: A Cadaveric Model
Neurospine. 2022;19(3):828-837.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244146.073
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Biomechanical Effects of Proximal Polyetheretherketone Rod Extension on the Upper Instrumented and Adjacent Levels in a Human Long-Segment Construct: A Cadaveric Model
Neurospine. 2022;19(3):828-837.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244146.073
Close
Objective
The high mechanical stress zone at the sudden transition from a rigid to flexible region is involved in proximal junctional kyphosis (PJK) physiopathology. We evaluated the biomechanical performance of polyetheretherketone (PEEK) rods used as a nontraditional long semirigid transition phase from a long-segment metallic rod construct to the nonfused thoracic spine.
Methods
Pure moment range of motion (ROM) tests (7.5 Nm) were performed on 7 cadaveric spine segments followed by compression (200 N). Specimens were tested in the following conditions: (1) intact; (2) T10-pelvis pedicle screws and rods (PSRs); and (3) extending the proximal construct to T6 using PEEK rods (PSR+PEEK). T10–11 rod strain, T9 anterolateral bone strain, and T10 screw bending moments were analyzed.
Results
At the upper instrumented vertebra (UIV)+1, PSR+PEEK versus PSR significantly decreased ROM in flexion (115%, p = 0.02), extension (104%, p = 0.003), left lateral bending (46%, p = 0.02), and right lateral bending (63%, p = 0.008). Also, at UIV+1, PSR+PEEK versus intact significantly decreased ROM in flexion (111%, p = 0.01) and extension (105%, p = 0.003). The UIV+1 anterior column bone strain was significantly reduced with PSR+PEEK versus PSR during right lateral bending (p = 0.02). Rod strain polarities reversed with PEEK rods in all loading directions except compression.
Conclusion
Extending a long-segment construct using PEEK rods caused a decrease in adjacent-level hypermobility as a consequence of long-segment immobilization and also redistributed the strain on the UIV and adjacent levels, which might contribute to PJK physiopathology. Further studies are necessary to observe the clinical outcomes of this technique.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluation of Screw Loosening in Patients Undergoing Semi-rigid Stabilization with Polyetheretherketone (PEEK) Rods
    Nimetullah Alper Durmus, Ali Sahin, Sukru Oral, Halil Ulutabanca, Ahmet Kucuk, Rahmi Kemal Koc
    Indian Journal of Orthopaedics.2026;[Epub]     CrossRef
  • Proximal Junctional Kyphosis Prevention in Adult Spinal Deformity Surgery: A Technical Review of Tethering and Adjunctive Strategies
    Paritash Tahmasebpour, Pawel P. Jankowski, Jason Liang, Joshua Lin, Kyriakos D. Chatzis, Peter S. Tretiakov, Spencer Matthews, Louis Boissiere, John F. Burke, Christopher I. Shaffrey, Aaron Hockley, Peter Passias
    Operative Neurosurgery.2026;[Epub]     CrossRef
  • Relationship Between the Elastic Modulus of the Novel Pedicle Screw-Plate System and Biomechanical Properties Under Osteoporotic Condition: A Power-Law Regression Analysis Based on Parametric Finite Element Simulations
    Kaibin Wang, Chongyi Wang, Haipeng Si, Yanwei Zhang, Shaowei Sang, Runtong Zhang, Wencan Zhang, Junfei Chen, Chen Liu, Kunpeng Li, Bingtao Hu, Xiangyu Lin, Yunze Feng, Qingyang Fu, Zhihao Kang, Mingyu Xu, Dingxin Zhang, Wanlong Xu, Le Li
    Computer Methods and Programs in Biomedicine.2025; 265: 108760.     CrossRef
  • Optimizing Surgical Strategies for Preventing Proximal Junctional Complications: A Systematic Review and Meta-analysis of Operative Techniques in Adult Spinal Deformity
    HyungSub Jin, Kyung-Soo Suk, Byung Ho Lee, Si Young Park, Hak-Sun Kim, Seong-Hwan Moon, Sub-Ri Park, Namhoo Kim, Jae Won Shin, Ji-Won Kwon
    Neurospine.2025; 22(4): 1012.     CrossRef
  • A Biomechanical Comparison of 2 Different Topping-off Devices and Their Influence on the Sacroiliac Joint Following Lumbosacral Fusion Surgery
    Wei Fan, Song Yang, Jie Chen, Li-Xin Guo, Ming Zhang
    Neurospine.2024; 21(1): 244.     CrossRef
  • Application of Transverse Process Hooks at Distal Thoracic Vertebrae in Uppermost Vertebral Instrumentation for Adult Spinal Deformity Surgery: Special Focus on Delayed-Onset Neurologic Deficits
    Sun-Joon Yoo, Hyun-Jun Jang, Bong Ju Moon, Jeong-Yoon Park, Sung Uk Kuh, Dong-Kyu Chin, Keun-Su Kim, Jun Jae Shin, Yoon Ha, Kyung-Hyun Kim
    Neurospine.2024; 21(4): 1219.     CrossRef
  • Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients
    Chih-Chang Chang, Hsuan-Kan Chang, Chin-Chu Ko, Ching-Lan Wu, Yi-Hsuan Kuo, Tsung-Hsi Tu, Wen-Cheng Huang, Jau-Ching Wu
    Neurospine.2023; 20(1): 308.     CrossRef
  • Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study
    Sun Geon Yoon, Hyung Chang Lee, Sang-Min Lee
    Neurospine.2023; 20(1): 301.     CrossRef
  • 6,001 View
  • 183 Download
  • 9 Web of Science
  • 8 Crossref

Minimally Invasive Spinal Surgery SMISS-Neurospine Special Issue

Comparison Between 3-Dimensional-Printed Titanium and Polyetheretherketone Cages: 1-Year Outcome After Minimally Invasive Transforaminal Interbody Fusion
Do-Yeon Kim, O-Hyuk Kwon, Jeong-Yoon Park
Neurospine 2022;19(3):524-532.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244140.070

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Comparison Between 3-Dimensional-Printed Titanium and Polyetheretherketone Cages: 1-Year Outcome After Minimally Invasive Transforaminal Interbody Fusion
Neurospine. 2022;19(3):524-532.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244140.070
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Comparison Between 3-Dimensional-Printed Titanium and Polyetheretherketone Cages: 1-Year Outcome After Minimally Invasive Transforaminal Interbody Fusion
Neurospine. 2022;19(3):524-532.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244140.070
Close
Objective
Three-dimensional (3D)-printed titanium implants have been developed recently, but the utility is not yet proven. The aim of this study was to compare 3D-printed titanium and polyetheretherketone (PEEK) implants after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
Methods
Between October 2018 and September 2021, we retrospectively analyzed 83 patients who underwent single-level MIS-TLIF (3D-printed titanium, 40; PEEK, 43). Radiologic parameters were assessed with x-ray and computed tomography (CT) at postoperative 1 week, 6 months, and 1 year. Clinical status was evaluated using Oswestry Disability Index, visual analogue scale score, and Bridwell fusion grading was assessed on 6-month and 1-year postoperative CT.
Results
There were no differences between the 2 groups in demographics and clinical outcomes. At 1-year of follow-up, the reported 3D-printed titanium fusion grades were grade I: 77.5% (31 patients), grade II: 17.5% (7 patients), and grade III: 5% (2 patients). The PEEK fusion grades were grade I: 51.2% (22 patients), grade II: 41.9% (18 patients), and grade III: 7.0% (3 patients). For overall fusion rate (grade I + II), there was no difference between the 2 cages (95.0% vs. 93.0%, p = 0.705), but grade I was reported at a higher incidence in 3D-printed titanium than PEEK (77.5% vs. 51.2%, p = 0.013). There was no difference between cages based on subsidence and complications.
Conclusion
There were no significant differences in the overall fusion rate for MIS-TLIF surgery between 3D-printed titanium and PEEK, but the fusion grade was better in 3D-printed titanium than in PEEK. Long-term follow-up is required to verify the effectiveness.

Citations

Citations to this article as recorded by  Crossref logo
  • Do Three-Dimensional Printed Porous Titanium Relative to Polyetheretherketone Interbody Cages Reduce Complications and Revisions after Transforaminal Lumbar Interbody Fusion?
    Hannah A. Levy, Abdelrahman M. Hamouda, Christopher A. Magera, Jayanth Kumar, Cassandra Willson, Brian C. Goh, James T. Bernatz, Benjamin D. Elder, Brett A. Freedman, Arjun S. Sebastian
    Global Spine Journal.2026; 16(1): 185.     CrossRef
  • Lumbar Fusion With Micro- & Nano-Textured, 3D Printed Porous Titanium Versus PEEK Interbody Cages in TLIF: A Single-Blinded, Randomized Controlled Trial
    Joshua H. Weinberg, Nathan Ritchey, Witty Kwok, Shravani Khisti, Bryan Ladd, Stephanus Viljoen, Siri S. Khalsa, David S. Xu, Andrew J. Grossbach
    Global Spine Journal.2026; 16(1): 434.     CrossRef
  • Evaluation of the porosity and structural stability of 3D-printed porous titanium pedicle screws using finite element analysis
    Kwang Hyeon Kim, Junsu Bae, Kyeong-Joo Yoo, Seonghoon Jeong, Byung-Jou Lee
    Biomedical Engineering Letters.2026; 16(1): 55.     CrossRef
  • Three-Dimensional Printing of a Spinal Interbody: Design Principles, Biomaterials, and Translational Considerations
    Sahil Garg, Patrick Young, Christopher Franquemont, Rachel Conley, Sanjitpal Gill
    Journal of Functional Biomaterials.2026; 17(3): 143.     CrossRef
  • Optimal cage biomaterials for fusion and subsidence outcomes in lumbar spinal fusion: a network meta-analysis of 4881 patients
    Gilberto Perez Rodriguez Garcia, James Kelbert, Dana Saleh, Annemarie Pico, Nikhil Dholaria, Giovanni Barbagli, Zachary Wetsel, Salma Bakr, Tyler Krall, Vick Sahni, Amna Hussein, Joseph Georges, Sananthan Sivakanthan, Michael Prim, Ali A. Baaj
    European Spine Journal.2026;[Epub]     CrossRef
  • Titanium-coated PEEK versus 3D-Printed Porous Titanium Cages in Transforaminal Lumbar Interbody Fusion: A Meta-analysis
    Youngmin Yu, Thomas Cho, Jiayong Liu
    Journal of Orthopaedics.2026;[Epub]     CrossRef
  • Trabecular Bone Remodeling after Posterior Lumbar Interbody Fusion: Comparison of the Osseointegration in Three-Dimensional Porous Titanium Cages and Polyether-Ether-Ketone Cages
    Naoki Segi, Hiroaki Nakashima, Sadayuki Ito, Jun Ouchida, Ryotaro Oishi, Ippei Yamauchi, Yuichi Miyairi, Yoshinori Morita, Tomohiro Matsumoto, Shunsuke Kanbara, Keigo Ito, Shiro Imagama
    Global Spine Journal.2025; 15(1): 66.     CrossRef
  • A comprehensive review on the State of the Art in the research and development of poly-ether-ether-ketone (PEEK) biomaterial-based implants
    Prabaha Sikder
    Acta Biomaterialia.2025; 191: 29.     CrossRef
  • Evaluation of Healthcare Outcomes of Patients Treated with 3D-Printed-Titanium and PEEK Cages During Fusion Procedures in the Lumbar Spine
    Katherine Corso, Andreas Teferra, Annalisa Michielli, Kristin Corrado, Amy Marcini, Mark Lotito, Caroline Smith, Michelle Costa, Jill Ruppenkamp, Anna Wallace
    Medical Devices: Evidence and Research.2025; Volume 18: 37.     CrossRef
  • 3D Printed Titanium Scaffolds with Bi‐Directional Gradient QK‐Functionalized Surface
    Xiaoyun Sun, Ru Zhong, Congcong Wu, Silin Ye, Haipeng Yuan, Zhou Fang, Junjian Chen, Delin Cheng, Lijing Hao, Lei Chu, Lin Wang
    Advanced Materials.2025;[Epub]     CrossRef
  • Clinical and radiological outcomes of titanium cage versus polyetheretherketone cage in lumbar interbody fusion: a systematic review and meta-analysis
    Haozhong Wang, Hao Zhang, Changming Xiao, Kaiquan Zhang, Lisheng Qi
    Neurosurgical Review.2025;[Epub]     CrossRef
  • Clinical and radiological outcomes of posterior lumbar interbody fusion with titanium cage
    Ehab A.E. Elshal, Amer A. Mostafa, Mohammed A.E.B.A. Elfattah
    Al-Azhar Assiut Medical Journal.2025; 23(1): 1.     CrossRef
  • Advancements in biomaterials and bioactive solutions for lumbar spine fusion cages: Current trends and future perspectives
    Iulian Antoniac, Veronica Manescu (Paltanea), Gheorghe Paltanea, Aurora Antoniac, Marco Fosca, Dan Laptoiu, Julietta V. Rau
    Bioactive Materials.2025; 53: 656.     CrossRef
  • Comparative Analysis Between Single and Double 3-Dimensional Printed Titanium Cages: 1-Year Outcomes After Unilateral Biportal Endoscopic Transforaminal Lumbar Interbody Fusion
    Ji Yeon Kim, Jin Hong Hyun, Su Yong Choi, Dong Chan Lee, Hyeun Sung Kim, Dong Hwa Heo
    Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(Suppl 2): S225.     CrossRef
  • Current Applications and Future Directions of Technologies Used in Adult Deformity Surgery for Personalized Alignment: A Narrative Review
    Janet Hsu, Taikhoom M. Dahodwala, Noel O. Akioyamen, Evan Mostafa, Rami Z. AbuQubo, Xiuyi Alexander Yang, Priya K. Singh, Daniel C. Berman, Rafael De la Garza Ramos, Yaroslav Gelfand, Saikiran G. Murthy, Jonathan D. Krystal, Ananth S. Eleswarapu, Mitchell
    Journal of Personalized Medicine.2025; 15(10): 480.     CrossRef
  • Expandable Cage in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparative Data with Static Cage from a Single Institution and a Single Surgeon
    Dongkyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Jeong Yoon Park
    World Neurosurgery.2025; 202: 124428.     CrossRef
  • Comparative Evaluation of PEEK, 3D-Printed Titanium Mesh and Solid Titanium Implants on HU Distortion and Dose Calculation Accuracy in Radiotherapy
    Sook Yang, Euncheol Choi, Seung Gyu Park, Byungyong Kim, Ye Won Kim, Myeongsoo Kim
    Applied Sciences.2025; 15(20): 11264.     CrossRef
  • Is Ti-Coated PEEK Superior to PEEK for Lumbar and Cervical Fusion Procedures? A Systematic Review and Meta-Analysis
    Julia Kincaid, Richelle J. Kim, Akash Verma, Ryan W. Turlip, David D. Liu, Daksh Chauhan, Mert Marcel Dagli, Richard J. Chung, Hasan S. Ahmad, Yohannes Ghenbot, Ben Gu, Jang Won Yoon
    Journal of Clinical Medicine.2025; 14(21): 7696.     CrossRef
  • 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
    Yuchen Duan, Dagang Feng, Tong Li, Yiran Wang, Leiming Jiang, Yong Huang
    World Neurosurgery.2024; 183: 144.     CrossRef
  • Expandable Cages for Lumbar Interbody Fusion: A Narrative Review
    Soo-Bin Lee, Jonghun Yoon, Sung-Jun Park, Dong-Sik Chae
    Journal of Clinical Medicine.2024; 13(10): 2889.     CrossRef
  • A comparison of transforaminal lumbar interbody fusion (TLIF) cage material on fusion rates: A systematic review and network meta-analysis
    Sutipat Pairojboriboon, Supranee Niruthisard, Chandhanarat Chandhanayingyong, Chalinee Monsereenusorn, Siwaporn Poopan, Sheng-Fu Larry Lo
    World Neurosurgery: X.2024; 23: 100392.     CrossRef
  • Evolution of Titanium Interbody Cages and Current Uses of 3D Printed Titanium in Spine Fusion Surgery
    Justin J. Lee, Freddy P. Jacome, David M. Hiltzik, Manasa S. Pagadala, Wellington K. Hsu
    Current Reviews in Musculoskeletal Medicine.2024; 18(12): 635.     CrossRef
  • Effect of Cage Material and Size on Fusion Rate and Subsidence Following Biportal Endoscopic Transforaminal Lumbar Interbody Fusion
    Ki-Han You, Samuel K. Cho, Jae-Yeun Hwang, Sun-Ho Cha, Min-Seok Kang, Sang-Min Park, Hyun-Jin Park
    Neurospine.2024; 21(3): 973.     CrossRef
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Vertebral Endplate Cyst Formation in Relation to Properties of Interbody Cages
Manabu Sasaki, Masao Umegaki, Takanori Fukunaga, Yasukazu Hijikata, Yohei Banba, Katsumi Matsumoto, Yasuyoshi Miyao
Neurospine 2021;18(1):170-176.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040498.249

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Vertebral Endplate Cyst Formation in Relation to Properties of Interbody Cages
Neurospine. 2021;18(1):170-176.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040498.249
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Vertebral Endplate Cyst Formation in Relation to Properties of Interbody Cages
Neurospine. 2021;18(1):170-176.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040498.249
Close
Objective
This retrospective study aimed to compare vertebral endplate cyst formation (VECF), an early predictor for pseudoarthrosis, in different types of interbody cages.
Methods
We reviewed 84 cases treated with single-level posterior/transforaminal lumbar interbody fusion. We utilized a polyetheretherketone cage in 20 cases (group P), a titanium cage in 16 cases (group Ti), a titanium-coating polyetheretherketone cage in 13 cases (group TiP) and a porous tantalum cage in 35 cases (group Tn). VECF was evaluated comparing the computed tomography scans taken at day 0 and 6-month postoperation. We defined VECF (+) as enlargement of a pre-existing cyst or de novo formation of a cyst with the diameter over 2 mm. We calculated the adjusted odds ratio (OR) and 95% confidence intervals (CIs) as an indicator of association between different types of cages and VECF using a logistic regression model.
Results
VECF was observed in 13 (65%), 7 (44%), 9 (69%), and 8 (23%) cases in groups P, Ti, TiP and Tn, respectively. VECF correlated with the type of cage (p = 0.04). In comparison with group P, the proportion of VECF (+) cases was lower in group Tn (OR, 0.16; 95% CI, 0.04–0.60) but not different in group Ti (OR, 0.47; 95% CI, 0.10–2.20) and group TiP (OR, 1.06; 95% CI, 0.21–5.28). No patient underwent additional surgery for the fused spinal level during the follow-up periods (average, 37.9 months; range, 6–76 months).
Conclusion
VECF was the least in the porous Tn cage, suggesting its potential superiority for initial stability.

Citations

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  • Comparative Effects of Porous Tantalum and Porous Titanium: A Systematic Review and Meta-Analysis
    Youhao Wang, Zehao Jing, Lu Xu, Xu Yang, Renhua Ni, Hong Cai, Weishi Li
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  • Sagittal Alignment and Clinical Outcomes After Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using a Single Expandable Cage: One Year Follow-up
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    World Neurosurgery.2026; 205: 124698.     CrossRef
  • Comprehensive Learning Curve, Clinical Outcomes, and Radiological Evaluation of Modified Trans-Kambin Endoscopic Lumbar Interbody Fusion at over 1-Year Follow-Up
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    World Neurosurgery.2026; 207: 124818.     CrossRef
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    European Spine Journal.2026;[Epub]     CrossRef
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    Tarek Elfiky, Yaser El Mansy, Martin N. Stienen, Abdelrahman Sa'ed Alabsi, Mahmoud Nafady
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    Neurosurgical Review.2025;[Epub]     CrossRef
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Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature
Elie Massaad, Nida Fatima, Ali Kiapour, Muhamed Hadzipasic, Ganesh M. Shankar, John H. Shin
Neurospine 2020;17(1):125-135.   Published online March 31, 2020
DOI: https://doi.org/10.14245/ns.2040058.029
Correction in: Neurospine 2020;17(2):473

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Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature
Neurospine. 2020;17(1):125-135.   Published online March 31, 2020
DOI: https://doi.org/10.14245/ns.2040058.029
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Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature
Neurospine. 2020;17(1):125-135.   Published online March 31, 2020
DOI: https://doi.org/10.14245/ns.2040058.029
Close
Objective
Lumbar fusion with implantation of interbody cage is a common procedure for treatment of lumbar degenerative disease. This study aims to compare the fusion and subsidence rates of titanium (Ti) versus polyetheretherketone (PEEK) interbody cages after posterior lumbar interbody fusion and investigate the effect of clinical and radiological outcomes following fusion on patient-reported outcomes.
Methods
A systematic search strategy of 4 electronic databases (MEDLINE, Embase, Web of Science, and Cochrane) was conducted using different MeSH (medical subject headings) terms until January 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using fixed and random-effect models based upon the heterogeneity (I2) to estimate the association between interbody cages and the measured outcomes.
Results
A total of 1,094 patients from 11 studies were reviewed. The final analysis included 421 patients (38.5%) who had lumbar surgery using a Ti and/or a Ti-coated interbody cage and 673 patient (61.5%) who had lumbar surgery using a PEEK cage. Overall, PEEK interbody devices were associated with a significantly lower fusion rate compared with Ti interbody devices (OR, 0.62; 95% CI, 0.41–0.93; p = 0.02). There was no difference in subsidence rates between Ti and PEEK groups (OR, 0.91; 95% CI, 0.54–1.52; p = 0.71). Also, there were no statistically significant differences in visual analogue scale (VAS)-low back pain (p = 0.14) and Japanese Orthopedic Association scale (p = 0.86) between the 2 groups. However, the PEEK group had lower odds of leg pain after surgery compared to the Ti group (OR [VAS-leg], 0.61; 95% CI, 0.28–0.94; p = 0.003).
Conclusion
Ti and Ti-coated PEEK cages used for posterior lumbar interbody fusion are associated with similar rates of subsidence, but a higher rate of fusion compared to PEEK interbody cages. Randomized controlled trials are needed to better assess the effect of cage materials and potential factors that could influence the outcomes of interbody lumbar fusion.

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Clinical Article

Comparison between Two Different Cervical Interbody Fusion Cages in One Level Stand-alone ACDF: Carbon Fiber Composite Frame Cage Versus Polyetheretherketone Cage
Minwook Yoo, Wook-Ha Kim, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim
Korean J Spine 2014;11(3):127-135.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.127

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Comparison between Two Different Cervical Interbody Fusion Cages in One Level Stand-alone ACDF: Carbon Fiber Composite Frame Cage Versus Polyetheretherketone Cage
Korean J Spine. 2014;11(3):127-135.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.127
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Comparison between Two Different Cervical Interbody Fusion Cages in One Level Stand-alone ACDF: Carbon Fiber Composite Frame Cage Versus Polyetheretherketone Cage
Korean J Spine. 2014;11(3):127-135.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.127
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Objective

The authors conducted a retrospective study to compare the implantation of carbon fiber composite frame cages (CFCFCs) to the implantation of polyetheretherketone (PEEK) cages after anterior cervical discectomy for cervical degenerative disc disease. In addition, the predictive factors that influenced fusion or subsidence were investigated.

Methods

A total of 58 patients with single-level degenerative disc disease were treated with anterior cervical discectomy and implantation of stand-alone cages; CFCFCs were used in 35 patients, and PEEK cages were used in 23 patients. Preoperative and postoperative radiological and clinical assessments were performed.

Results

During the mean follow-up period of 41 months, fusion occurred in 43 patients (74.1%), and subsidence developed in 18 patients (31.0%). Pain decreased in all patients, and the patients' satisfaction rate was 75.9%. Neither fusion nor subsidence was related to the clinical outcome. There were no significant differences in the clinical and radiological outcomes between the CFCFC and the PEEK cage groups. Smoking history (p=0.023) was significantly associated with pseudarthrosis, and cage height (≥7mm) (p=0.037) were significantly associated with subsidence.

Conclusion

The clinical and radiological results were similar between the CFCFC and the PEEK cage groups. Fusion or subsidence did not affect the clinical outcomes. Smoking history and cage height (≥7mm) were predictive factors for pseudarthrosis or subsidence in anterior cervical discectomy and fusion with stand-alone cages.

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  • 12,641 View
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  • 19 Crossref

Review

Development and Perspective of Biomaterials for Spinal Fusion.
Byung Ho Yoon, Hyeon Ee Kim
Korean J Spine 2010;7(4):221-227.

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Development and Perspective of Biomaterials for Spinal Fusion.
Korean J Spine. 2010;7(4):221-227.
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Development and Perspective of Biomaterials for Spinal Fusion.
Korean J Spine. 2010;7(4):221-227.
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In this article, research trend of biomaterials for spinal fusion was summarized with an emphasis on hydroxyapatite (HA), titanium(Ti), and polyetheretherketone (PEEK) as representatives of ceramics, metals, and polymers, respectively. Ceramic materials represented by HA are highly biocompatible but have low strength and fracture toughness, so there has been much effort to improve these mechanical properties. Metals such as titanium, Ti, are mechanically strong but have a drawback of stress shielding effect, which can be avoided by fabricating into porous body. Also there have been many researches to improve the biocompatibility of PEEK, which has been widely used recently as a substitute to Ti.
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