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"Polyetheretherketone cage"

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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
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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
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; 77: 124.     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; 69(4): 596.     CrossRef
  • Preoperative coronal magnetic resonance imaging: a critical evaluation of the Kambin’s triangle for the transforaminal lumbar interbody fusion procedure
    Koopong Siribumrungwong, Bunyaporn Wuttiworawanit, Punnawit Pinitchanon, Chanon Chiarnpattanodom, Thongchai Suntharapa
    Asian Spine Journal.2026;[Epub]     CrossRef
  • Impact of endplate–graft geometric matching on cage subsidence following stand-alone lateral lumbar interbody fusion: a finite element analysis
    Youchen Ye, Hao Li, Fangcai Li
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • 3D-Printed Porous Titanium versus Polyetheretherketone Cages in Lumbar Interbody Fusion: A Prospective, Multicenter, Randomized Controlled Trial with Bone Mineral Density Stratification
    Jae-Won Shin, Mun-Su Park, Ji-Won Kwon, Sang-Ho Kim, Joonoh Seo, Hak-Sun Kim, Kyung-Soo Suk, Seong Hwan Moon, Si-Young Park, Byung Ho Lee
    The Spine Journal.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
  • 9,823 View
  • 232 Download
  • 25 Web of Science
  • 25 Crossref

Clinical Article

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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
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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
Close
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.

Citations

Citations to this article as recorded by  Crossref logo
  • Adverse Impact of Smoking on Spine Fusion and Patient-Reported Outcomes: A Systematic Review and Meta-Analysis
    P.M. Arnold, J.S. Harrop, G. Mariscal, R.C. Sasso, M.P. Steinmetz, C.D. Chaput, W.B. Jacobs, C.D. Witiw, J.E. O'Toole
    Global Spine Journal.2026; 16(2): 1329.     CrossRef
  • Four-level ACDF surgical series 2000–2022: a systematic review of clinical and radiological outcomes and complications
    Alisa Arnautovic, Joseph Mijares, Emir Begagić, Adi Ahmetspahić, Mirza Pojskić
    British Journal of Neurosurgery.2025; 39(6): 750.     CrossRef
  • Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review and meta-analysis
    Floor E. de Vries, Azra Gül, Ignacio Mesina-Estarrón, Rania A. Mekary, Carmen L. A. Vleggeert-Lankamp
    Neurosurgical Review.2025;[Epub]     CrossRef
  • Facet Distraction Distance Independently Predicts Cage Subsidence Following Anterior Cervical Discectomy and Fusion
    Chengkun Zhao, Shijie Wang, Jingjing Zhang, Hegang Niu, Yun Cao, Cailiang Shen, Yinshun Zhang
    World Neurosurgery.2025; 198: 123960.     CrossRef
  • Considering the Effects of Age and Patient Factors on Subsidence and Implant Selection in Anterior Cervical Discectomy and Fusion
    Jeffrey B. Weinreb, Jake Carbone, Hershil Patel, Amit Ratanpal, Rohan I. Suresh, Tyler J. Pease, Ryan A. Smith, Joseph Blommer, Anthony K. Chiu, Idris Amin, Louis J. Bivona, Julio J. Jauregui, Daniel L. Cavanaugh, Eugene Y. Koh, Charles A. Sansur, Steven
    Clinical Spine Surgery.2025;[Epub]     CrossRef
  • How to Choose the Measurement Methods for Cage Subsidence Following Anterior Cervical Discectomy and Fusion?
    Chengkun Zhao, Shijie Wang, Jingjing Zhang, Hegang Niu, Yun Cao, Cailiang Shen, Yinshun Zhang
    World Neurosurgery.2025; 203: 124485.     CrossRef
  • Structural Allograft Versus Mechanical Interbody Devices Augmented With Osteobiologics in Anterior Cervical Discectomy and Fusion: A Systematic Review
    Amit Jain, Suraj Dhanjani, Andrew Harris, Miguel Cartagena, Jacob Babu, Daniel Riew, John Shin, Jeffrey C. Wang, S. Tim Yoon, Zorica Buser, Hans Jörg Meisel
    Global Spine Journal.2024; 14(2_suppl): 34.     CrossRef
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    Lan-Li Hsueh, Yu-Cheng Yeh, Meng-Ling Lu, Chi-An Luo, Ping-Yeh Chiu, Po-Liang Lai, Chi-Chien Niu
    Scientific Reports.2023;[Epub]     CrossRef
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    Chiduziem Onyedimma, Ousman Jallow, Yagiz U. Yolcu, Mohammed Ali Alvi, Anshit Goyal, Abdul Karim Ghaith, Atiq ur Rehman Bhatti, Kingsley Abode-Iyamah, Alfredo Quinones-Hinojosa, Brett A. Freedman, Mohamad Bydon
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    Frizzi Mayer, Franziska Heider, Florian Haasters, Christoph Mehren, Panagiotis Korovessis
    BioMed Research International.2022;[Epub]     CrossRef
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  • Single-Level Anterior Cervical Discectomy and Interbody Fusion: A Comparison between Porous Tantalum and Polyetheretherketone Cages
    Edoardo Mazzucchi, Giuseppe La Rocca, Andrea Perna, Fabrizio Pignotti, Gianluca Galieri, Vincenzo De Santis, Pierluigi Rinaldi, Francesco Ciro Tamburrelli, Giovanni Sabatino
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    Jared D. Ament, Amir Vokshoor, Randy Yee, J. Patrick Johnson
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  • Correlation Between Different Interbody Grafts and Pseudarthrosis After Anterior Cervical Discectomy and Fusion Compared with Control Group: Systematic Review
    Eduardo Augusto Iunes, Enrico Affonso Barletta, Telmo Augusto Barba Belsuzarri, Franz Jooji Onishi, Sergio Cavalheiro, Andrei Fernandes Joaquim
    World Neurosurgery.2020; 134: 272.     CrossRef
  • Anterior cervical discectomy and fusion: Techniques, complications, and future directives
    Heath Gould, Omar A. Sohail, Colin M. Haines
    Seminars in Spine Surgery.2020; 32(1): 100772.     CrossRef
  • Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review
    I. Noordhoek, M. T. Koning, C. L. A. Vleggeert-Lankamp
    European Spine Journal.2019; 28(2): 386.     CrossRef
  • Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: a systematic review
    Iris Noordhoek, Marvyn T. Koning, Wilco C. H. Jacobs, Carmen L. A. Vleggeert-Lankamp
    Acta Neurochirurgica.2018; 160(4): 873.     CrossRef
  • Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter “PIERCE-PEEK” study
    Olaf Suess, Martin Schomaker, Mario Cabraja, Marco Danne, Theodoros Kombos, Michael Hanna
    Patient Safety in Surgery.2017;[Epub]     CrossRef
  • Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages
    Woong-Beom Kim, Seung-Jae Hyun, Hoyong Choi, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim
    Journal of Korean Neurosurgical Society.2016; 59(4): 385.     CrossRef
  • 12,852 View
  • 112 Download
  • 19 Crossref