Comparison of Fusion, Subsidence, and Clinical Results Between 3D-Printed Porous Titanium Cage and Polyetheretherketone Cage in Posterior Lumbar Interbody Fusion: A Minimum of 2 Years Follow-Up

Abstract

The occurrence of early osteointegration and reduced modulus of elasticity have been proved with 3-dimensinally (3D) printed porous titanium (3DP-titanium) cages used for posterior lumbar interbody fusion (PLIF). The present study was conducted to demonstrate the fusion rate, subsidence, and clinical outcomes for the 3DP-titanium cage in PLIF and to compare its results with those of the polyetheretherketone (PEEK) cage. A total of 150 patients who underwent 1-2-level PLIF and were followed up for >2 years were retrospectively reviewed. The fusion rates, subsidence, segmental lordosis, visual analog scale (VAS) score for back pain, VAS score for leg pain, and Oswestry disability index were assessed. A higher 1-year (3DP-titanium, 86.9%; PEEK, 67.7%; P= 0.002) and 2-year (3DP-titanium, 92.9%; PEEK, 82.3%; P= 0.037) fusion rate could be achieved with 3DP-titanium cages for PLIF than with PEEK cages. The amount of subsidence (3DP-titanium, 1.4 ± 1.6 mm; PEEK, 1.9 ± 1.8 mm; P= 0.092) and incidence of significant subsidence (3DP-titanium, 17.9%; PEEK, 23.4%; P= 0.389) was not significantly different between the 2 materials. Furthermore, the VAS score for back pain and leg pain and Oswestry disability index were not significantly different between the 2 groups. On logistic regression analysis, cage material (P= 0.027) showed a significant association with fusion, and the number of levels fused (P= 0.012) was associated with subsidence. The 3DP-titanium cage resulted in a higher fusion rate than the PEEK cage when used for PLIF. The subsidence rate did not differ significantly between the 2 cage materials. Therefore, the 3DP-titanium cage can be safely used for PLIF, considering its stable construct.