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PEEK Cages in Lumbar Fusion: Mid-term Clinical Outcome and Radiologic Fusion
Janneke J P Schimmel1, Marcel S Poeschmann, Philip P Horsting
1Sint Maartenskliniek, Nijmegen, The Netherlands.
Clinical Spine Surgery
|May 20, 2016
Summary
High reoperation rates after anterior lumbar interbody fusion using polyetheretherketone (PEEK) cages were observed, primarily due to pseudarthrosis. These findings suggest potential issues with initial stability and fusion assessment, necessitating clinical vigilance for persistent back pain.
Area of Science:
- Spinal Surgery
- Orthopedic Biomaterials
- Radiology
Background:
- Anterior lumbar interbody fusion (ALIF) is an option for chronic low back pain after conservative treatment failure.
- Polyetheretherketone (PEEK) cages aim to improve upon titanium cages by reducing subsidence and aiding fusion evaluation.
- The Synfix-LR PEEK cage was investigated as an alternative to traditional methods.
Purpose of the Study:
- To evaluate the mid-term clinical outcomes and radiologic fusion rates in patients undergoing ALIF with Synfix-LR PEEK cages.
- To assess the incidence of reoperations and identify reasons for failure.
Main Methods:
- A historical cohort analysis of 95 patients undergoing single or double-level ALIF with Synfix-LR cages.
- Clinical outcomes were measured using the Oswestry Disability Index (ODI).
- Radiologic fusion was assessed via computed tomography (CT) scans using a novel scoring system.
Main Results:
- A significant number of patients (26/95) required reoperation, primarily for symptomatic pseudarthrosis.
- While ODI scores improved post-surgery, reoperated patients showed less improvement.
- Inter-observer agreement for assessing bony bridging on CT scans was only moderate.
Conclusions:
- The Synfix-LR PEEK cage was associated with a high rate of reoperations due to pseudarthrosis, potentially linked to insufficient initial stability.
- The ease of radiologic fusion evaluation was not supported by the findings.
- Clinicians should suspect pseudarthrosis in patients with persistent or worsening symptoms after Synfix-LR cage implantation.
