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3D printed titanium banana interbody cages versus titanium-coated PEEK bullet cages for TLIF.

Clin Neurol Neurosurg

January 2025

Department of Neurosurgery, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, United States.

Introduction: Lumbar degenerative spinal disease is a common, major cause of pain and disability. Titanium and polyetheretherketone (PEEK) are popular materials for interbody implants although evidence is mixed on which material is superior in terms of fusion and subsidence. The purpose of this study was to evaluate the clinical outcome of 3D printed titanium (3DPT) cages in patients undergoing TLIFs, as well as complication profiles based on widely used outcome metrics and reoperation events.

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Article Synopsis
  • The study aimed to investigate the incidence of interbody subsidence in patients who underwent transforaminal lumbar interbody fusion (TLIF), along with identifying risk factors and evaluating the consequences of subsidence on complications and fusion rates.
  • A retrospective analysis was conducted on adult patients who had one- or two-level TLIF from 2017-2019, excluding those with certain conditions or incomplete follow-ups, and used CT scans to measure subsidence after surgery.
  • Results indicated that 28% of fusion levels encountered moderate subsidence, while 35% faced severe subsidence, with factors such as cage surface area and material type linked to higher subsidence rates.
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Objective: This meta-analysis aims to refine the understanding of the optimal choice between different cage shapes in transforaminal lumbar interbody fusion (TLIF) by systematically comparing perioperative data, radiological outcomes, clinical results, and complications associated with banana-shaped and straight bullet cages.

Methods: A meticulous literature search encompassing PubMed, Embase, Scopus, Web of Science, China Knowledge Network, and Wanfang Data was executed up to October 5, 2023. Inclusion criteria focused on studies comparing banana-shaped and straight bullet cages in TLIF.

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Background: Minimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) is an increasingly common procedure for the treatment of lumbar degenerative pathologies. The MIS-TLIF technique often results in less soft-tissue injury compared with the open TLIF technique, reducing postoperative pain and recovery time. However, the narrow surgical aperture of this minimally invasive technique has increased the difficulty of interbody cage placement.

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Study Design: The study design was a retrospective study.

Objective: The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the "Insert Flip Technique" of cage insertion and to demonstrate effective restoration of IVD height and segmental lordosis (SL) and their influence on the functional outcome postoperatively.

Methods: IVD height and SL were recorded pre- and postoperatively.

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