3D-printed porous titanium vs 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 et al.
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In 30 seconds
This prospective, multicenter randomized controlled trial compared 3D-printed porous titanium with PEEK cages for single-level lumbar interbody fusion in patients with degenerative lumbar disease, including analyses stratified by bone mineral density. Among patients completing 2-year follow-up, fusion rates were comparable, but overall cage subsidence was lower with 3D-Ti than PEEK (7.1% vs 37.0%, p=.010). The difference was most pronounced in patients with osteoporosis: subsidence occurred in 12.5% with 3D-Ti and 58.3% with PEEK (p=.039), alongside better reported pain and disability scores with 3D-Ti.
Key findings
- At 2 years, fusion rates were similar with 3D-Ti and PEEK cages (92.9% vs 92.6%, p=1.000).
- Overall subsidence was lower with 3D-Ti than PEEK (7.1% vs 37.0%, p=.010).
- Among osteoporotic patients, subsidence was 12.5% with 3D-Ti versus 58.3% with PEEK (p=.039); PEEK patients also had inferior VAS back pain and ODI scores.
- For PEEK, subsidence depth correlated with lower T-scores (rho=-0.68, p<.001); ROC analysis identified a T-score cut-off of -2.4 (AUC 0.865) for elevated subsidence risk.
Why it matters
Cage subsidence can compromise structural stability after lumbar fusion. These randomized findings suggest that bone quality may modify the relative subsidence performance of cage materials: fusion rates were comparable overall, while the observed advantage for 3D-Ti was concentrated in patients with osteoporosis. This distinction may inform interpretation of implant outcomes across patients with differing bone mineral density.
What to keep in mind
The per-protocol analysis included 55 of 66 randomized patients who completed 2-year follow-up; subgroup findings in osteoporosis therefore involve a limited number of patients.