Timo Zippelius1, Patrick Strube2, Farid Suleymanov2, Michael Putzier3, Alexander Hölzl2. 1. Klinik für Orthopädie, Universitätsklinikum Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland. timo.zippelius@uni-jena.de. 2. Klinik für Orthopädie, Universitätsklinikum Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland. 3. Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité, Universitätsmedizin Berlin, Berlin, Deutschland.
Abstract
BACKGROUND: Electron beam melting (EBM) technique enables cage design changes such as the integration of guide rails on the cage surface or a 3D matrix for osseointegration. A change in manufacturing technique or design can lead to a decreased fusion rate or impaired applicability. OBJECTIVE: The aim of the present study was to evaluate cage handling, lordosis reconstruction capability, and fusion rate 1 year after surgery. MATERIALS AND METHODS: In this study, 50 patients who had undergone minimally invasive transforaminal lumbar interbody fusion (TLIF) or open posterior lumbar interbody fusion (PLIF) using an EBM-manufactured cage were retrospectively included. Fusion evaluation was based on routinely performed CTs and flexion-extension radiographs 12 months postoperatively. Lumbar and segmental lordosis were compared between pre-, post, and 1‑year follow-up. Postoperative cage position was used for evaluation of cage handling. RESULTS: The radiological fusion rate was 97% at the 1‑year follow-up. Two cages were placed into the endplates during surgery without an effect on fusion. In 31% of the cages, placement at the anterior third of the disk space was possible. Lumbar lordosis was improved by a mean of 5° and segmental lordosis by a mean of 4°. At final follow-up, 1° was lost in both parameters. No implant-associated complications were registered. CONCLUSION: The implant is safe and leads to a very high fusion rate. A learning curve results from the fact that the cage follows a defined radius dictated by the guide rails. Addressing this, exact placement at the anterior endplate can be achieved.
BACKGROUND: Electron beam melting (EBM) technique enables cage design changes such as the integration of guide rails on the cage surface or a 3D matrix for osseointegration. A change in manufacturing technique or design can lead to a decreased fusion rate or impaired applicability. OBJECTIVE: The aim of the present study was to evaluate cage handling, lordosis reconstruction capability, and fusion rate 1 year after surgery. MATERIALS AND METHODS: In this study, 50 patients who had undergone minimally invasive transforaminal lumbar interbody fusion (TLIF) or open posterior lumbar interbody fusion (PLIF) using an EBM-manufactured cage were retrospectively included. Fusion evaluation was based on routinely performed CTs and flexion-extension radiographs 12 months postoperatively. Lumbar and segmental lordosis were compared between pre-, post, and 1‑year follow-up. Postoperative cage position was used for evaluation of cage handling. RESULTS: The radiological fusion rate was 97% at the 1‑year follow-up. Two cages were placed into the endplates during surgery without an effect on fusion. In 31% of the cages, placement at the anterior third of the disk space was possible. Lumbar lordosis was improved by a mean of 5° and segmental lordosis by a mean of 4°. At final follow-up, 1° was lost in both parameters. No implant-associated complications were registered. CONCLUSION: The implant is safe and leads to a very high fusion rate. A learning curve results from the fact that the cage follows a defined radius dictated by the guide rails. Addressing this, exact placement at the anterior endplate can be achieved.
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