KMID : 1189320200140020229
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Asian Spine Journal 2020 Volume.14 No. 2 p.229 ~ p.237
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Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion
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Elfiky Tarek Anwar
Patil Nirmal Dhananjay Allam Yasser Ragab Raafat
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Abstract
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Study Design: A retrospective radiographic analysis.
Purpose: The aim of the current study is to assess endplate changes after the use of polyetheretherketone (PEEK) cages in posterior lumbar interbody fusion (PLIF).
Overview of Literature: A few recent reports had revealed endplate abnormalities due to PEEK cages, which may lead to nonunions.
Methods: A retrospective computed tomography (CT)-based analysis of the endplate cavities and fusion status following PLIFs with PEEK cages was conducted by two independent observers. The term ¡°cavity¡± was used to describe the endplate changes. The vertebral endplate cavities were assessed according to the size, multiplicity, location, and presence or absence of sclerosis.
Results: There were 86 fixed levels in 65 consecutive patients, with a mean age of 35.44¡¾19.60 years. The mean follow-up was 16.5¡¾10.1 months (range, 6?57 months). Definite fusion was seen in 56 levels (65.12%) by observer 1 versus 44 levels (51.16) by observer 2. The strength of agreement was moderate. Endplate cavities were observed in 42 levels (48.84%) by observer 1 versus 47 levels (54.65%) by observer 2, with fair agreement. The strengths of agreement for the locations, multiplicity, and size were moderate, fair, and poor, respectively. Neither age, sex, etiology, levels, nor follow-up period was significantly associated with the presence of cavities. With regard to fusions, the nonunions detected by observer 1 were significantly associated with the presence of cavities (p<0.0001). However, those detected by observer 2 were nearly significant (p=0.05).
Conclusions: There was a high rate of unfavorable radiographic findings in the form of endplate cavities in PLIF cases with PEEK cages. A more comprehensive classification for the assessment of fusions and endplate cavities should be formulated. We strongly recommend further CT-based studies with larger sample size and longer follow-up periods.
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KEYWORD
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Interbody, Fusion, Polyetheretherketone, End plate changes, Cavities
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