Highlights
- •Three novel porous cage designs were tested for subsidence performance.
- •The porous titanium cage showed the least amount of subsidence displacement.
- •Cage design plays a greater role in the cage subsidence performance than material.
Abstract
Background
Cage subsidence remains a major complication after spinal surgery. The goal of this
study was to compare the subsidence performance of three modern porous cage designs.
Methods
Three porous cages were evaluated: a porous titanium cage, a porous polyetheretherketone
cage and a truss titanium cage. Mechanical testing was performed for each cage per
the American Society for Testing and Materials F2077 and F2267 standards to evaluate
cage stiffness and block stiffness, and per a novel clinically relevant dynamic subsidence
testing method simulating cyclic spine loading during 3-months postoperatively to
evaluate the subsidence displacement.
Findings
The porous polyetheretherketone cage demonstrated the lowest cage stiffness (21.0 ± 1.1
kN/mm), less than half of both titanium cages (truss titanium cage, 49.1 kN/mm; porous
titanium cage, 43.6 kN/mm). The block stiffness was greatest for the porous titanium
cage (2867.7 ± 105.3 N/mm), followed by the porous polyetheretherketone (2563.4 ± 72.9 N/mm)
and truss titanium cages (2213.7 ± 21.8 N/mm). The dynamic subsidence displacement
was greatest for the truss titanium cage, which was 1.5 and 2.5 times the subsidence
displacement as the porous polyetheretherketone and porous titanium cages respectively.
Interpretations
Specific porous cage design plays a crucial role in the cage subsidence performance,
to a greater degree than the selection of cage materials. A porous titanium cage with
body lattice and microporous endplates significantly outperformed a truss titanium
cage with a similar cage stiffness in subsidence performance, and a porous polyetheretherketone
cage with half of its stiffness.
Keywords
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Article info
Publication history
Published online: September 14, 2022
Accepted:
September 12,
2022
Received:
June 21,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
