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Expandable Polyaryl-Ether-Ether-Ketone Spacers for Interbody Distraction in the Lumbar Spine.

Alimi M, Shin B, Macielak M, Hofstetter CP, Njoku I, Tsiouris AJ, Elowitz E, Härtl R - Global Spine J (2015)

Bottom Line: PEEK implants have been successfully used as interbody devices.There was a significant increase in the average disk height (6.49 versus 8.18 mm, p = 0.037) and foraminal height (15.6 versus 18.53 mm, p = 0.0001), and a significant reduction in the listhesis (5.13 versus 3.15 mm, p = 0.005).Conclusions Midterm results indicate that expandable PEEK spacers can effectively and durably restore disk and foraminal height and improve the outcome without significant subsidence.

View Article: PubMed Central - PubMed

Affiliation: Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, United States.

ABSTRACT
Study Design Retrospective case series. Objective StaXx XD (Spine Wave, Inc., Shelton, CT, United States) is an expandable polyaryl-ether-ether-ketone (PEEK) wafer implant utilized in the treatment of lumbar degenerative disease. PEEK implants have been successfully used as interbody devices. Few studies have focused on expandable PEEK devices. The aim of the current study is to determine the radiographic and clinical outcome of expandable PEEK cages utilized for transforaminal lumbar interbody fusion in patients with lumbar degenerative diseases. Methods Forty-nine patients who underwent lumbar interbody fusion with implantation of expandable PEEK cages and posterior instrumentation were included. The clinical outcome was evaluated using the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Radiographic parameters including disk height, foraminal height, listhesis, local disk angle of the index level/levels, regional lumbar lordosis, and graft subsidence were measured preoperatively, postoperatively, and at latest follow-up. Results At an average follow-up of 19.3 months, the minimum clinically important difference for the ODI and VAS back, buttock, and leg were achieved in 64, 52, 58, and 52% of the patients, respectively. There was statistically significant improvement in VAS back (6.42 versus 3.11, p < 0.001), VAS buttock (4.66 versus 1.97, p = 0.002), VAS leg (4.55 versus 1.96, p < 0.001), and ODI (21.7 versus 12.1, p < 0.001) scores. There was a significant increase in the average disk height (6.49 versus 8.18 mm, p = 0.037) and foraminal height (15.6 versus 18.53 mm, p = 0.0001), and a significant reduction in the listhesis (5.13 versus 3.15 mm, p = 0.005). The subsidence of 0.66 mm (7.4%) observed at the latest follow-up was not significant (p = 0.35). Conclusions Midterm results indicate that expandable PEEK spacers can effectively and durably restore disk and foraminal height and improve the outcome without significant subsidence.

No MeSH data available.


Related in: MedlinePlus

Example distraction of L5–S1 disk space resulting from in situ expansion of an interbody cage. Top left: L5–S1 disk space prior to surgery. Top right: Implantation of the expandable polyaryl-ether-ether-ketone (PEEK) spacer prior to expansion. Bottom left: In situ expansion of the PEEK spacer. Bottom right: The end of the operation.
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FI1400011or-1: Example distraction of L5–S1 disk space resulting from in situ expansion of an interbody cage. Top left: L5–S1 disk space prior to surgery. Top right: Implantation of the expandable polyaryl-ether-ether-ketone (PEEK) spacer prior to expansion. Bottom left: In situ expansion of the PEEK spacer. Bottom right: The end of the operation.

Mentions: After decompression of the spinal pathology, a diskectomy was performed using pituitary rongeurs and shavers. The end plates were carefully prepared and then the bone graft or substitute and an expandable StaXx XD PEEK cage were inserted. The implant has no graft chamber and the bone graft needs to be placed surrounding the cage. The PEEK cage is 7 mm in the collapsed state when inserted and can be expanded in situ (Fig. 1) to an appropriate height with distraction of the disk space, up to 15 mm. The final height was determined based on the adjacent disk levels as well as based on the manual resistance experienced during delivery of the individual wafers. Posterior instrumentation was then inserted using the standard techniques. Various bone graft substitutes or expanders were used for fusion. In the open procedures, a posterolateral fusion was performed in addition to the interbody fusion. In minimally invasive cases, only an interbody fusion was performed.


Expandable Polyaryl-Ether-Ether-Ketone Spacers for Interbody Distraction in the Lumbar Spine.

Alimi M, Shin B, Macielak M, Hofstetter CP, Njoku I, Tsiouris AJ, Elowitz E, Härtl R - Global Spine J (2015)

Example distraction of L5–S1 disk space resulting from in situ expansion of an interbody cage. Top left: L5–S1 disk space prior to surgery. Top right: Implantation of the expandable polyaryl-ether-ether-ketone (PEEK) spacer prior to expansion. Bottom left: In situ expansion of the PEEK spacer. Bottom right: The end of the operation.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4472284&req=5

FI1400011or-1: Example distraction of L5–S1 disk space resulting from in situ expansion of an interbody cage. Top left: L5–S1 disk space prior to surgery. Top right: Implantation of the expandable polyaryl-ether-ether-ketone (PEEK) spacer prior to expansion. Bottom left: In situ expansion of the PEEK spacer. Bottom right: The end of the operation.
Mentions: After decompression of the spinal pathology, a diskectomy was performed using pituitary rongeurs and shavers. The end plates were carefully prepared and then the bone graft or substitute and an expandable StaXx XD PEEK cage were inserted. The implant has no graft chamber and the bone graft needs to be placed surrounding the cage. The PEEK cage is 7 mm in the collapsed state when inserted and can be expanded in situ (Fig. 1) to an appropriate height with distraction of the disk space, up to 15 mm. The final height was determined based on the adjacent disk levels as well as based on the manual resistance experienced during delivery of the individual wafers. Posterior instrumentation was then inserted using the standard techniques. Various bone graft substitutes or expanders were used for fusion. In the open procedures, a posterolateral fusion was performed in addition to the interbody fusion. In minimally invasive cases, only an interbody fusion was performed.

Bottom Line: PEEK implants have been successfully used as interbody devices.There was a significant increase in the average disk height (6.49 versus 8.18 mm, p = 0.037) and foraminal height (15.6 versus 18.53 mm, p = 0.0001), and a significant reduction in the listhesis (5.13 versus 3.15 mm, p = 0.005).Conclusions Midterm results indicate that expandable PEEK spacers can effectively and durably restore disk and foraminal height and improve the outcome without significant subsidence.

View Article: PubMed Central - PubMed

Affiliation: Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, United States.

ABSTRACT
Study Design Retrospective case series. Objective StaXx XD (Spine Wave, Inc., Shelton, CT, United States) is an expandable polyaryl-ether-ether-ketone (PEEK) wafer implant utilized in the treatment of lumbar degenerative disease. PEEK implants have been successfully used as interbody devices. Few studies have focused on expandable PEEK devices. The aim of the current study is to determine the radiographic and clinical outcome of expandable PEEK cages utilized for transforaminal lumbar interbody fusion in patients with lumbar degenerative diseases. Methods Forty-nine patients who underwent lumbar interbody fusion with implantation of expandable PEEK cages and posterior instrumentation were included. The clinical outcome was evaluated using the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Radiographic parameters including disk height, foraminal height, listhesis, local disk angle of the index level/levels, regional lumbar lordosis, and graft subsidence were measured preoperatively, postoperatively, and at latest follow-up. Results At an average follow-up of 19.3 months, the minimum clinically important difference for the ODI and VAS back, buttock, and leg were achieved in 64, 52, 58, and 52% of the patients, respectively. There was statistically significant improvement in VAS back (6.42 versus 3.11, p < 0.001), VAS buttock (4.66 versus 1.97, p = 0.002), VAS leg (4.55 versus 1.96, p < 0.001), and ODI (21.7 versus 12.1, p < 0.001) scores. There was a significant increase in the average disk height (6.49 versus 8.18 mm, p = 0.037) and foraminal height (15.6 versus 18.53 mm, p = 0.0001), and a significant reduction in the listhesis (5.13 versus 3.15 mm, p = 0.005). The subsidence of 0.66 mm (7.4%) observed at the latest follow-up was not significant (p = 0.35). Conclusions Midterm results indicate that expandable PEEK spacers can effectively and durably restore disk and foraminal height and improve the outcome without significant subsidence.

No MeSH data available.


Related in: MedlinePlus