• Dominik Adl Amini, Manuel Moser, Lisa Oezel, Jiaqi Zhu, Ichiro Okano, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, and Alexander P Hughes.
• Spine Care Institute, Hospital for Special Surgery, New York, New York, USA; Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Berlin, Germany.
• World Neurosurg. 2022 Jun 1; 162: e14-e20.

ObjectiveTo compare outcomes of three-dimensional-printed porous titanium (Ti) versus polyetheretherketone (PEEK) cage implantation for stand-alone lateral lumbar interbody fusion (SA-LLIF) in treatment of symptomatic adjacent segment degeneration.MethodsBetween October 2016 and July 2020, 44 patients (59 levels) underwent stand-alone lateral lumbar interbody fusion with Ti or PEEK cages. The primary outcome was cage subsidence. Secondary outcomes included revision and/or recommendations for revision surgery, back and/or leg pain severity, changes in disc and/or foraminal height, and global and/or segmental lumbar lordosis.ResultsThe study included 44 patients (21 females) with a mean age at surgery of 61.8 ± 11.5 years, mean radiological follow-up of 12.5 ± 8.2 months, and mean clinical follow-up of 11.0 ± 7.1 months. Overall subsidence rate was significantly less in the Ti versus PEEK group (20% vs. 58.8%, P = 0.004). Revision was recommended to none of the patients in the Ti group and 3 patients in the PEEK group (P = 0.239). Patients in the Ti group showed significantly better improvement in back pain numeric rating scale score (P = 0.001). Disc height (P < 0.001) and foraminal height restoration (P = 0.011) were statistically significant in the Ti group, whereas only disc height restoration was significant in the PEEK group (P = 0.003).ConclusionsIn patients undergoing stand-alone lateral lumbar interbody fusion to treat adjacent segment degeneration, Ti cages had a significantly lower overall subsidence rate compared with PEEK cages. Furthermore, Ti cages resulted in fewer recommendations for revision surgery. Whether greater pain reduction in the Ti group is associated with earlier or higher fusion rates needs to be further elucidated.Copyright © 2021. Published by Elsevier Inc.

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