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Comparative effectiveness of PEEK rods versus titanium alloy rods in lumbar fusion: A preliminary report

  • Clinical Article - Spine
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Abstract

Background

Posterior lumbar instruments made of titanium and its alloys could change the physiological distribution of load at the instrumented and adjacent segments, which is a main cause of implant failure, non-fusion and adjacent segment degeneration. Posterior lumbar rods made of polyetheretherketone (PEEK) which is a semirigid alternative to titanium and its alloys have been introduced in lumbar fusion. This prospective study compared the radiological and clinical outcomes of patients undergoing lumbar fusion with PEEK rods versus titanium alloy rods.

Methods

Using transpedicular fixation and lumbar fusion, 21 patients were treated with titanium alloy rods (TI group), and 20 patients with PEEK rods (PEEK group). Radiological and clinical outcomes were evaluated, including the status of the implanted instruments, fusion rate, lumbar lordosis angle (LA), disc space height (DH), visual analog score (VAS) for lower back pain (VAS-BP) and leg pain (VAS-LP), Japanese Orthopedic Association scoring system (JOA score) and complications.

Results

Clinical VAS-BP, VAS-LP and JOA scores were significantly improved at 3 months, 6 months, and 1 year postoperatively as compared with preoperative scores in both groups (p < 0.05), with similar levels of improvement observed at the same time points postoperatively between the two groups. The overall fusion rate was 100 % at the 1-year follow-up for both groups. No significant differences in lumbar lordosis angle were found preoperatively, 1 week and 1 year postoperatively in both groups (p > 0.05). The postoperative increase of disc space height and loss of disc space height during the follow-up showed a similar extent of change between both groups (p > 0.05).

Conclusions

PEEK rods offer a similar radiological and clinical efficacy as titanium alloy rods. PEEK rods, as a semirigid implant with unique characteristics, may be an effective alternative treatment for patients with degenerative lumbar disease in lumbar fusion.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Spine Surgery, Qilu Hospital, Shandong University, No.107, Wenhua Xi Road, Jinan, Shandong, 250012, China

    Lei Qi, Mu Li, Shuai Zhang, Jingsong Xue & Haipeng Si

Authors
  1. Lei Qi
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  2. Mu Li
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  3. Shuai Zhang
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  4. Jingsong Xue
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  5. Haipeng Si
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Corresponding author

Correspondence to Lei Qi.

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Comment

Transpedicle screw and rod instrumentation has become the preferred technique for performing stabilization and fusion in the treatment of degenerative lumbar spine disease. The authors now have added a relevant and well-done study to this field of spinal surgical management. In their series, 41 patients suffering from lumbar degenerative disease were treated using either a polyetheretherketone (PEEK) or titanium alloy rod system for single level posterior fusion. Meanwhile, it was demonstrated that PEEK rods have a similar high fusion and low reoperation rate when compared to previous instrumentation modalities (1,3). Furthermore, PEEK rods confer similar clinical efficacy as titanium alloy constructs and their semirigid properties, combined with their radiolucency, suggest that PEEK rods have even some advantages over titanium alloy rods for application in posterior lumbosacral instrumentation. However, the biomechanical effects of implantation of stabilization systems limit the range of motion and produce an unforeseeable nonphysiological stress on the operated functional spinal unit when compared to the nonoperated and intact spine. Additionally, the centre of rotation and stress distribution might differ according to the design and material of the implants used (2). Therefore, the indication for the necessity of spinal instrumentation and fusion should be assessed with scrutiny and the potential biomechanical effects of current materials and systems applied should be carefully considered before final clinical implementation.

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Markus F. Oertel

Bern, Switzerland

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Qi, L., Li, M., Zhang, S. et al. Comparative effectiveness of PEEK rods versus titanium alloy rods in lumbar fusion: A preliminary report. Acta Neurochir 155, 1187–1193 (2013). https://doi.org/10.1007/s00701-013-1772-3

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  • DOI: https://doi.org/10.1007/s00701-013-1772-3

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