Dominik Adl Amini, Ichiro Okano, Lisa Oezel, Jiaqi Zhu, Erika Chiapparelli, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi, Alexander P. Hughes

August 2021, Volume 30, Issue 8, pp 2377 - 2384 Original Article Read Full Article 10.1007/s00586-021-06912-2

First Online: 02 July 2021


This study aims to compare the early subsidence rate (6–12 months) of standalone novel 3D-printed titanium (Ti) versus polyetheretherketone (PEEK) interbody cages after lateral lumbar interbody fusion (LLIF).


A retrospective study of 113 patients (186 levels) who underwent LLIF surgery with Ti or PEEK cages was conducted. Early subsidence was measured in each treated level using the Marchi et al. classification in radiographs or CT scans acquired at 6–12 months follow-up. Multivariate logistic regression analyses with generalized mixed models, setting subsidence as the outcome variable and including cage type (Ti vs PEEK) as well as significant and trending variables (p < 0.10) in univariate analyses, were conducted.


In total, 51 female and 62 male patients were analyzed. The median [IQR] age at surgery was 60.0 [51.0–70.0] years. Of the 186 levels, 119 levels were treated using PEEK and 67 levels with Ti cages. The overall subsidence rate for Grades I-III was significantly less in the Ti versus the PEEK group (p = 0.003). For high-grade subsidence (Grade II or III), Ti cages also demonstrated a subsidence rate (3.0%) that was significantly less compared to PEEK cages (18.5%) (p = 0.002). Multivariate analysis showed that patients treated with Ti cages were less likely to develop severe subsidence compared to those treated with PEEK (OR = 0.05, 95% CI = 0.01, 0.30) (p = 0.001).


Our study demonstrated that 3D-printed novel Ti cages had a significantly lower early subsidence rate compared to PEEK cages in standalone LLIF patients.

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