The Use of Titan and PEEK Implants in Stand Alone ALIF Surgery for Degenerative Disease of the Lumbosacral Spine – a Prospective Study

Authors: L. Hrabálek 1;  I. Rešková 1;  J. Bučil 2;  M. Vaverka 1;  M. Houdek 1
Authors‘ workplace: Neurochirurgická klinika LF UP a FN Olomouc 1;  Radiologická klinika LF UP a FN Olomouc 2
Published in: Cesk Slov Neurol N 2009; 72/105(1): 38-44
Category: Original Paper


The use of cages is one of the methods to obtain anterior lumbar fusion (ALIF). The study reviews the clinical results in correlation with radiological findings for two types of implants: a titan implant (SynCage, Synthes, USA) is compared with a PEEK implant (Visios, Synthes, USA) used in a stand-alone ALIF surgery in patients with degenerative disease of the lumbosacral spine. The set of patients is made up of two identical groups each consisting of 14 patients, with a follow-up time of at least one year. The correlations between the clinical findings expressed by Visual Analogue Scale, Oswestry Disability Index and neurological examination and the CT and MRI findings prior to surgery and one year post-op were assessed by standard statistical methods. The presence of Modic changes type 1 in MRI one year post-op was associated with a lower degree of improvement of clinical status as compared with other Modic changes. Modic changes type 1 developed post-op in five patients (35.7%) with a PEEK implant. Cystic bone changes detected by CT one year after the implantation of PEEK cages was recorded in eight patients (57.1%) and was also associated with a lower degree of improvement of clinical status as compared with patients without such changes. Implant-based comparison of the two groups of patients showed worse clinical results for the patients with a PEEK implant. Modic changes type 1 in MRI images and bone cysts in CT findings probably reflect insufficient healing of the PEEK implant in the stand-alone ALIF procedure. Additional posterior transpedicular fixation and subsequent increase of stability reduces the number of the above-mentioned CT and MRI findings and results in an improved clinical status. The authors therefore recommend only the titan implant for stand-alone ALIF. The PEEK implant should be used only with posterior transpedicular fixation and is not suitable for the stand-alone ALIF procedure.

Key words:
lumbar spine – ALIF – magnetic resonance imaging – Modic changes – titan implant – PEE K implant – SynCage – Visios


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