Background/Objectives: Spinal fusion surgery is an accepted form of management for select patients who suffer from degenerative lumbar disease. The need for cost-effective durable techniques is paramount as our population ages. This study compares the radiographic and clinical outcomes of PEEK and 3D-printed titanium interbody cages. Methods: This study compared two cohorts which underwent either PEEK or 3D-printed titanium (3DPT) interbody fusion at a single institution between 2013 and 2022. The PEEK cohort was a retrospective analysis of a prospectively collected registry. The 3DPT data were prospectively collected. The inclusion criteria were adults >18 years who underwent 1 or 2 level lumbar interbody fusion for degenerative spine disease with at least 6 months follow-up. Patient demographics, radiographs, and PROMs were collected. The cohorts were compared using ANOVA for continuous variables and Fisher’s exact test for categorical variables, with significance set to 0.05. Results: The final study included 91 patients, 49 PEEK and 42 3DPT. The 3DPT patients were older (p = 0.047) with increased incidence of hypertension (p < 0.001). The 3DPT patients had less bone morphogenetic protein (BMP) usage (80.9% vs. 54.8%; p = 0.012), but more cellular allograft (p < 0.001). Fusion rate was high for both cohorts, with PEEK at 95.9% and 3DPT at 97.6%. There was no significant difference in reoperation rate. Both the PEEK and 3DPT cohorts demonstrated an improvement in the Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D) at 1 and 2 years compared to preoperative baseline. More patients in the 3DPT group met the MCID for EQ-5D at 1 and 2 years compared to PEEK; however, this was not significant (p = 0.350; p = 1.000). Conclusions: The 3DPT interbody provided comparable if not superior fusion properties to the PEEK interbody given the decreased use of BMP. Both cohorts demonstrated similar improvements in ODI and EQ-5D compared to preoperative baseline. These results suggest that 3DPT cages may be a cost-effective alternative in spinal fusion. Further studies utilizing a larger population with higher follow-up rates are indicated to determine the economic and clinical benefits of 3DPT compared to PEEK cages in lumbar fusion surgery.

BACKGROUND AND OBJECTIVES: The appropriate utilization of lumbar fusion when performing laminectomy for lumbar spondylolisthesis is uncertain. The objective was to determine whether the use of a surgical expert review panel recommending fusion might improve patient selection, possibly reducing surgical failures. METHODS: Randomized clinical trial of patients with symptomatic degenerative lumbar stenosis with spondylolisthesis enrolled from 14 North American hospitals was conducted with patients randomized to receive an expert panel review of their case or not. Spinal expert review consisted of 10 to 15 surgeons' review of patient images and clinical data with voting on the appropriateness of fusion. Primary outcome was the percentage of patients who failed to improve their 1-year EuroQol-5 Dimension (EQ-5D) score. Secondary analysis focused on whether a supermajority (>80% consensus) of spinal experts recommending fusion might reduce operative failures. The trial (SLIP II) was registered at ClinicalTrials.gov (NCT03570801). RESULTS: Between November 1, 2017, and June 30, 2022, 663 patients were randomized (mean age 65.6 years; [59.6%] female) and 523 of 574 patients (91%; who had surgery) were included in the 1-year analysis. Final follow-up was on March 5, 2024. Among the 523 patients, 270 underwent review and 253 had no review. The overall surgical failure rate (using EQ-5D) did not differ between the review groups, 16.7% vs 17.4% (no review: difference 0.7%; 95% CI, −8% to 6%; P = .92). However, with supermajority recommending fusion, the proportion of patients who failed to improve EQ-5D score after surgery was 8.4% (review group) vs 18.4% (nonreview group: difference 10%; 95% CI, 2%-18%; P = .03). Supermajority recommendation for fusion was associated with 0.296 vs 0.240 EQ-5D change in the nonreview group (difference 0.056, 95% CI, 0.002-0.108; P = .04). CONCLUSION: Among patients with grade I degenerative lumbar spondylolisthesis, an expert panel review with a supermajority favoring fusion was associated with a greater improvement in health-related quality of life and fewer surgical failures.