Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 10

Application of Biologically Integrated Titanium Cages of Unique Design for Transforaminal Fusion in Patients with Degenerative Diseases of the Spine

Renat Nurmukhametov*

Head of Spinal Department at Scientific Clinical Center #2 of Russian scientific center of surgery named after B.V. Petrovskiy Head of spinal clinical base at Neurosurgery department RUDN, Russia

*Corresponding Author: Renat Nurmukhametov, Head of Spinal Department at Scientific Clinical Center #2 of Russian scientific center of surgery named after B.V. Petrovskiy Head of spinal clinical base at Neurosurgery department RUDN, Russia.

Received: May 18, 2022; Published: September 07, 2022


This publication discusses aspects of the possibilities of improving technologies and materials for transforaminal spinal fusion in patients with degenerative diseases of the spine. The technology of surgical treatment of patients with degenerative diseases of the spine's intervertebral discs using biologically integrated titanium cages of unique design based on computer 3D modeling has been proposed and experimentally tested.

Objective: To compare the radiological and clinical results of posterior interbody fusion of the lumbar spine using a porous 3D titanium alloy cage and a titanium-coated PEEK cage. Study characteristics: a randomized, prospective, interventional, double-blind, single-blind, single-center, post-marketing study conducted to assess the difference infusion rate and the difference compared to PEEK cages. The experiment involved 80 patients, 40 in the Study Group and 40 in the Control Group with degenerative-dystrophic diseases of the lumbar spine, who underwent surgery using the technique of posterior transforaminal fusion with transpedicular fixation at the operating levels. Research methods: assessment by computed tomography (CT), Oswestry questionnaire (every 3, 6 months), and evaluation by visual analog scales (VAS), if necessary - clinical neurological examination. Results of the study: patients of two groups show comparable late (from 6 months - 1 year after surgery) results of fusion and the degree of cage subsidence. In the Study Group: migrations, screw instability - 0; the number of reoperations for adjacent segment syndrome - 2; back pain at a minimal level. According to CT data from 3-6 months after the operation - the screws are stable, the incisors of the cages are cut into the endplates, sclerosis of the endplates around the cage. In the control group: migration of the cage into the spinal canal with screw instability - 1; instability of screws without migration, but with the formation of pseudoarthrosis - 1; adjacent segment syndrome - 2; a number of revisions - 4. Conclusions: the effectiveness of the technology for treating patients with degenerative diseases of the spine/or instability of the spinal motion segments with elements of neural compression using biologically integrated titanium cages of unique design based on computer 3D has been confirmed, which makes it possible to use a new method of spinal fusion in practice, allowing restore the local sagittal balance of the spinal motion segment, reduce the incidence of pseudarthrosis and, as a consequence, the frequency of revision surgery.


Keywords: Degenerative Diseases of the Spine; Titanium Cages; Transforaminal Fusion; Custom Design Cages; Biologically Integrable Titanium Cages; Custom Design of Computer 3D Modeling


  1. Nemoto O., et al. “Comparison of fusion rates following transforaminal lumbar interbody fusion using polyetheretherketone cages or titanium cages with transpedicular instrumentation”. European Spine Journal10 (2014): 2150-2155.
  2. Wang B., et al. “Biomechanical evaluation of transforaminal lumbar interbody fusion and oblique lumbar interbody fusion on the adjacent segment: a finite element analysis”. World Neurosurgery 126 (2019): e819-e824.
  3. Li J., et al. “Biomechanical Effects of Polyetheretherketone and Titanium Rods in Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis” (2021).
  4. Wang X., et al. “Biomechanical analysis of a newly developed shape memory alloy hook in a transforaminal lumbar interbody fusion (TLIF) in vitro model”. PLoS One12 (2014): e114326.
  5. Zhou C., et al. “Shape optimisation of a transforaminal lumbar interbody fusion cage featuring an I-beam cross-section”. In Orthopaedic Proceedings6 (2017): 125-125.
  6. Cole CD., et al. “Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches”. Current Reviews in Musculoskeletal Medicine2 (2009): 118-126.
  7. Faizan A., et al. “Biomechanical analysis of various footprints of transforaminal lumbar interbody fusion devices”. Clinical Spine Surgery4 (2014): E118-E127.
  8. Byvaltsev VA., et al. “Facet fixation combined with lumbar interbody fusion: comparative analysis of clinical experience and a new method of surgical treatment of patients with lumbar degenerative diseases”. Annals of the Russian Academy of Medical Sciences5 (2016): 375-384.
  9. Chen HH., et al. “Biomechanical analysis of unilateral fixation with interbody cages”. Spine4 (2005): E92-E96.
  10. Zhao J., et al. “Posterior interbody fusion using a diagonal cage with unilateral transpedicular screw fixation for lumbar stenosis”. Journal of Clinical Neuroscience3 (2011): 324-328.
  11. Alvarez K and Nakajima H. “Metallic scaffolds for bone regeneration”. Materials 2.3 (2009): 790-832.
  12. Jain S., et al. “Advances in spinal interbody cages”. Orthopaedic Surgery3 (2016): 278-284.
  13. Kersten RFMR., et al. “Polyetheretherketone (PEEK) cages in cervical applications: a systematic review”. The Spine Journal 6 (2015): 1446-1460.
  14. Basgul C., et al. “Does annealing improve the interlayer adhesion and structural integrity of FFF 3D printed PEEK lumbar spinal cages?” Journal of the Mechanical Behavior of Biomedical Materials 102 (2020):
  15. Kurtz SM. “PEEK biomaterials handbook”. William Andrew (2019).
  16. Lin W., et al. “Diagnosing pseudoarthrosis after anterior cervical discectomy and fusion”. Neurospine3 (2018): 194.
  17. Kandziora F., et al. “Biomechanical comparison of expandable cages for vertebral body replacement in the cervical spine”. Journal of Neurosurgery: Spine1 (2003): 91-97.
  18. Provaggi E., et al. “Applications of 3D printing in the management of severe spinal conditions”. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine6 (2017): 471-486.
  19. Provaggi E., et al. “3D printing assisted finite element analysis for optimising the manufacturing parameters of a lumbar fusion cage”. Materials and Design163 (2019):
  20. Sheha ED., et al. “3D printing in spine surgery”. Annals of Translational Medicine 5 (2019).
  21. Description to the patent of the Russian Federation No. 2339342, IPC A61F 2/28 (2008).
  22. Watters WC., et al. “Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion”. Journal of Neurosurgery: Spine1 (2014): 79-90.
  23. Cherepanov EA. “Russian version of the Oswestry Disability Index: cross-cultural adaptation and validity”. Hirurgiâ Pozvonočnika (Spine Surgery) 3 (2009): 093-098.


Citation: Renat Nurmukhametov. “Application of Biologically Integrated Titanium Cages of Unique Design for Transforaminal Fusion in Patients with Degenerative Diseases of the Spine". Acta Scientific Orthopaedics 5.10 (2022): 03-10.


Copyright: © 2022 Renat Nurmukhametov. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 10, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US