3D-Printed Titanium: Game-Changer for Standalone Lateral Lumbar Interbody Fusion? An Analysis of Risk Factors for Revision Surgery

Study DesignSingle-center retrospective cohort study.ObjectiveTo evaluate whether 3D-printed titanium (3DTi) cages reduce the risk of revision surgery compared to polyetheretherketone (PEEK) cages in standalone lateral lumbar interbody fusion (SA-LLIF).MethodsSA-LLIF procedures performed between 09/2018 and 08/2022 were retrospectively reviewed. Minimum follow-up was 2 years. Baseline characteristics and surgical details were compared between those treated with 3DTi and those with PEEK. Univariable, multivariable Poisson, and hierarchical mixed-effects Poisson regression models were performed to identify independent predictors. Secondary analyses examined differences in timing and types of revision surgeries between the 2 implant types.ResultsA total of 233 patients (43.8% female) were included, with a median age of 65 years (IQR: 56-71), BMI of 28.0 (IQR: 24.7-32.1), and a median of 2 levels fused (range 1-4). Overall, 17.6% underwent revision surgery, with a mean time to revision of 26 ± 16 months. Revisions were more frequent after PEEK (26.3%) vs 3DTi (13.0%; <i>P</i> = 0.017). In multivariable analysis adjusting for follow-up and surgical levels, 3DTi was independently associated with reduced revision risk (RR: 0.52, 95% CI: 0.30-0.90; <i>P</i> = 0.027), which remained significant in a hierarchical mixed-effects model accounting for surgeon-level variation (<i>P</i> = 0.042). Early revisions (<2 years) were more common with PEEK (13.8% vs 4.1%; <i>P</i> < 0.05), while late revisions (>2 years) were similar (11.5% vs 8.9%; <i>P</i> = 0.521).Conclusions3D-printed titanium cages in SA-LLIF was associated with lower revision risk compared to PEEK, particularly in the early postoperative period. These findings support the implementation of 3Dti implants to improve surgical outcomes in SA-LLIF.