{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:07:40Z","timestamp":1792789660861,"version":"4.5.0"},"reference-count":44,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T00:00:00Z","timestamp":1755388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Johnson &amp; Johnson","award":["DUA-SPINE-2022-053"],"award-info":[{"award-number":["DUA-SPINE-2022-053"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The success of lumbar interbody fusion depends on the implant design and the surgical approach used. This study evaluated the clinical and radiographic outcomes of lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF) using a 3D-printed porous titanium interbody cage system. Methods: A retrospective, single-center review of 48 patients treated for degenerative lumbar spine disease was conducted. Patients underwent LLIF, ALIF, or a combination of both using a 3D-printed titanium cage system (J&amp;J MedTech, Raynham, MA, USA). The Oswestry disability index (ODI) and Patient-Reported Outcomes Measurement Information System (PROMIS) metrics were assessed after 6 weeks, 3 months, 6 months, and 12 months. Linear mixed-effects models evaluated the pre- and post-operative differences. Fusion performance and complications were assessed using the Bridwell grading system over 24 months. Results: A total of 78 levels (62 LLIF and 16 ALIF) were analyzed. Fusion rates were 90.3% (56\/62) for LLIF levels and 81.3% (13\/16) for ALIF levels by the end of 12 months. ODI scores improved significantly after 3 months (MD \u221213.0, p &lt; 0.001), 6 months (MD \u221212.3, p &lt; 0.001), and 12 months (MD \u221214.9, p &lt; 0.001). PROMIS Pain Interference scores improved after 3 months (MD \u22126.1, p &lt; 0.001), 6 months (MD \u22123.4, p &lt; 0.001), and 12 months (MD \u22125.8, p &lt; 0.001). PROMIS Physical Function scores improved after 3 months (MD +3.4, p = 0.032) and 12 months (MD +4.9, p &lt; 0.001). Conclusions: This novel interbody cage demonstrated high fusion rates, significant pain and function improvements, and a favorable safety profile, warranting further comparative studies.<\/jats:p>","DOI":"10.3390\/jcm14165814","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T15:34:53Z","timestamp":1755531293000},"page":"5814","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluating the Efficacy of a Novel Titanium Cage System in ALIF and LLIF: A Retrospective Clinical and Radiographic Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9258-2123","authenticated-orcid":false,"given":"Ryan W.","family":"Turlip","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5201-6720","authenticated-orcid":false,"given":"Mert Marcel","family":"Dagli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daksh","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6481-5747","authenticated-orcid":false,"given":"Richelle J.","family":"Kim","sequence":"additional","affiliation":[{"name":"Columbia College, Columbia University, New York, NY 10027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kincaid","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6152-2510","authenticated-orcid":false,"given":"Hasan S.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohannes","family":"Ghenbot","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang Won","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jocn.2017.06.013","article-title":"A meta-analysis comparing ALIF, PLIF, TLIF and LLIF","volume":"44","author":"Teng","year":"2017","journal-title":"J. Clin. Neurosci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1007\/s11420-019-09737-4","article-title":"Interbody Fusions in the Lumbar Spine: A Review","volume":"16","author":"Verma","year":"2020","journal-title":"HSS J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"168","DOI":"10.21037\/jss.2017.05.03","article-title":"Subsidence following anterior lumbar interbody fusion (ALIF): A prospective study","volume":"3","author":"Rao","year":"2017","journal-title":"J. Spine Surg."},{"key":"ref_4","first-page":"2","article-title":"Lumbar interbody fusion: Techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs","year":"2015","journal-title":"J. Spine Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1186\/s13018-023-03652-5","article-title":"Comparison of radiographic and clinical outcomes between ALIF, OLIF, and TLIF over 2-year follow-up: A comparative study","volume":"18","author":"Tung","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e626","DOI":"10.1016\/j.wneu.2022.03.087","article-title":"Choice of Spinal Interbody Fusion Cage Material and Design Influences Subsidence and Osseointegration Performance","volume":"162","author":"Fogel","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.14444\/8559","article-title":"Implant Surface Technologies to Promote Spinal Fusion: A Narrative Review","volume":"17","author":"Croft","year":"2023","journal-title":"Int. J. Spine Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1007\/s00586-021-06912-2","article-title":"Evaluation of cage subsidence in standalone lateral lumbar interbody fusion: Novel 3D-printed titanium versus polyetheretherketone (PEEK) cage","volume":"30","author":"Okano","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"163","DOI":"10.21037\/jss.2017.05.01","article-title":"Elastic modulus in the selection of interbody implants","volume":"3","author":"Heary","year":"2017","journal-title":"J. Spine Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1007\/s00586-021-06748-w","article-title":"Titanium (Ti) cages may be superior to polyetheretherketone (PEEK) cages in lumbar interbody fusion: A systematic review and meta-analysis of clinical and radiological outcomes of spinal interbody fusions using Ti versus PEEK cages","volume":"30","author":"Tan","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e471","DOI":"10.1016\/j.wneu.2022.10.006","article-title":"A Comparison of Polyetheretherketone and Titanium-Coated Polyetheretherketone in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Randomized Clinical Trial","volume":"168","author":"Singhatanadgige","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1302\/0301-620X.99B10.BJJ-2016-1292.R2","article-title":"Transforaminal lumbar interbody fusion using polyetheretherketone oblique cages with and without a titanium coating: A randomised clinical pilot study","volume":"99-b","author":"Rickert","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s11420-020-09752-w","article-title":"The Importance of Surface Technology in Spinal Fusion","volume":"16","author":"Katsuura","year":"2020","journal-title":"HSS J."},{"key":"ref_14","first-page":"403","article-title":"Adhesion, growth and differentiation of osteoblasts on surface-modified materials developed for bone implants","volume":"60","year":"2011","journal-title":"Physiol. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3363","DOI":"10.1016\/j.actbio.2014.03.037","article-title":"Implant osseointegration and the role of microroughness and nanostructures: Lessons for spine implants","volume":"10","author":"Gittens","year":"2014","journal-title":"Acta Biomater."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.spinee.2021.12.004","article-title":"3D-printed titanium cages without bone graft outperform PEEK cages with autograft in an animal model","volume":"22","author":"Laratta","year":"2022","journal-title":"Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6268","DOI":"10.1016\/j.actbio.2012.12.002","article-title":"The roles of titanium surface micro\/nanotopography and wettability on the differential response of human osteoblast lineage cells","volume":"9","author":"Gittens","year":"2013","journal-title":"Acta Biomater."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hou, C., An, J., Zhao, D., Ma, X., Zhang, W., Zhao, W., Wu, M., Zhang, Z., and Yuan, F. (2022). Surface Modification Techniques to Produce Micro\/Nano-scale Topographies on Ti-Based Implant Surfaces for Improved Osseointegration. Front. Bioeng. Biotechnol., 10.","DOI":"10.3389\/fbioe.2022.835008"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.msec.2015.10.069","article-title":"Effect of pore size on bone ingrowth into porous titanium implants fabricated by additive manufacturing: An in vivo experiment","volume":"59","author":"Taniguchi","year":"2016","journal-title":"Mater. Sci. Eng. C Mater. Biol. Appl."},{"key":"ref_20","first-page":"251","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"82","author":"Altman","year":"2008","journal-title":"Rev. Esp. Salud Publica"},{"key":"ref_21","first-page":"q902","article-title":"TRIPOD+ AI statement: Updated guidance for reporting clinical prediction models that use regression or machine learning methods","volume":"385","author":"Collins","year":"2024","journal-title":"BMJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1097\/00007632-199506020-00014","article-title":"Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?","volume":"20","author":"Bridwell","year":"1995","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"110","DOI":"10.3171\/2013.4.SPINE12319","article-title":"Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion","volume":"19","author":"Marchi","year":"2013","journal-title":"J. Neurosurg. Spine"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hoppe, S., Albers, C.E., Elfiky, T., Deml, M.C., Milavec, H., Bigdon, S.F., and Benneker, L.M. (2018). First Results of a New Vacuum Plasma Sprayed (VPS) Titanium-Coated Carbon\/PEEK Composite Cage for Lumbar Interbody Fusion. J. Funct. Biomater., 9.","DOI":"10.3390\/jfb9010023"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e31534","DOI":"10.1097\/MD.0000000000031534","article-title":"MIS-TLIF or CLIF for single segmental lumbar degenerative disease","volume":"101","author":"Nazierhan","year":"2022","journal-title":"Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Velluto, C., Mundis, G., Scaramuzzo, L., Perna, A., Capece, G., Cruciani, A., Inverso, M., Borruto, M.I., and Proietti, L. (2024). Radiological evaluation of fusion patterns after Lateral Lumbar Interbody fusion with 3D-printed porous titanium cages vs. conventional titanium cages. Front. Surg., 11.","DOI":"10.3389\/fsurg.2024.1446792"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"663","DOI":"10.3171\/2022.4.SPINE2245","article-title":"Subsidence after lateral lumbar interbody fusion using a 3D-printed porous titanium interbody cage: Single-institution case series","volume":"37","author":"Alan","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e732","DOI":"10.1016\/j.wneu.2023.06.132","article-title":"Comparison of Fusion, Subsidence, and Clinical Results Between 3D-Printed Porous Titanium Cage and Polyetheretherketone Cage in Posterior Lumbar Interbody Fusion: A Minimum of 2 Years Follow-Up","volume":"177","author":"Yang","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1177\/21925682241255686","article-title":"Trabecular Bone Remodeling after Posterior Lumbar Interbody Fusion: Comparison of the Osseointegration in Three-Dimensional Porous Titanium Cages and Polyether-Ether-Ketone Cages","volume":"15","author":"Segi","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3171\/2023.4.SPINE22492","article-title":"Graft subsidence and reoperation after lateral lumbar interbody fusion: A propensity score-matched and cost analysis of polyetheretherketone versus 3D-printed porous titanium interbodies","volume":"39","author":"Alan","year":"2023","journal-title":"J. Neurosurg. Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"22","DOI":"10.21037\/jss-23-120","article-title":"3D-printed titanium alloy cage in anterior and lateral lumbar interbody fusion for degenerative lumbar spine disease","volume":"10","author":"Donaldson","year":"2024","journal-title":"J. Spine Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"123536","DOI":"10.1016\/j.wneu.2024.11.119","article-title":"Enhancing the Technical Pearls for L5-S1 Anterior Lumbar Interbody Fusion in Patients with Body Mass Index More Than 30: Clinical and Radiographic Outcomes at 1-Year Follow-Up","volume":"194","author":"Giraldo","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_33","first-page":"e54461","article-title":"A Comprehensive Review of the Historical Description of Spine Surgery and Its Evolution","volume":"16","author":"Mamdouhi","year":"2024","journal-title":"Cureus"},{"key":"ref_34","first-page":"2057","article-title":"CT evaluation of lumbar interbody fusion: Current concepts","volume":"26","author":"Williams","year":"2005","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Li, K., Zhang, Z., Ran, J., Ma, L., and Meng, X. (2025). Unilateral Endoscopic and Unilateral Biportal Endoscopic surgery for lumbar spinal stenosis: A systematic review and meta-analysis. Front. Surg., 12.","DOI":"10.3389\/fsurg.2025.1585783"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"503","DOI":"10.5603\/pjnns.97784","article-title":"Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in treatment of degenerative diseases of lumbosacral spine compared to modified open TLIF: A prospective randomised controlled study","volume":"58","author":"Kalina","year":"2024","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s13018-024-04630-1","article-title":"Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: A retrospective cohort study","volume":"19","author":"Zhu","year":"2024","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Drossopoulos, P.N., Bardeesi, A., Wang, T.Y., Huang, C.C., Ononogbu-Uche, F.C., Than, K.D., Crutcher, C., Pokorny, G., Shaffrey, C.I., and Pollina, J. (2024). Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases. J. Clin. Med., 13.","DOI":"10.3390\/jcm13041112"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s00132-018-03670-w","article-title":"Lumbar fusion-Indications and techniques","volume":"48","author":"Schnake","year":"2019","journal-title":"Orthopade"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1007\/s00586-023-08108-2","article-title":"Does type of bone graft matter? A retrospective review of the use of biological bone grafts in patients undergoing elective 1-3 level spinal interbody fusion","volume":"33","author":"Zeitouni","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Liu, D., Chan, J.L., Eleanore, A., DeCost, K., Luk, J., Neukam, L.C., Rizvi, T.Z., Lin, Z., Ghogawala, Z., and Magge, S.N. (2025). Radiographic and Clinical Comparison of Polyetheretherketone Versus 3D-Printed Titanium Cages in Lumbar Interbody Fusion-A Single Institution\u2019s Experience. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061813"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2889","DOI":"10.1111\/os.13896","article-title":"Comparison between Three-Dimensional Printed Titanium and PEEK Cages for Cervical and Lumbar Interbody Fusion: A Prospective Controlled Trial","volume":"15","author":"Deng","year":"2023","journal-title":"Orthop. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s10143-025-03453-w","article-title":"Clinical and radiological outcomes of titanium cage versus polyetheretherketone cage in lumbar interbody fusion: A systematic review and meta-analysis","volume":"48","author":"Wang","year":"2025","journal-title":"Neurosurg. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"37","DOI":"10.2147\/MDER.S493988","article-title":"Evaluation of Healthcare Outcomes of Patients Treated with 3D-Printed-Titanium and PEEK Cages During Fusion Procedures in the Lumbar Spine","volume":"18","author":"Corso","year":"2025","journal-title":"Med. Devices"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5814\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:29:20Z","timestamp":1760034560000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,17]]},"references-count":44,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165814"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165814","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,17]]}}}