{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:28:03Z","timestamp":1792805283796,"version":"4.5.0"},"reference-count":77,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MTPConnect","award":["BMTH Project Round: Four"],"award-info":[{"award-number":["BMTH Project Round: Four"]}],"id":[{"id":"https:\/\/ror.org\/04gf0sp21","id-type":"ROR","asserted-by":"crossref"}]},{"name":"3DMorphic Pty Ltd.","award":["BMTH Project Round: Four"],"award-info":[{"award-number":["BMTH Project Round: Four"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Lumbar Interbody Fusion (LIF) is a surgical procedure aimed at addressing a range of pathological conditions affecting the structure and function of the spine. Patient-Specific Interbody Cages (PSICs) are an emerging technology that are used in LIF; however, there is a lack of clinical outcome data, making it difficult to assess the potential risks, benefits, and value of PSICs. The purpose of this present study is to contribute data to the field on this new emerging technology. The aims were to investigate Quality of Life (QoL), pain, and the complications of PSICs in LIF. To provide a comparative cohort, we performed a systematic review of patient-reported outcomes of conventional fusion techniques. Methods: This study reports on a multi-surgeon, multi-centre clinical trial of patients with lumbar degenerative disc disease, necessitating discectomy and fusion. All patients underwent LIF procedures with 3D-printed PSICs. Pain Visual Analogue Scale (VAS) and QoL (EQ-5D) scores were collected pre-operatively and at 6m, 12m, and 24m post-operatively. For comparative purposes, we performed a systematic review of the VAS scores from traditional LIF cages and analysed the Australian Spine Registry QoL data. Results: The literature search yielded 4272 publications. The studies were subdivided into four groups based on the interbody device type. All the groups demonstrated improvements in the VAS (for back pain) scores post-operatively. In total, 78 patients (109 instrumented levels) underwent LIF procedures with 3DP PSICs. There were three reoperations (3.8%) and no revisions of any PSIC. The mean VAS scores improved significantly (p &lt; 0.01) from 7.85 (1.50 SD) pre-operatively to 2.03 (2.13 SD) at 24 months post-operatively. The mean QoL index scores improved significantly (p &lt; 0.01) from a pre-operative 0.257 (0.332 SD) to 0.815 (0.208 SD) at 24 months. Conclusions: The systematic review indicated that device fixation to the interbody space was associated with lower VAS scores. The results from the investigational cohort suggest that PSICs may represent a new progression in implant design for spinal fusion, with an associated clinical benefit for LIF.<\/jats:p>","DOI":"10.3390\/jpm15070320","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T10:46:05Z","timestamp":1752662765000},"page":"320","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical Outcomes of 3D-Printed Titanium Patient-Specific Implants in Lumbar Interbody Fusion: A Prospective Clinical Trial with a Systematic Review of Conventional Techniques"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0051-8323","authenticated-orcid":false,"given":"Kevin A.","family":"Seex","sequence":"first","affiliation":[{"name":"Macquarie Neurosurgery, Macquarie University Hospital, Macquarie Park, NSW 2109, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6542-6836","authenticated-orcid":false,"given":"Ralph J.","family":"Mobbs","sequence":"additional","affiliation":[{"name":"Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia"},{"name":"NeuroSpine Surgery Research Group (NSURG), Randwick, NSW 2031, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Coughlan","sequence":"additional","affiliation":[{"name":"Coastal Neurosurgery, Gosford Private Hospital, Gosford, NSW 2250, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1643-6696","authenticated-orcid":false,"given":"Matthew","family":"Pelletier","sequence":"additional","affiliation":[{"name":"Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW), Randwick, NSW 2031, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-6148","authenticated-orcid":false,"given":"William R.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW), Randwick, NSW 2031, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5418-1019","authenticated-orcid":false,"given":"Jackson C.","family":"Hill","sequence":"additional","affiliation":[{"name":"3DMorphic Pty Ltd., Matraville, NSW 2036, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C. H.","family":"Parr","sequence":"additional","affiliation":[{"name":"Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW), Randwick, NSW 2031, Australia"},{"name":"3DMorphic Pty Ltd., Matraville, NSW 2036, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S173","DOI":"10.1016\/j.spinee.2004.07.002","article-title":"A Review of Spinal Fusion for Degenerative Disc Disease: Need for Alternative Treatment Approach of Disc Arthroplasty?","volume":"4","author":"Lee","year":"2004","journal-title":"Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1093\/neuros\/nyw162","article-title":"Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis","volume":"80","author":"Yavin","year":"2017","journal-title":"Neurosurgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1177\/21925682231161304","article-title":"How Good Are Surgeons at Achieving Their Preoperative Goal Sagittal Alignment Following Adult Deformity Surgery?","volume":"14","author":"Smith","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"741","DOI":"10.3171\/2020.9.SPINE20230","article-title":"The Minimally Invasive Interbody Selection Algorithm for Spinal Deformity","volume":"34","author":"Mummaneni","year":"2021","journal-title":"J. Neurosurg. Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/os.12259","article-title":"Evolution of Design of Interbody Cages for Anterior Lumbar Interbody Fusion","volume":"8","author":"Phan","year":"2016","journal-title":"Orthop. Surg."},{"key":"ref_6","first-page":"73","article-title":"Therapeutics for Enhancement of Spinal Fusion: A Mini Review","volume":"31","author":"Zhang","year":"2021","journal-title":"J. Orthop. Transl."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lewin, A.M., Fearnside, M., Kuru, R., Jonker, B.P., Naylor, J.M., Sheridan, M., and Harris, I.A. (2021). Rates, Costs, Return to Work and Reoperation Following Spinal Surgery in a Workers\u2019 Compensation Cohort in New South Wales, 2010\u20132018: A Cohort Study Using Administrative Data. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06900-8"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.wneu.2017.05.011","article-title":"Evaluating Outcomes of Stand-Alone Anterior Lumbar Interbody Fusion: A Systematic Review","volume":"104","author":"Giang","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e321","DOI":"10.1016\/j.wneu.2019.11.158","article-title":"Three-Dimensional Morphometric Analysis of Lumbar Vertebral End Plate Anatomy","volume":"135","author":"Singh","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"160","DOI":"10.5435\/JAAOS-D-16-00390","article-title":"The Effect of Cervical Interbody Cage Morphology, Material Composition, and Substrate Density on Cage Subsidence","volume":"25","author":"Suh","year":"2017","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_11","unstructured":"Hull, C.W. (1984). Apparatus for Production of Three-Dimensional Objects by Stereolithography. (638,905), U.S. Patent."},{"key":"ref_12","first-page":"704","article-title":"Medical Applications for 3D Printing: Current and Projected Uses","volume":"39","author":"Ventola","year":"2014","journal-title":"Pharm. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5340616","DOI":"10.1155\/2019\/5340616","article-title":"The Role of 3D Printing in Medical Applications: A State of the Art","volume":"2019","author":"Aimar","year":"2019","journal-title":"J. Healthc. Eng."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e327","DOI":"10.1016\/j.wneu.2019.09.002","article-title":"Use of 3-Dimensional Printing Technology in Complex Spine Surgeries","volume":"133","author":"Lador","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1097\/00007632-199906150-00013","article-title":"Spinal Biomodeling","volume":"24","author":"Askin","year":"1999","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1007\/s00586-016-4871-z","article-title":"One-Step Reconstruction with a 3D-Printed, Custom-Made Prosthesis after Total En Bloc Sacrectomy: A Technical Note","volume":"26","author":"Wei","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.wneu.2018.01.078","article-title":"L5 En-Bloc Vertebrectomy with Customized Reconstructive Implant: Comparison of Patient-Specific versus off-the-Shelf Implant","volume":"112","author":"Mobbs","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/BSD.0000000000001026","article-title":"3D-Printed Patient-Specific Spine Implants: A Systematic Review","volume":"33","author":"Wallace","year":"2020","journal-title":"Clin. Spine Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1007\/s00586-019-06236-2","article-title":"3D-Printed Spine Surgery Implants: A Systematic Review of the Efficacy and Clinical Safety Profile of Patient-Specific and off-the-Shelf Devices","volume":"29","author":"Burnard","year":"2020","journal-title":"Eur. Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.spinee.2018.05.001","article-title":"Outcome and Safety Analysis of 3D-Printed Patient-Specific Pedicle Screw Jigs for Complex Spinal Deformities: A Comparative Study","volume":"19","author":"Garg","year":"2019","journal-title":"Spine J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e961","DOI":"10.1016\/j.wneu.2019.07.047","article-title":"Three-Dimensional\u2013Printed Individualized Guiding Templates for Surgical Correction of Severe Kyphoscoliosis Secondary to Ankylosing Spondylitis: Outcomes of 9 Cases","volume":"130","author":"Tu","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.wneu.2018.07.219","article-title":"Three-Dimensional Planning and Use of Individualized Osteotomy-Guiding Templates for Surgical Correction of Kyphoscoliosis: A Technical Case Report","volume":"119","author":"Pijpker","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Tredan, D.A.M., Mobbs, R.J., Maharaj, M., and Parr, W.C.H. (2023). Combining Virtual Surgical Planning and Patient-Specific 3D-Printing as a Solution to Complex Spinal Revision Surgery. J. Pers. Med., 13.","DOI":"10.3390\/jpm13010019"},{"key":"ref_24","unstructured":"Apos, E., Bulmer, S., Truong, T., Garduce, P., Pourghaderi, A., Cunningham, A.S., Kuru, R., Ho, S., Mt, I., and Stanford, R. The Australian Spine Registry Annual Report, 2023: Spine Society of Australia and Public Health and Preventive Medicine, April 2024, Report No. 06."},{"key":"ref_25","unstructured":"Rosner, B.A. (2006). Fundamentals of Biostatistics, Thomson-Brooks\/Cole."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1136\/emj.18.3.205","article-title":"The Minimum Clinically Significant Difference in Visual Analogue Scale Pain Score Does Not Differ with Severity of Pain","volume":"18","author":"Kelly","year":"2001","journal-title":"Emerg. Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1227\/NEU.0000000000000561","article-title":"Outcomes of Anterior Lumbar Interbody Fusion Surgery Based on Indication: A Prospective Study","volume":"76","author":"Rao","year":"2015","journal-title":"Neurosurgery"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3171\/2023.2.SPINE221341","article-title":"Effect of Workers\u2019 Compensation Status on Pain, Disability, Quality of Life, and Return to Work after Lumbar Spine Surgery: A 1-Year Propensity-Matched Analysis","volume":"39","author":"Hani","year":"2023","journal-title":"J. Neurosurg. Spine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jtbi.2012.01.030","article-title":"Toward Integration of Geometric Morphometrics and Computational Biomechanics: New Methods for 3D Virtual Reconstruction and Quantitative Analysis of Finite Element Models","volume":"301","author":"Parr","year":"2012","journal-title":"J. Theor. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Niinomi, M., and Boehlert, C.J. (2015). Titanium Alloys for Biomedical Applications. Advances in Metallic Biomaterials: Tissues, Materials and Biological Reactions, Springer.","DOI":"10.1007\/978-3-662-46836-4_8"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E208","DOI":"10.1097\/BSD.0b013e31826851a4","article-title":"PEEK versus Ti Interbody Fusion Devices: Resultant Fusion, Bone Apposition, Initial and 26-Week Biomechanics","volume":"29","author":"Pelletier","year":"2016","journal-title":"Clin. Spine Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S8756-3282(97)00204-4","article-title":"Effects of Surface Roughness of Titanium Implants on Bone Remodeling Activity of Femur in Rabbits","volume":"21","author":"Suzuki","year":"1997","journal-title":"Bone"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E417","DOI":"10.1097\/BRS.0000000000003303","article-title":"Effects of Surface Topography and Chemistry on Polyether-Ether-Ketone (PEEK) and Titanium Osseointegration","volume":"45","author":"Torstrick","year":"2020","journal-title":"Spine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3815","DOI":"10.3390\/ma8073815","article-title":"Nanosized Hydroxyapatite Coating on PEEK Implants Enhances Early Bone Formation: A Histological and Three-Dimensional Investigation in Rabbit Bone","volume":"8","author":"Johansson","year":"2015","journal-title":"Materials"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2364","DOI":"10.1007\/s11999-016-4994-x","article-title":"Does PEEK\/HA Enhance Bone Formation Compared with PEEK in a Sheep Cervical Fusion Model?","volume":"474","author":"Walsh","year":"2016","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"354","DOI":"10.21037\/jss-24-157","article-title":"The Importance of Stabilisation in Enabling Bone Fusion Demonstrated by Successful Revision of Failed Occipitocervical Fusion Using Patient-Specific Atlantoaxial Joint Spacers: A Case Report","volume":"11","author":"Yataganbaba","year":"2025","journal-title":"J. Spine Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0168-8510(90)90421-9","article-title":"EuroQol-a New Facility for the Measurement of Health-Related Quality of Life","volume":"16","author":"Group","year":"1990","journal-title":"Health Policy"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/1475-4932.00087","article-title":"S2 The Value of Life and Health for Public Policy*","volume":"79","author":"Abelson","year":"2003","journal-title":"Econ. Rec."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s40273-023-01243-0","article-title":"The Use of a Discrete Choice Experiment Including Both Duration and Dead for the Development of an EQ-5D-5L Value Set for Australia","volume":"41","author":"Norman","year":"2023","journal-title":"Pharmacoeconomics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.jval.2011.04.009","article-title":"Time Trade-off Derived EQ-5D Weights for Australia","volume":"14","author":"Viney","year":"2011","journal-title":"Value Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s12955-016-0537-0","article-title":"Health-Related Quality of Life Measured Using the EQ-5D-5L: South Australian Population Norms","volume":"14","author":"McCaffrey","year":"2016","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_43","unstructured":"Higgins, J.P.T. (2011). Chapter 8: Assessing Risk of Bias in Included Studies. Cochrane Handbook for Systematic Reviews of Interventions, The Cochrane Collaboration."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1186\/s13643-021-01744-z","article-title":"Application of Weighting Methods for Presenting Risk-of-Bias Assessments in Systematic Reviews of Diagnostic Test Accuracy Studies","volume":"10","author":"Vali","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/s41592-019-0686-2","article-title":"SciPy 1.0: Fundamental Algorithms for Scientific Computing in Python","volume":"17","author":"Virtanen","year":"2020","journal-title":"Nat. Methods"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"E534","DOI":"10.1097\/BSD.0000000000000029","article-title":"Two-Level Circumferential Lumbar Fusion Comparing Midline and Paraspinal Posterior Approach: 5-Year Interim Outcomes of a Randomized, Blinded, Prospective Study","volume":"28","author":"Buttermann","year":"2015","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"8","DOI":"10.14444\/1008","article-title":"Prospective Randomized Controlled Trial of the Stabilis Stand Alone Cage (SAC) versus Bagby and Kuslich (BAK) Implants for Anterior Lumbar Interbody Fusion","volume":"8","author":"Lavelle","year":"2014","journal-title":"Int. J. Spine Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1097\/BRS.0b013e318054e377","article-title":"Results of the Prospective, Randomized, Multicenter Food and Drug Administration Investigational Device Exemption Study of the ProDisc-L Total Disc Replacement Versus Circumferential Fusion for the Treatment of 1-Level Degenerative Disc Disease","volume":"32","author":"Zigler","year":"2007","journal-title":"Spine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"705","DOI":"10.2106\/JBJS.I.00680","article-title":"Prospective, Randomized, Multicenter Food and Drug Administration Investigational Device Exemption Study of the ProDisc-L Total Disc Replacement Compared with Circumferential Arthrodesis for the Treatment of Two-Level Lumbar Degenerative Disc Disease: Results at Twenty-Four Months","volume":"93","author":"Delamarter","year":"2011","journal-title":"J. Bone Jt. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1097\/BRS.0b013e3181a401bf","article-title":"Results of Surgery for Discogenic Low Back Pain A Randomized Study Using Discography Versus Discoblock for Diagnosis","volume":"34","author":"Ohtori","year":"2009","journal-title":"Spine"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"E1600","DOI":"10.1097\/BRS.0b013e318217668f","article-title":"Lumbar Disc Arthroplasty with MAVERICK Disc versus Stand-Alone Interbody Fusion: A Prospective, Randomized, Controlled, Multicenter Investigational Device Exemption Trial","volume":"36","author":"Gornet","year":"2011","journal-title":"Spine"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2674","DOI":"10.1097\/00007632-200212010-00006","article-title":"Circumferential Lumbar Spinal Fusion With Brantigan Cage Versus Posterolateral Fusion With Titanium Cotrel-Dubousset Instrumentation A Prospective, Randomized Clinical Study of 146 Patients","volume":"27","author":"Christensen","year":"2002","journal-title":"Spine"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1007\/s00586-015-3852-y","article-title":"ALIF and Total Disc Replacement versus 2-Level Circumferential Fusion with TLIF: A Prospective, Randomized, Clinical and Radiological Trial","volume":"25","author":"Hoff","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"E319","DOI":"10.1097\/BSD.0000000000000802","article-title":"Clinical Outcome After Anterior Lumbar Interbody Fusion With a New Osteoinductive Bone Substitute Material A Randomized Clinical Pilot Study","volume":"32","author":"Rickert","year":"2019","journal-title":"Clin. Spine Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1007\/s00586-022-07275-y","article-title":"Ceramic Bone Graft Substitute vs Autograft in XLIF: A Prospective Randomized Single-Center Evaluation of Radiographic and Clinical Outcomes","volume":"31","author":"Menezes","year":"2022","journal-title":"Eur. Spine J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"924","DOI":"10.14444\/7141","article-title":"A Prospective, Randomized Study Evaluating Clinical and Radiographic Efficacy of Lumbar Interbody Fusion Performed Using a Truss Technology\u2013Based Interbody Fusion Device with Homologous Bone or Bone Marrow Aspirate","volume":"14","author":"Chatterjee","year":"2020","journal-title":"Int. J. Spine Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1097\/01.brs.0000170587.32676.0e","article-title":"A Prospective, Randomized, Multicenter Food and Drug Administration Investigational Device Exemptions Study of Lumbar Total Disc Replacement With the CHARIT\u00c9TM Artificial Disc Versus Lumbar Fusion Part I: Evaluation of Clinical Outcomes","volume":"30","author":"Blumenthal","year":"2005","journal-title":"Spine"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1097\/BRS.0b013e3181a005d7","article-title":"A Prospective, Randomized, Blinded, Single-Site Study to Evaluate the Clinical and Radiographic Differences Between Frozen and Freeze-Dried Allograft When Used as Part of a Circumferential Anterior Lumbar Interbody Fusion Procedure","volume":"34","author":"Thalgott","year":"2009","journal-title":"Spine"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s00586-005-1034-z","article-title":"A Prospective, Randomised Controlled Trial of Femoral Ring Allograft versus a Titanium Cage in Circumferential Lumbar Spinal Fusion with Minimum 2-Year Clinical Results","volume":"14","author":"McKenna","year":"2005","journal-title":"Eur. Spine J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14444\/8354","article-title":"Evaluation of Anterior Lumbar Interbody Fusion Performed Using a Stand-Alone, Integrated Fusion Cage","volume":"17","author":"Guyer","year":"2023","journal-title":"Int. J. Spine Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.1016\/j.wneu.2021.09.108","article-title":"Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion versus Anterior Lumbar Interbody Fusion with Posterior Instrumentation at L5\/S1","volume":"157","author":"Jacob","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_62","first-page":"e11684","article-title":"Safety Profile and Radiographic and Clinical Outcomes of Stand-Alone 2-Level Anterior Lumbar Interbody Fusion: A Case Series of 41 Consecutive Patients","volume":"12","author":"Kashlan","year":"2020","journal-title":"Cureus"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"E1259","DOI":"10.1097\/BRS.0000000000002145","article-title":"Transforaminal Lumbar Interbody Fusion Versus Mini-Open Anterior Lumbar Interbody Fusion with Oblique Self-Anchored Stand-Alone Cages for the Treatment of Lumbar Disc Herniation","volume":"42","author":"Kuang","year":"2017","journal-title":"Spine"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1007\/s00586-014-3364-1","article-title":"Stand-Alone ALIF with Integrated Intracorporeal Anchoring Plates in the Treatment of Degenerative Lumbar Disc Disease: A Prospective Study on 65 Cases","volume":"23","author":"Allain","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/2017.8.FOCUS17423","article-title":"Preliminary Results of Anterior Lumbar Interbody Fusion, Anterior Column Realignment for the Treatment of Sagittal Malalignment","volume":"43","author":"Hosseini","year":"2017","journal-title":"Neurosurg. Focus."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1007\/s00586-014-3642-y","article-title":"Anterior Stand-Alone Fusion Revisited: A Prospective Clinical, X-Ray and CT Investigation","volume":"24","author":"Siepe","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.spinee.2023.09.008","article-title":"Does the Interfacing Angle between Pedicle Screws and Support Rods Affect Clinical Outcomes after Posterior Thoracolumbar Fusion? A Retrospective Clinical Study","volume":"24","author":"Noriega","year":"2024","journal-title":"Spine J."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1016\/j.spinee.2025.01.035","article-title":"Maximizing Screw Length in Expandable Lateral Lumbar Interbody Spacers with Integrated Fixation May Obviate the Need for Supplemental Pedicle Screws","volume":"25","author":"Malham","year":"2025","journal-title":"Spine J."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.spinee.2020.11.002","article-title":"Single Position Circumferential Fusion Improves Operative Efficiency, Reduces Complications and Length of Stay Compared with Traditional Circumferential Fusion","volume":"21","author":"Buckland","year":"2021","journal-title":"Spine J."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1186\/s13063-017-2168-0","article-title":"Specific Barriers to the Conduct of Randomised Clinical Trials on Medical Devices","volume":"18","author":"Neugebauer","year":"2017","journal-title":"Trials"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1097\/01.bsd.0000175695.88920.62","article-title":"The Correlation Between Preoperative Disc Space Height and Clinical Outcomes After Anterior Lumbar Interbody Fusion","volume":"18","author":"Schuler","year":"2005","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1007\/s00586-008-0797-4","article-title":"Biomechanical Comparison of Two Different Concepts for Stand Alone Anterior Lumbar Interbody Fusion","volume":"17","author":"Schleicher","year":"2008","journal-title":"Eur. Spine J."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Chen, S.H., Chiang, M.C., Lin, J.F., Lin, S.C., and Hung, C.H. (2013). Biomechanical Comparison of Three Stand-Alone Lumbar Cages\u2014A Three-Dimensional Finite Element Analysis. BMC Musculoskelet. Disord., 14.","DOI":"10.1186\/1471-2474-14-281"},{"key":"ref_74","unstructured":"Horwitz, L., Chohreh Partovian, M., Lin, Z., Herrin, J., Grady, J., Mitchell Conover, M., Julia Montague, B., Chloe Dillaway, M., Kathleen Bartczak, B., and Lisa Suter, B. (2025, July 03). Hospital-Wide All-Cause Unplanned Readmission Measure Final Technical Report Submitted by Yale New Haven Health Services Corporation\/Center for Outcomes Research & Evaluation (YNHHSC\/CORE), Available online: https:\/\/www.cms.gov\/priorities\/innovation\/files\/fact-sheet\/bpciadvanced-fs-nqf1789.pdf."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1177\/21925682231216926","article-title":"Analysis of Personalized Interbody Implants in the Surgical Treatment of Adult Spinal Deformity","volume":"15","author":"Smith","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.14444\/8640","article-title":"Tomographic Assessment of Fusion Rate, Implant-Endplate Contact Area, Subsidence, and Alignment With Lumbar Personalized Interbody Implants at 1-Year Follow-Up","volume":"18","author":"Ames","year":"2024","journal-title":"Int. J. Spine Surg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s13018-020-01696-5","article-title":"Bone Ongrowth and Mechanical Fixation of Implants in Cortical and Cancellous Bone","volume":"15","author":"Walsh","year":"2020","journal-title":"J. Orthop. Surg. Res."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/7\/320\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:10:28Z","timestamp":1760033428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/7\/320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":77,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jpm15070320"],"URL":"https:\/\/doi.org\/10.3390\/jpm15070320","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,16]]}}}