{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:01:59Z","timestamp":1792623719075,"version":"4.5.0"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: To prevent postoperative problems in extreme lateral interbody fusion (XLIF), it is critical that the vertebral endplate not be injured. Unintentional endplate injuries may depend on the cage. A novel porous titanium cage for XLIF has improved geometry with a tapered tip and smooth surface. We hypothesized that this new cage should lead to fewer endplate injuries. Materials and Methods: This retrospective study included 32 patients (mean 74.1 \u00b1 6.7 years, 22 females) who underwent anterior and posterior combined surgery with XLIF for lumbar degenerative disease or adult spinal deformity from January 2018 to June 2022. A tapered 3D porous titanium cage (3DTi; 11 patients) and a squared PEEK cage (sPEEK; 21 patients) were used. Spinal alignment values were measured on X-ray images. Vertebral endplate concavity (VEC) was defined as concavity \u2265 1 mm of the endplate on computed tomography (CT) images, which were evaluated preoperatively and at 1 week and 3 months postoperatively. Results: There were no significant differences in the patient demographic data and preoperative and 3-month postoperative spinal alignments between the groups. A 3DTi was used for 25 levels and an sPEEK was used for 38 levels. Preoperative local lordotic angles were 4.3\u00b0 for 3DTi vs. 4.7\u00b0 for sPEEK (p = 0.90), which were corrected to 12.3\u00b0 and 9.1\u00b0 (p = 0.029), respectively. At 3 months postoperatively, the angles were 11.6\u00b0 for 3DTi and 8.2\u00b0 for sPEEK (p = 0.013). VEC was present in 2 levels (8.0%) for 3DTi vs. 17 levels (45%) for sPEEK (p = 0.002). After 3 months postoperatively, none of the 3DTi had VEC progression; however, eight (21%) levels in sPEEK showed VEC progression (p = 0.019). Conclusions: The novel 3DTi cage reduced endplate injuries by reducing the endplate load during cage insertion.<\/jats:p>","DOI":"10.3390\/medicina59020372","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T06:33:01Z","timestamp":1676442781000},"page":"372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Vertebral Endplate Concavity in Lateral Lumbar Interbody Fusion: Tapered 3D-Printed Porous Titanium Cage versus Squared PEEK Cage"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9681-2422","authenticated-orcid":false,"given":"Naoki","family":"Segi","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"},{"name":"Department of Orthopedic Surgery, Anjo Kosei Hospital, 28 Higashihirokute, Anjo 446-8602, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0039-9678","authenticated-orcid":false,"given":"Hiroaki","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuichi","family":"Shinjo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Anjo Kosei Hospital, 28 Higashihirokute, Anjo 446-8602, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujiro","family":"Kagami","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Anjo Kosei Hospital, 28 Higashihirokute, Anjo 446-8602, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2570-4488","authenticated-orcid":false,"given":"Masaaki","family":"Machino","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadayuki","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Ouchida","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuaki","family":"Morishita","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryotaro","family":"Oishi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ippei","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Imagama","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.spinee.2005.08.012","article-title":"Extreme Lateral Interbody Fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006","journal-title":"Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/CORR.0000000000001915","article-title":"Poor Bone Quality, Multilevel Surgery, and Narrow and Tall Cages Are Associated with Intraoperative Endplate Injuries and Late-onset Cage Subsidence in Lateral Lumbar Interbody Fusion: A Systematic Review","volume":"480","author":"Wu","year":"2022","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E1582","DOI":"10.1097\/BRS.0000000000000645","article-title":"Radiographical and Clinical Evaluation of Extreme Lateral Interbody Fusion: Effects of Cage Size and Instrumentation Type with a Minimum of 1-Year Follow-up","volume":"39","author":"Tohmeh","year":"2014","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"907","DOI":"10.4184\/asj.2016.10.5.907","article-title":"Predisposing Factors for Intraoperative Endplate Injury of Extreme Lateral Interbody Fusion","volume":"10","author":"Satake","year":"2016","journal-title":"Asian Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"20149","DOI":"10.1038\/s41598-021-99751-6","article-title":"Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion","volume":"11","author":"Kim","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"105208","DOI":"10.1016\/j.jmbbm.2022.105208","article-title":"Effects of 3D printed surface topography and normal force on implant expulsion","volume":"130","author":"Heimbrook","year":"2022","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"171","DOI":"10.22603\/ssrr.2019-0089","article-title":"Novel Titanium Cages for Minimally Invasive Lateral Lumbar Interbody Fusion: First Assessment of Subsidence","volume":"4","author":"Krafft","year":"2020","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_8","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_9","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_10","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1016\/j.wneu.2021.11.122","article-title":"Early Outcomes of Three-Dimensional\u2013Printed Porous Titanium versus Polyetheretherketone Cage Implantation for Stand-Alone Lateral Lumbar Interbody Fusion in the Treatment of Symptomatic Adjacent Segment Degeneration","volume":"162","author":"Moser","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"323","DOI":"10.21037\/jss-22-17","article-title":"Fusion assessment in standalone lateral lumbar interbody fusion: 3D-printed titanium versus polyetheretherketone (PEEK) cages","volume":"8","author":"Moser","year":"2022","journal-title":"J. Spine Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1227\/NEU.0000000000000182o","article-title":"The Comprehensive Anatomical Spinal Osteotomy Classification","volume":"74","author":"Schwab","year":"2014","journal-title":"Neurosurgery"},{"key":"ref_13","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: Clinical article","volume":"19","author":"Marchi","year":"2013","journal-title":"J. Neurosurg. Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.spinee.2015.09.038","article-title":"Does impaction of titanium-coated interbody fusion cages into the disc space cause wear debris or delamination?","volume":"16","author":"Kienle","year":"2016","journal-title":"Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1002\/jbm.820241107","article-title":"Friction properties of the interface between porous-surfaced metals and tibial cancellous bone","volume":"24","author":"Rancourt","year":"1990","journal-title":"J. Biomed. Mater. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1002\/jbm.820270205","article-title":"Experimental determination of friction characteristics at the trabecular bone\/porous-coated metal interface in cementless implants","volume":"27","author":"Dammak","year":"1993","journal-title":"J. Biomed. Mater. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.msec.2019.04.064","article-title":"Review on titanium and titanium based alloys as biomaterials for orthopaedic applications","volume":"102","author":"Kaur","year":"2019","journal-title":"Mater. Sci. Eng. C"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Jamari, J., Ammarullah, M.I., Santoso, G., Sugiharto, S., Supriyono, T., and van der Heide, E. (2022). In Silico Contact Pressure of Metal-on-Metal Total Hip Implant with Different Materials Subjected to Gait Loading. Metals, 12.","DOI":"10.3390\/met12081241"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Vara, J.C., Delgado, J., Estrada-Mart\u00ednez, A., P\u00e9rez-Pevida, E., Brizuela, A., Bosch, B., P\u00e9rez, R., and Gil, J. (2022). Effect of the Nature of the Particles Released from Bone Level Dental Implants: Physicochemical and Biological Characterization. Coatings, 12.","DOI":"10.3390\/coatings12020219"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Jamari, J., Ammarullah, M.I., Santoso, G., Sugiharto, S., Supriyono, T., Prakoso, A.T., Basri, H., and van der Heide, E. (2022). Computational Contact Pressure Prediction of CoCrMo, SS 316L and Ti6Al4V Femoral Head against UHMWPE Acetabular Cup under Gait Cycle. J. Funct. Biomater., 13.","DOI":"10.3390\/jfb13020064"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.biomaterials.2016.01.012","article-title":"Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: A review","volume":"83","author":"Wang","year":"2016","journal-title":"Biomaterials"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"779854","DOI":"10.3389\/fbioe.2021.779854","article-title":"Analysis of Mechanical Properties and Permeability of Trabecular-Like Porous Scaffold by Additive Manufacturing","volume":"9","author":"Chao","year":"2021","journal-title":"Front. Bioeng. Biotechnol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Putra, R.U., Basri, H., Prakoso, A.T., Chandra, H., Ammarullah, M.I., Akbar, I., Syahrom, A., and Kamarul, T. (2023). Level of Activity Changes Increases the Fatigue Life of the Porous Magnesium Scaffold, as Observed in Dynamic Immersion Tests, over Time. Sustainability, 15.","DOI":"10.3390\/su15010823"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.msec.2013.11.020","article-title":"Porous material based on spongy titanium granules: Structure, mechanical properties, and osseointegration","volume":"35","author":"Rubshtein","year":"2014","journal-title":"Mater. Sci. Eng. C"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1093\/rb\/rbw016","article-title":"Biomedical titanium alloys with Young\u2019s moduli close to that of cortical bone","volume":"3","author":"Niinomi","year":"2016","journal-title":"Regen. Biomater."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"203","DOI":"10.22603\/ssrr.1.2017-0004","article-title":"Cage subsidence in lateral interbody fusion with transpsoas approach: Intraoperative endplate injury or late-onset settling","volume":"1","author":"Satake","year":"2017","journal-title":"Spine Surg. Relat. Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/372\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:36:37Z","timestamp":1760121397000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,15]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["medicina59020372"],"URL":"https:\/\/doi.org\/10.3390\/medicina59020372","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,15]]}}}