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Hyun W Bae, MD, is a medical director at The Spine Institute (Saint John’s Health Center, Santa Monica, USA) and professor of Surgery at Cedars-Sinai Medical Center (Los Angeles, USA). An orthopaedic spine specialist, Dr Bae is a leader in minimally invasive surgery, motion preservation technology, artificial disc replacement, and non-fusion technologies. Alongside his clinical practice, Dr Bae is a prominent researcher and has been published extensively in top journals and presented at many national and international meetings. Here, using examples from his clinical practice, he discusses the benefits of using the Lucent XP Expandable Interbody device (Spinal Elements) made from PEEK-OPTIMA™ Natural polymer (Invibio Biomaterial Solutions™) and titanium during spine surgery.
Key features of the Lucent XP Expandable Interbody fusion device
The Lucent XP Expandable Interbody device is a unique addition to the spinal fusion market. The main features of the device are its ability to expand in height and increase in lordotic angle after it has been surgically implanted. It can expand up to 3mm, which helps restore the height of the spinal disc space and the lordotic angling helps correct the curvature of the spine. Surgeons are able to achieve up to 15 degrees of lordotic angle with the Lucent XP Interbody device, helping restore sagittal balance for the patient.
Another key features of the expandable device relates to its multifunctional surface material. A titanium-coated PEEK device, the radiolucent properties of the PEEK material allow for superior imaging quality compared to other materials on the market. This enhances crucial post-operative evaluation of the fusion progression. It also has a lower modulus of elasticity than titanium. In addition, the mechanical properties of PEEK along with the design of the device allow for a more load-sharing construct.
Given these benefits, it is not surprising that Dr Bae has chosen to use the Lucent XP Expandable Interbody device in his clinical practice. Talking to Spinal News International, he explains how it has become an integral part of his practice and expresses his high level of satisfaction with regard to imaging, fusion assessment and overall clinical outcome.
He focuses in particular on the qualities of the titanium-coated PEEK surface. He mentions that “the roughened surface of titanium-coated PEEK is more biologically and bone friendly. It is able to interact with the bone far better than smooth PEEK,” allowing for a more positive outcome for his patients.
The radiolucency of the PEEK material has also contributed to his positive experience with the device. The improved imaging quality has made his post-operative assessments far more useful for both patient and practitioner. “The imaging qualities of PEEK are far superior to its competitors,” he says.
A better device for patient and practitioner
Dr Bae mentions specifically how easy the Lucent XP Expandable Interbody device is to use. It gives “great feedback”, with the torque limiter being an “excellent addition” to the cage. He also comments on how the device compares favourably to 3D printed titanium cages, noting in particular that the unique Ti-Bond coating offers the best features of both titanium as well as PEEK. “The device has the strength of PEEK with the benefits of microtextured titanium,” he remarks.
Ultimately, Dr Bae says that he chose to adopt the Lucent XP device over other available expandable cages because it “provides the best of all worlds”. He reiterates the superior surface grip and friction that are essential to a successful procedure. This, in tandem with the best qualities of PEEK and titanium, makes for a high-quality device with noticeable advantages over other devices.
Addressing the concerns of surgeons who might consider PEEK an inappropriate material for an expandable cage, Dr Bae stresses the reliability of the material. “I have never seen a PEEK cage collapse on itself,” he tells Spinal News International.
The Lucent XP Expandable Interbody device has had a noticeable and positive impact on Dr Bae’s clinical practice, allowing for a smooth surgical procedure for both his patients and himself. Another key benefit for the patient is that recovery time is rapid. Dr Bae describes two specific cases during which he had used the Lucent XP device. One of these cases relates to a patient who is an avid cyclist, but had been experiencing severe back pain for 10 years. After undergoing a bilateral transforaminal lumbar interbody fusion using the Lucent XP Expandable Interbody device, she was in the hospital for just one night post-operatively. Now, one year later, she is not only actively working but is also back into cycling.
In essence, the Lucent XP Expandable Interbody device offers a simple solution to the many complexities of spinal surgery. “The device is easy to use,” Dr Bae concludes. “Its ability to expand in height and restore lordotic angle are exactly what I need to address the challenges of spinal fusion.”
Transforaminal Lumbar Interbody fusion in a middle-aged female using the Lucent XP Expandable Interbody cage
A 55-year-old female patient presented with severe low back pain and bilateral lower extremity pain with standing and walking. She has had lower back pain for approximately 10 years, however this was exacerbated after a car accident and can now stand for only five minutes without pain. She has had multiple injections to include epidurals and facet rhizotomies. She has had physical therapy over the past year and has presented with bilateral extensor hallicus longus weakness 4+/5. This individual had a decreased sensation to light touch and pinprick within an L5 and S1 distribution.
We performed a bilateral transforaminal lumbar interbody fusion at L5–S1 with cortical screws and a Lucent XP Expandable Interbody cage from Spinal Elements.
The patient was discharged from hospital the day after surgery. At one year, she is experiencing no back or leg pain and is actively working. The patient is a cyclist and she is also back to cycling.
Transforaminal Lumbar Interbody fusion in a middle-aged male using the Lucent XP Expandable Interbody cage
A 60-year-old male, who denies injury or trauma, presented with severe left lower extremity pain for one month. He had increased pain with standing for longer than 10 minutes. He walked with a limp because of pain and numbness, and could not walk more than a block without needing to stop. He has had one caudal epidural and one selective nerve block with no relief of symptoms. This patient has also tried physical therapy, which resulted in increased pain. On examination he has weakness in the left foot with 4+/5 anterior tibialis and 4/5 extensor hallicus longus. He had decreased sensation to light touch and pinprick in a left L5 distribution. Ankle jerk was absent on the left and an MRI of the lumbar spine revealed an extraforaminal disc herniation at L4–L5.
We performed a left-sided transforaminal lumbar interbody fusion at L4–5 with cortical screws and the Lucent XP Expandable Interbody cage from Spinal Elements.
The patient was discharged from hospital after a two-night stay and is now at one and a half years’ post-surgery. A retired police officer, he is now back to work as a security guard and plays golf regularly. He has minimal pain and only occasionally takes Advil.
INVIBIO™, PEEK-OPTIMA™, INVIBIO BIOMATERIAL SOLUTIONS™ are trademarks of Victrex plc or its group companies. Lucent® is a registered trademark of Spinal Elements.