Three dimensional printed patient-specific PEEK versus titanium mesh cage for anterior column reconstruction after spondylectomy for spinal tumours: a prospective controlled cohort study.

PURPOSE: The objective of this study was to compare implant subsidence at 12 months following vertebral body replacement (VBR) with 3D-printed patient-specific polyetheretherketone (PEEK) implants versus off-the-shelf titanium mesh cages after spondylectomy for spinal tumours. METHODS: Prospective non-randomized controlled cohort study. Adult patients with thoracic or lumbar spine tumours requiring VBR were enrolled between April 2022 and February 2025. Patients received either fused filament fabrication PEEK implants (n = 30) or titanium mesh cages (n = 30), with group allocation determined by manufacturing queue availability. The primary endpoint was subsidence exceeding 3 mm at 12 months. Secondary endpoints included osseous integration, segmental height, quality of life (SOSGOQ2.0), neurological status, and complications. RESULTS: Fifty-three patients completed follow-up (PEEK n = 27, Ti Mesh n = 26). Subsidence occurred in one of 27 PEEK patients (3.7%) versus 11 of 26 Ti Mesh patients (42.3%; absolute risk difference - 38.6%, 95% CI - 58.9 to - 18.3; p < 0.001). Endplate mismatch > 10° was absent in the PEEK group versus 46% in the Ti Mesh group (p < 0.001). Brantigan-Steffee grade 4-5 at 12 months was achieved in 96% versus 73% (p = 0.16). SOSGOQ2.0 total scores were higher in the PEEK group at three and six months (p = 0.006 and p = 0.014), with differences non-significant by 12 months. Neurological outcomes and perioperative complication rates were comparable. CONCLUSION: 3D-printed patient-specific PEEK VBR achieved significantly lower subsidence rates than titanium mesh cages at 12 months with comparable safety and neurological outcomes. These findings support its use as a technically feasible option in anterior column reconstruction after spondylectomy for spinal tumours. REGISTRY: MinZdrav.gov.ru, TRN: 2023/17-1, Registration date: 28 February 2023.