Computed tomography color mapping for evaluation of bone ongrowth on the surface of a titanium-coated polyetheretherketone cage in vivo: A pilot study

Bone ongrowth on the surfaces of titanium (Ti)-coated polyetheretherketone (PEEK) materials has been demonstrated in animal models; however, whether this occurs on the surfaces of Ti-coated PEEK cages in lumbar interbody fusion has not been demonstrated clinically in vivo. This prospective observational study was aimed to develop and validate a computed tomography (CT) color mapping based on Hounsfield unit (HU) values for evaluation of bone ongrowth on the surfaces of the Ti-coated PEEK cage after posterior lumbar interbody fusion (PLIF). Twenty-four consecutive patients (11 men and 13 women; mean age, 67.0 years; range, 20–82 years) who underwent single- or 2-level PLIF since March 2015 were included. Two Ti-coated PEEK cages were inserted in all PLIF segments. From reconstructed sagittal planes from postoperative CT scans (within 1 week and 6 months postoperatively), bone ongrowth on the surfaces of cage frames was evaluated by CT color mapping. Inter- and intraobserver reliability of the assessment of bone ongrowth by CT color mapping was evaluated by Cohen's kappa coefficient. The relation between CT color mapping and HU values on the surfaces of cage frames was also analyzed. A total of 248 surfaces of cage frames were evaluated. Bone ongrowth was observed in 134 of 248 surfaces (54.0%) by CT color mapping. Intraobserver reliability for the evaluation of bone ongrowth was kappa = 0.831, and interobserver reliability was kappa = 0.713. The HU values in the local regions of interest (ROIs) on the surfaces of cage frames where the postoperative bone ongrowth existed on CT color mapping increased significantly postoperatively (P < .001), and the median postoperative change rate of the HU values in the local ROIs was 22.4%. The assessment of bone ongrowth on the surfaces of Ti-coated PEEK cages by CT color mapping had adequate inter- and intraobserver reliability, which was useful especially in detecting local increase in HU values on the surfaces of the cages. This method is an easy and visually comprehensible method for the assessment of bone ongrowth in the bone-implant interface.