Titanium (Ti) cages may be superior to polyetheretherketone (PEEK) cages in lumbar interbody fusion: a systematic review and meta-analysis of clinical and radiological outcomes of spinal interbody fusions using Ti versus PEEK cages

Abstract

Aim Interbody cages are commonly used to augment interbody fusion. Commonly used materials include titanium (Ti) and polyetheretherketone (PEEK), with their inherent differences. The aim of this study is to perform a systematic review and meta-analysis to compare between the various clinical and radiological outcomes of Ti and PEEK interbody spinal cages. Methods A systematic review and meta-analysis comparing clinical and radiological outcomes between Ti and PEEK interbody cages in patients undergoing spinal fusion was performed. PubMed, Scopus, Web of Science, Embase, and Cochrane Central Register of Controlled Trials database were searched. All studies that compared the clinical and radiological outcomes of patients who underwent Ti and PEEK cages were included. Subgroup analyses was performed to differentiate between patients who had cervical and lumbar interbody fusion. Results A total of 11 articles were identified, with a total of 743 patients. Spinal fusion rates at final follow-up did not differ between Ti and PEEK cages (OR 1.50, 95% CI 0.57-3.94, P = 0.41), although in patients undergoing lumbar fusion, Ti cages demonstrated superior fusion (OR 2.12, 95% CI 1.05-4.28, P = 0.04). In patients with non-infective etiologies, Ti cages had a higher rate of cage subsidence (RR 2.17, 95% CI 1.13-4.16, P = 0.02). Both types of cages had similar operating time, postoperative hematoma formation, neuropathic pain, segmental angle correction and postoperative clinical outcome improvement. ConclusionIn non-infective lumbar spine conditions, Ti cage may be the superior option due to the higher fusion rate. Level of evidence III.

Dissolution Behavior of Hydrothermally Treated Hydroxyapatite–Titanium Nitride Films Coated on PEEK: In Vitro Study

“…The systematic review comparing the titanium and PEEK cages for interfusion showed no difference in postoperative complications. The titanium cage had higher subsidence than the PEEK cage, but the PEEK was lower in fusion rate [ 48 ]. Integration between PEEK and bone is essential to these applications’ success.…”

A state-of-the-art review of the fabrication and characteristics of titanium and its alloys for biomedical applications

“…The most prevalent biomedical application of titanium is currently for hip and knee replacements, with shoulder and elbow joint implants following closely. Titanium has also seen frequent utilization in the spinal area for spinal correction parts, spinal fixation devices, spinal fusion cages, and in recent years, replacements of spinal disks [ 45 , 46 ]. Rib cages for children made of titanium allow the implant to expand as the body grows, thereby allowing young patients to grow with the rib cage [ 47 ].…”

Biomechanical analysis of customized cage conforming to the endplate morphology in anterior cervical discectomy fusion: A finite element analysis

“…Optimizing intervertebral fusion devices by changing their material properties and constructing for microporosity are favorable research directions. The advent of the cage in materials like titanium and poly-ether-ether-ketone (PEEK) has gradually replaced autologous bone grafts and become mainstream, owing to the better stability and biocompatibility of titanium alloys; the elastic modulus of PEEK is close to that of cortical bone [ 10 , 11 ]. Wang et al [ 12 ] performed local topological optimization of the unit lattice to obtain a lattice structure filled into the lumbar fusion for microporous fusion, which reduced the weight and showed a more uniform stress distribution.…”