Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature

Seaman, Scott C.; Kerezoudis, Panagiotis; Bydon, Mohamad; Torner, James C.; Hitchon, Patrick W.

doi:10.1016/j.jocn.2017.06.062

Cited by 205 publications

(139 citation statements)

References 27 publications

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“…38,39 In this study, there was no difference in subsidence rates between Ti and PEEK cages. However, Seaman et al, 40 reviewed 4 cervical studies and 2 lumbar studies and showed that the rate subsidence for Ti was greater in the cervical and lumbar spine. This meta-analysis included exclusively 11 lumbar studies that give our results more power, but also included Ti-coated PEEK cages, a composite that overcomes the modulus of elasticity of Ti that leads to subsidence and provides effective osseointegration.…”

Section: Discussionmentioning

confidence: 99%

“…Also, a small-study effect was demonstrated in the setting of low-quality evidence, indicating that the results should be carefully interpreted. While Seaman et al 40 published a meta-analysis including 4 anterior cervical discectomy and fusion studies and 2 additional TLIF studies using Ti and PEEK, this is the first study that evaluates the outcomes of Ti and PEEK in posterior lumbar fusion procedures. However, the results of this meta-analysis need to be investigated in a randomized controlled trial (RCT) that takes into account all the possible factors that could be associated with the clinical outcomes of interbody lumbar fusion.…”

Section: Discussionmentioning

confidence: 99%

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Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

et al. 2020

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Objective: Lumbar fusion with implantation of interbody cage is a common procedure for treatment of lumbar degenerative disease. This study aims to compare the fusion and subsidence rates of titanium (Ti) versus polyetheretherketone (PEEK) interbody cages after posterior lumbar interbody fusion and investigate the effect of clinical and radiological outcomes following fusion on patient-reported outcomes. Methods: A systematic search strategy of 4 electronic databases (MEDLINE, Embase, Web of Science, and Cochrane) was conducted using different MeSH (medical subject headings) terms until January 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using fixed and random-effect models based upon the heterogeneity (I 2 ) to estimate the association between interbody cages and the measured outcomes. Results: A total of 1,094 patients from 11 studies were reviewed. The final analysis included 421 patients (38.5%) who had lumbar surgery using a Ti and/or a Ti-coated interbody cage and 673 patient (61.5%) who had lumbar surgery using a PEEK cage. Overall, PEEK interbody devices were associated with a significantly lower fusion rate compared with Ti interbody devices (OR, 0.62; 95% CI, 0.41-0.93; p = 0.02). There was no difference in subsidence rates between Ti and PEEK groups (OR, 0.91; 95% CI, 0.54-1.52; p = 0.71). Also, there were no statistically significant differences in visual analogue scale (VAS)-low back pain (p = 0.14) and Japanese Orthopedic Association scale (p = 0.86) between the 2 groups. However, the PEEK group had lower odds of leg pain after surgery compared to the Ti group (OR [VAS-leg], 0.61; 95% CI, 0.28-0.94; p = 0.003). Conclusion: Ti and Ti-coated PEEK cages used for posterior lumbar interbody fusion are associated with similar rates of subsidence, but a higher rate of fusion compared to PEEK interbody cages. Randomized controlled trials are needed to better assess the effect of cage materials and potential factors that could influence the outcomes of interbody lumbar fusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

et al. 2020

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“…Others have affirmed that the type of spacer makes no difference in bone fusion rates [9]. Furthermore, a report has stater that PEEK and titanium spacers were associated with similar rate of fusion, but there is an increased rate of subsidence with titanium spacers [33].Therefore, a single point of view has not yet been defined.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Effects of Implant Materials on Posterior Lumbar Interbody Fusion: Comparison of Polyetheretherketone and Titanium Spacers Using Finite Element Analysis and Considering Bone Density

Sato¹,

Yonezawa²,

Todo³

et al. 2018

JBiSE

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Few biomechanical data exist regarding whether the polyetheretherketone (PEEK) spacer or titanium spacer is better for posterior lumbar interbody fusion (PLIF). This study evaluated the biomechanical influence that these types of spacers with different levels of hardness exert on the vertebra by using finite element analysis including bone strength distribution. To evaluate the risk of spacer subsidence for PLIF, we built a finite element model of the lumbar spine using computed tomography data of osteoporosis patients. Then, we simulated PLIF in L3/4 and built models with the hardness of the interbody spacer set as PEEK and titanium. Bones around the spacer were subjected to different load conditions. Then, fracture elements and some stress states of the two modalities were compared. In both models of PLIF simulation, fracture elements and stress were concentrated in the bones around the spacer. Fracture elements and stress values of the model simulating the PEEK spacer were significantly smaller compared to those of the titanium simulation model. For PLIF of osteoporotic vertebrae, this suggested that the PEEK spacer is in a mechanical environment less susceptible to subsidence caused by microfractures of bone tissue and bone remodeling-related fusion aspects. Therefore, PEEK spacers are biomechanically more useful.

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“…They found minimal evidence for better clinical and radiographic outcome for PEEK cages compared with bone grafts in the cervical spine, but no differences were found between PEEK, titanium, and carbon fibre cages. Another review of the literature was done in June 2017 by S. Seaman et al 22 This time titanium and PEEK cages have been evaluated in the cervical and lumbar spine. Six large studies were included in meta-analysis with a total of 410 patients (Ti-228, PEEK-182) and 587 levels (Ti-327, PEEK-260).…”

Section: Comparison Between Different Materials and Designs-clinical mentioning

confidence: 99%

Towards the optimum spinal fusion device

Gorenšek¹,

Jenko²,

Kocjančič³

et al. 2018

Mater. Tehnol.

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Spinal interbody fusion (spondylodesis) remains a gold standard for the treatment of instability, deformity and degenerative disease of the spine. Over the past 40 years surgical techniques and implant-device (cage) technology for spinal fusion have changed significantly. Design and materials have evolved with one common goal, to develop suitable implants that would address all three major issues of the procedure: stability, restoration of lordosis and osteointegration. Historically, two main materials have been utilized in the creation of cages: titanium (Ti) and polyetheretherketone (PEEK). The focus of spinal surgeons is constantly shifting from one material to another, because of the aggressive, commercial drive from the industry. The choice of optimal spinal interbody fusion device was always a matter of controversy. Therefore, this article aims to provide an overview of the different materials and designs from the biomechanical and also clinical aspect. A systematic review of the literature was made. The inadequate available clinical trials and lack of comparisons between different models have prevented definitive conclusions; therefore, further prospective randomized studies are necessary in the future to define one cage as a mainstay of clinical practice. Keywords: spondylodesis, cage, titanium, polyetheretherketone Zatrditev hrbteni~nega segmenta (spondilodeza) predstavlja zlati standard zdravljenja nestabilnosti, deformacij in degenerativnih bolezni hrbtenice. V zadnjih 40 letih so se kirur{ka tehnika in umetni medvreten~ni vsadki (kletke) ob~utno spremenili. Oblika in materiali so se razvijali z enim skupnim ciljem, to je odkriti vsadek, ki bi omogo~al stabilnost hrbteni~nega segmenta, vzdr`evanje lordoze ter osteointegracijo. Zgodovinsko gledano sta bila dva najpogosteje uporabljena materiala titan in polietereterketon. Dandanes med hrbteni~nimi kirurgi ostaja nesoglasje glede optimalne izbire umetnega medvreten~nega vsadka. Namen tega~lanka je predstaviti prednosti in slabosti najpogosteje uporabljenih materialov. Na podlagi aktualne strokovne literature je bila opravljena primerjava biomehanskih in klini~nih rezultatov razli~nih vsadkov. Glede na pomanjkljivost naklju~nih prospektivnih multicentri~nih {tudij ostaja izbira optimalnega umetnega hrbteni~nega vsadka {e naprej problemati~na.

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Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature

Cited by 205 publications

References 27 publications

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature

Biomechanical Effects of Implant Materials on Posterior Lumbar Interbody Fusion: Comparison of Polyetheretherketone and Titanium Spacers Using Finite Element Analysis and Considering Bone Density

Towards the optimum spinal fusion device

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