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

Abstract

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.

Superior Osteo-Inductive and Osteo-Conductive Properties of Trabecular Titanium vs. PEEK Scaffolds on Human Mesenchymal Stem Cells: A Proof of Concept for the Use of Fusion Cages

“…In this frame, Ti has shown higher ability to support osteo-integration [ 11 ]. Consistently, recent reports and literature meta-analyses reported not only a comparable rate of subsidence but a better prevalence of fusion for titanium or titanium-coated cages with respect to nude PEEK [ 12 , 13 ].…”

PEEK versus titanium cages in lateral lumbar interbody fusion: a comparative analysis of subsidence

“…In a recent meta-analysis, Massaad et al extracted all available subsidence data from 6 PLIF comparative studies. 22 The ranges of subsidence rates in the titanium and PEEK groups for these posterior and posterolateral procedures were 0%-36% and 0%-31%, respectively. [23][24][25][26][27] Based upon the authors' analysis, there was no difference in the rate of subsidence between titanium and PEEK interbody cages in the PLIF population.…”

“…[23][24][25][26][27] Based upon the authors' analysis, there was no difference in the rate of subsidence between titanium and PEEK interbody cages in the PLIF population. 22 Similar extensive comparative evaluations of the literature have been performed in the cervical spine literature as well. A 2016 study included two randomized and two nonrandomized clinical trials comparing PEEK and titanium cage groups.…”

Comparison of MRI Visualization Following Minimally Invasive and Open TLIF: A Retrospective Single-Center Study

“…Titanium interbody cages, having high strength and biocompatibility, are most often used to stabilize the anterior supporting complex, but they are paramagnetic and can distort the magnetic field and impede visualization of the anatomy of the operative area [19,20]. Polymer composites reinforced with carbon fiber or based on PEEK are common alternative nonmetallic biomaterials for interbody spacers [21,22].…”