Similar fusion rate and clinical outcome in ACDF completed with PEEK vs titanium cage

Study Type: Meta-analysis/Systematic Review
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Four studies (two randomized controlled trials [RCTs] and two non-RCT comparative trials) were included in this systematic review and meta-analysis to compare outcomes following anterior cervical discectomy and fusion with either a polyetheretherketon (PEEK) cage or a titanium cage. Pooled results demonstrated no significant differences in the rate of successful fusion, clinical outcome on the Odom's criteria measure, final segmental angle, or loss in segmental correction over follow-up between groups. A significantly higher Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: National Natural Science Foundation of China; Project of Natural Science Foundation of Tianjin
Conflicts: None disclosed
Why was this study needed now?
Degenerative disease and radiculopathy of the cervical spine have traditionally been treated via anterior cervical discectomy and fusion (ACDF). Two common materials for fusion cages are polyetheretherketone (PEEK) and titanium. Despite their common use in ACDF procedures, only a few randomized controlled trials have been performed comparing the two types of cages, and a meta-analysis pooling the results of the high-quality literature had yet to be performed.
What was the principal research question?
In anterior cervical discectomy and fusion, are there any significant differences in the rate of successful fusion, clinical outcome, or radiographic measures between procedures completed with polyetheretherketone (PEEK) cages and titanium cages?
Data Source: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for relevant articles published up to October 2015. Reference lists of identified articles were manually searched for additional studies possibly missed by the electronic search.
Index Terms: Keyword terms included: "cervical", "titanium", "polyetheretherketone", and "PEEK".
Study Selection: Eligibility criteria included: randomized and non-randomized comparative studies; enrollment of participants undergoing anterior cervical discectomy and fusion; compared between groups who received a PEEK fusion cage and who received a titanium fusion cage; and reported sufficient data for pooling in the full-text. Search and selection was performed independently by two reviewers, with disagreements resolved through discussion and consensus. A total of four studies, two randomized controlled trials and two non-randomized clinical trials, were selected for final inclusion.
Data Extraction: Data extraction was performed independently by two reviewers, with disagreements resolved by discussion and consensus.
Data Synthesis: Statistical analysis was performed using Review Manager software (RevMan 5.1). Mean differences were calculated for continuous outcomes, and odds ratios for dichotomous outcomes, both with associated 95% confidence intervals. Heterogeneity was assessed using the Chi-square test and I-squared (I^2) statistic and considered significant at values of p<0.1 and >50% for the tests, respectively. A random-effects model was used in the presence of significant statistical heterogeneity, and a fixed-effects model when heterogeneity was not significant.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.