Similar fusion rate and clinical outcome in ACDF completed with PEEK vs titanium cage
Is PEEK cage better than titanium cage in anterior cervical discectomy and fusion surgery? A meta-analysisBMC Musculoskelet Disord. 2016 Sep 1;17:379
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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 incidence of cage migration was noted with titanium cages. The results from this meta-analysis were based on data from only four studies, only two of which were RCTs. This highlights the need for additional RCTs to verify the results of this meta-analysis and strengthen the current body of literature comparing PEEK and titanium cages in ACDF procedures.
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Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
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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?
What were the important findings?
- Dichotomized results for Odom's criteria of clinical outcome demonstrated no significant difference between PEEK cages and titanium cages (3 studies; OR 0.89 [95%CI 0.49-1.63]; p=0.71).
- Qualitative assessment of the Neck Disability Index demonstrated significantly lower NDI scores for the PEEK group compared to the titanium group at 12-month follow-up in one study, while no significant differences were noted between groups at over 2-year follow-up in another study.
- No significant difference in overall fusion rate was observed between PEEK groups and titanium groups (3 studies; OR 0.20 [95%CI 0.01-3.93]; p=0.29).
- The incidence of cage subsidence was significantly higher for titanium cages (33/211) compared to PEEK cages (11/184) (4 studies; OR 3.14 [95%CI 1.56-6.30]; p=0.001).
- Analyses demonstrated no significant differences in either final segmental angle (3 studies; MD -1.19 [95%CI -2.60, 0.23]; p=0.10) or loss of segmental correction at follow-up (3 studies; MD 2.03 [95%CI -1.10, 5.17]; p=0.20).
What should I remember most?
In anterior cervical discectomy and fusion (ACDF), no significant differences were observed between PEEK cages and titanium cages in pooled results of fusion success, the clinical outcome on Odom's criteria, or angle of segmental correction. Cage migration was significantly more frequent with titanium cages compared to PEEK cages.
How will this affect the care of my patients?
The results of this study suggest that the use of either a PEEK cage or a titanium cage offers similar results following anterior cervical discectomy and fusion. However, the current results are based on data from only four studies and ever fewer randomized controlled trials. As such, additional RCTs are needed to verify the suggestions of the current body of literature comparing PEEK and titanium cages in ACDF procedures.
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