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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

·Eur Spine J·2021·88 citations·Spine
DOI·PubMed
SummaryAbstract on PubMed →

This systematic review and meta-analysis (11 studies, 743 patients) asks whether titanium or PEEK interbody cages produce better fusion and clinical outcomes in spinal interbody fusion, with subgroup analyses separating cervical from lumbar procedures.

Study Snapshot

Design
Systematic review and meta-analysis
Objective
Whether Ti cages produce superior fusion and clinical outcomes compared to PEEK cages in spinal interbody fusion.
Outcome(s)
Fusion rate; subsidence rate; clinical improvement scores
Subjects
743 patients across 11 studies
  • Titanium (Ti) interbody cages
  • Polyetheretherketone (PEEK) interbody cages
Inclusion
  • Studies comparing Ti vs PEEK interbody cages
  • Spinal interbody fusion procedures
  • Reported fusion or clinical outcomes
Follow-up
Not verifiable from uploaded text
Statistics
Meta-analysisSubgroup analysisOdds ratioRisk ratio

Key Findings

  • Overall fusion rates were not significantly different between Ti and PEEK cages across all spinal levels (OR 1.50, 95% CI 0.57–3.94, P = 0.41)
  • In lumbar fusion specifically, Ti cages achieved superior fusion rates over PEEK (OR 2.12, 95% CI 1.05–4.28, P = 0.04) — the only statistically significant efficacy difference
  • Ti cages carried a higher subsidence rate in non-infective cases (RR 2.17, 95% CI 1.13–4.16, P = 0.02), a meaningful trade-off against the fusion advantage
  • Operating time, hematoma, neuropathic pain, segmental angle correction, and clinical improvement scores were equivalent between materials
Board PearlTi cages achieve superior lumbar fusion rates over PEEK (OR 2.12, P=0.04) but carry roughly twice the subsidence risk — weigh endplate quality when choosing cage material.

Clinical Relevance

When planning lumbar interbody fusion in a non-infective setting, Ti cages offer a fusion rate advantage over PEEK but come with roughly twice the subsidence risk — factor endplate quality and bone density into cage material selection.

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|

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

·Eur Spine J·2021·88 citations·Spine
DOI·PubMed
SummaryAbstract on PubMed →

This systematic review and meta-analysis (11 studies, 743 patients) asks whether titanium or PEEK interbody cages produce better fusion and clinical outcomes in spinal interbody fusion, with subgroup analyses separating cervical from lumbar procedures.

Study Snapshot

Design
Systematic review and meta-analysis
Objective
Whether Ti cages produce superior fusion and clinical outcomes compared to PEEK cages in spinal interbody fusion.
Outcome(s)
Fusion rate; subsidence rate; clinical improvement scores
Subjects
743 patients across 11 studies
  • Titanium (Ti) interbody cages
  • Polyetheretherketone (PEEK) interbody cages
Inclusion
  • Studies comparing Ti vs PEEK interbody cages
  • Spinal interbody fusion procedures
  • Reported fusion or clinical outcomes
Follow-up
Not verifiable from uploaded text
Statistics
Meta-analysisSubgroup analysisOdds ratioRisk ratio

Key Findings

  • Overall fusion rates were not significantly different between Ti and PEEK cages across all spinal levels (OR 1.50, 95% CI 0.57–3.94, P = 0.41)
  • In lumbar fusion specifically, Ti cages achieved superior fusion rates over PEEK (OR 2.12, 95% CI 1.05–4.28, P = 0.04) — the only statistically significant efficacy difference
  • Ti cages carried a higher subsidence rate in non-infective cases (RR 2.17, 95% CI 1.13–4.16, P = 0.02), a meaningful trade-off against the fusion advantage
  • Operating time, hematoma, neuropathic pain, segmental angle correction, and clinical improvement scores were equivalent between materials
Board PearlTi cages achieve superior lumbar fusion rates over PEEK (OR 2.12, P=0.04) but carry roughly twice the subsidence risk — weigh endplate quality when choosing cage material.

Clinical Relevance

When planning lumbar interbody fusion in a non-infective setting, Ti cages offer a fusion rate advantage over PEEK but come with roughly twice the subsidence risk — factor endplate quality and bone density into cage material selection.

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