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Outcomes of Interbody Fusion Cages Used in 1 and 2-levels Anterior Cervical Discectomy and Fusion: Titanium Cages Versus Polyetheretherketone (PEEK) Cages

Niu, Chi-Chien MD; Liao, Jen-Chung MD; Chen, Wen-Jer MD; Chen, Lih-Huei MD

Journal of Spinal Disorders & Techniques: July 2010 - Volume 23 - Issue 5 - p 310-316
doi: 10.1097/BSD.0b013e3181af3a84
Original Articles

Study Design A prospective study was performed in case with cervical spondylosis who underwent anterior cervical discectomy and fusion (ACDF) with titanium or polyetheretherketone (PEEK) cages.

Objective To find out which fusion cage yielded better clinical and radiographic results.

Summary of Background Data Although use of autogenous iliac-bone grafts in ACDF for cervical disc diseases remain standard surgical procedure, donor site morbidity and graft collapse or breakage are concerns. Cage technology was developed to prevent these complications. However, there is no comparison regarding the efficacy between titanium and PEEK cage.

Methods January 2005 to January 2006, 53 patients who had 1 and 2-levels ACDF with titanium or PEEK cages were evaluated. We measured the rate and amount of interspace collapse, segmental sagittal angulations, and the radiographic fusion success rate. Odom criteria were used to assess the clinical results.

Results The fusion rate was higher in the PEEK group (100% vs. 86.5%, P=0.0335). There was no significant difference between both groups in loss of cervical lordosis (3.2±2.4 vs. 2.8±3.4, P=0.166). The mean anterior interspace collapse (1.6±1.0 mm) in the titanium group was significantly higher than the collapse of the PEEK group (0.5±0.6 mm) (P<0.0001). The mean posterior interspace collapse was also higher in the titanium group (1.6±0.9 mm vs. 0.5±0.5 mm, P<0.0001). An interspace collapse of 3 mm or greater was observed in 16.2% of the patients in the titanium group, compared with zero patients in the PEEK group (P<0.0001). The PEEK group achieved an 80% rate of successful clinical outcomes, compared with 75% in the titanium group (P=0.6642).

Conclusions The PEEK cage is superior to the titanium cage in maintaining cervical interspace height and radiographic fusion after 1 and 2-levels anterior cervical decompression procedures.

Department of Orthopedics Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

Reprints: Jen-Chung Liao, MD, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fu-Shin Street, Kweishian, Taoyuan 333, Taiwan (e-mail:

Received for publication March 5, 2009

accepted May 17, 2009

© 2010 Lippincott Williams & Wilkins, Inc.