Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature
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 i...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Spinal Neurosurgery Society
2020-03-01
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| Series: | Neurospine |
| Subjects: | |
| Online Access: | http://www.e-neurospine.org/upload/pdf/ns-2040058-029.pdf |
| _version_ | 1827365621129543680 |
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| author | Elie Massaad Nida Fatima Ali Kiapour Muhamed Hadzipasic Ganesh M. Shankar John H. Shin |
| author_facet | Elie Massaad Nida Fatima Ali Kiapour Muhamed Hadzipasic Ganesh M. Shankar John H. Shin |
| author_sort | Elie Massaad |
| collection | DOAJ |
| description | 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 (I2) 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. |
| first_indexed | 2024-03-08T08:33:09Z |
| format | Article |
| id | doaj.art-3ae5e99e51e04cb1bd15f357178c1e3e |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T08:33:09Z |
| publishDate | 2020-03-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-3ae5e99e51e04cb1bd15f357178c1e3e2024-02-02T02:19:19ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912020-03-0117112513510.14245/ns.2040058.029969Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the LiteratureElie Massaad0Nida Fatima1Ali Kiapour2Muhamed Hadzipasic3Ganesh M. Shankar4John H. Shin Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USAObjective 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 (I2) 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.http://www.e-neurospine.org/upload/pdf/ns-2040058-029.pdfspinal fusionlumbar spinepolyetheretherketoneinterbody cagetitanium |
| spellingShingle | Elie Massaad Nida Fatima Ali Kiapour Muhamed Hadzipasic Ganesh M. Shankar John H. Shin Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature Neurospine spinal fusion lumbar spine polyetheretherketone interbody cage titanium |
| title | Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature |
| title_full | Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature |
| title_fullStr | Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature |
| title_full_unstemmed | Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature |
| title_short | Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature |
| title_sort | polyetheretherketone versus titanium cages for posterior lumbar interbody fusion meta analysis and review of the literature |
| topic | spinal fusion lumbar spine polyetheretherketone interbody cage titanium |
| url | http://www.e-neurospine.org/upload/pdf/ns-2040058-029.pdf |
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