Comparison of the Surgical and Radiographic Outcomes Between Cage Materials Used for Patients Undergoing Anterior Discectomy and Fusion: A Systematic Review and Meta-analysis

Introduction: Interbody cages are currently being used to address diseases of the vertebra requiring surgical stabilization. Titanium cages were first introduced in 1988. Polyetheretherketone (PEEK) cages are utilized frequently as one of the alternatives to titanium cages in current practice. Numerous other materials have since been developed and utilized. A detailed and indirect comparison between the various interbody cage materials stratified according to the procedure type, the number of levels operated, and graft used to compare cage materials is lacking. This study aimed to compare available cage materials by reviewing the surgical and radiographic outcomes following anterior cervical discectomy and fusion (ACDF).

Methods: A comprehensive search of several electronic databases was conducted following the PRISMA guidelines. Baseline characteristics, operative outcomes, arthrodesis rates, subsidence rates and complications were collected from included studies. Collected outcomes were further stratified according to the procedure type, the number of levels operated, and graft used to compare cage materials.

Results: Following the screening for inclusion criteria, a total of 37 studies with 2,363 patients were included. The median age was 49.5 years, and the median follow-up was 26 months. Overall, no significant differences were found between PEEK and titanium cages regarding fusion, neurologic deficit, subsidence rates, or "good and excellent" outcome according to Odom criteria. However, the standalone comparison between PEEK, titanium, and PMMA cages showed a significantly lower fusion rate for PMMA. (PEEK: 94%, PMMA: 56%, Titanium: 95%, p < 0.01).

Conclusion : In the present systematic review and meta- analysis, a comparison of the long-term patient reported, and the radiographic outcomes associated with the use of titanium and PEEK, intervertebral body cages showed similar findings. However, there were significantly lower fusion rates for PMMA cages when using a standalone cage without graft material.