Evaluation of Titanium-coated Polyetheretherketone (TC-PEEK) versus Polyetheretherketone (PEEK) Cages in the Surgical Treatment of Multilevel Cervical Degenerative Disease

Introduction: Polyetheretherketone (PEEK) is widely utilized in multilevel anterior cervical discectomy and fusion (ACDF) due to its elastic modulus, which closely matches that of cortical bone. However, PEEK’s chemical inertness limits optimal bone integration. Titanium-coated PEEK (TC-PEEK) was developed to enhance bone fusion while retaining the biomechanical advantages of PEEK. This study aims to compare the long-term clinical and radiographic outcomes of patients undergoing multilevel ACDF with either TC-PEEK or PEEK cages.

Methods: This single-center retrospective cohort study included patients aged 18 years and older with cervical radiculopathy and/or myelopathy who underwent multilevel ACDF using either PEEK or TC-PEEK cages. All patients had a minimum of one year of postoperative follow-up. Radiographic outcomes, including level-specific fusion, cage migration, and subsidence, were assessed using flexion-extension cervical x-rays. Statistical analyses involved the two-sample t-test and χ² test. Fusion success was defined by less than 2 mm of spinous process motion and bridging bone on flexion-extension imaging. Clinical outcomes were evaluated using the Visual Annalog Scale (VAS) and Neck Disability Index (NDI), with repeated measures analysis of variance for statistical assessment.

Results: Forty patients met the inclusion criteria, with equal distribution between the PEEK (50%) and TC-PEEK (50%) groups. There were no significant differences in preoperative clinical scores or comorbidities. Postoperatively, VAS and NDI scores showed no significant differences between the groups, although TC-PEEK patients had lower values at all time points. The average follow-up period was 1.75 ± 0.34 years for the PEEK group and 1.67 ± 0.31 years for the TC-PEEK group. Fusion rates were 75% for PEEK and 80% for TC-PEEK, with no significant difference in fusion outcomes between the groups. No reoperations were required.

Conclusion : This study reveals no significant clinical or radiographic differences between PEEK and TC-PEEK cages in multilevel ACDF. These findings highlight the need for further investigation into the optimal implant choice for achieving optimal fusion and clinical outcomes.