Introduction: Interbody cage materials, such as titanium, PEEK, and polymers, each have specific advantages and limitations in lumbar fusion. Coatings can improve bone integration and reduce inflammation, but the optimal material choice remains uncertain, indicating a gap in the literature. Our aim Assess fusion rates of PEEK versus titanium in lumbar spine fusion for degenerative disease, with a secondary aim to review additional biomaterial comparisons.
Methods: A systematic review was conducted using PRISMA guidelines to evaluate the literature on cage biomaterials in lumbar fusion procedures. Studies from inception to October 2024 were systematically screened from four databases. Data regarding biomaterial design, study design, patient demographics, and radiological outcomes were collected. A meta-analysis compared fusion rates between PEEK, titanium, and other biomaterial types.
Results: Out of 4,051 studies, 38 met the inclusion criteria, comprising 3,910 patients. Most studies reported a mean BMI of 25 or higher. The primary surgical approach was translaminar lumbar interbody fusion (63%), followed by posterior (35%) and lateral (2%). PEEK was the most commonly used cage material (50%), with 27% incorporating surface coatings, mainly titanium (92% TiPEEK). Comparative analyses showed no significant differences in fusion success rate between PEEK and titanium (OR=1.43; 95% CI [0.77, 2.66]), 3D-printed titanium (OR=1.17; 95% CI [0.40, 3.39]), TiPEEK (OR=0.88; 95% CI [0.59, 1.32]), or n-HA/PA66 (OR=0.78; 95% CI [0.31, 1.97]), with low heterogeneity across studies. Individual studies suggested that carbon-fiber-reinforced and advanced composite cages, such as PEEK-Ti-HA, typically achieved fusion rates above 85%.
Conclusion : This review found no significant differences in fusion rates between PEEK, titanium, and other biomaterials in lumbar procedures. PEEK showed a non-significant trend toward higher rates than titanium, while TiPEEK showed a similar trend over PEEK, but no material proved superior. More research is needed, as studies comparing TiPEEK with titanium are lacking.
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