Introduction: The choice of the implant material is important for spinal fusion. While titanium demonstrates osteointegration, PEEK allows for radiographic monitoring. TiPEEK combines these advantages, but comparative evidence is limited. The aim of this study was to compare the fusion rates, functional outcomes, and complications between TiPEEK and PEEK cages a systematic review and meta-analysis of comparative studies was performed.
Methods: Four databases were systematically searched according to PRISMA. Adult patients who underwent one- or two-level lumbar fusion with TiPEEK or PEEK cages were included in the study. Studies that reported radiographic fusion and functional or complication outcomes were also included. Study quality was assessed using the Cochrane Risk of Bias tool and MINORS criteria. The meta-analysis was performed using Review Manager 5.4. Heterogeneity was assessed using I2, and random effects were used to analyze the heterogeneity.
Results: Eight studies (n=670) were analyzed. TiPEEK showed a significantly higher overall fusion rate (OR 1.83, 95%CI 1.18-2.83). TiPEEK cages presented significantly higher fusion rates at 6 months (OR 2.52, 95% CI 1.11 to 5.72), but there were no significant differences at 12 months (OR 1.33, 95% CI 0.65 to 2.73). No differences were observed in the global ODI (SMD -0.04, 95%CI -0.15-0.06). There were no significant differences regarding overall subsidence (OR 0.72, 95% CI 0.48 to 1.07), screw complications (OR 1.25, 95%CI 0.30-5.27) or reoperations (OR 0.61, 95%CI 0.11-3.37).
Conclusion : TiPEEK cages demonstrated an improved overall fusion rate compared to PEEK, particularly in the short term. However, the functional outcomes and safety profiles were comparable.