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Updated: Aug 25, 2025
Anterior Cervical Discectomy and Fusion in the Ovine Model
Published on: October 5, 2009
Titanium versus polyetheretherketone versus structural allograft in anterior cervical discectomy and fusion: A
Jacob L Goldberg1, Ross M Meaden1, Ibrahim Hussain1
1Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian. New York, New York, USA.
Introduction:
Anterior cervical discectomy and fusion (ACDF) is a common procedure to address cervical spine pathology. The most common grafts used are titanium, polyetheretherketone (PEEK), or structural allograft. Comparison of fusion rate is difficult due to non-standardized methods of assessment. We stratified studies by method of fusion assessment and performed a systematic review of fusion rates for titanium, PEEK, and allograft.
Research Question:
Which of the common implants used in ACDF has the highest reported rate of fusion?
Materials And Methods:
An experienced librarian performed a five-database systematic search for published articles between 01/01/1990 and 08/07/2021. Studies performed in adults with at least 1 year of radiographic follow up were included. The primary outcome was the rate of fusion. Fusion criteria were stratified into 6 classes based upon best practices.
Results:
34 studies met inclusion criteria. 10 studies involving 924 patients with 1094 cervical levels, used tier 1 fusion criteria and 6 studies (309 patients and 367 levels) used tier 2 fusion criteria. Forty seven percent of the studies used class 3-6 fusion criteria and were not included in the analysis. Fusion rates did differ between titanium (avg. 87.3%, range 84%-100%), PEEK (avg. 92.8%, range 62%-100%), and structural allograft (avg. 94.67%, range 82%-100%).
Discussion And Conclusion:
After stratifying studies by fusion criteria, significant heterogeneity in study design and fusion assessment prohibited the performance of a meta-analysis. Fusion rate did not differ by graft type. Important surgical goals aside from fusion rate, such as degree of deformity correction, could not be assessed. Future studies with standardized high-quality methods of assessing fusion, are required.
