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Is Ti-Coated PEEK Superior to PEEK for Lumbar and Cervical Fusion Procedures? A Systematic Review and Meta-Analysis
Julia Kincaid1, Richelle J Kim1, Akash Verma1
1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Journal of Clinical Medicine
|November 13, 2025
Summary
Polyetheretherketone (PEEK) spinal fusion cages show varied effectiveness compared to titanium. Titanium cages offer higher fusion rates in anterior cervical discectomy and fusion (ACDF), while coated PEEK may improve outcomes in lumbar fusions.
Area of Science:
- Spinal surgery
- Biomaterials science
- Orthopedic research
Background:
- Polyetheretherketone (PEEK) cages are increasingly used for spinal fusion in the U.S.
- Limited comparative data exists on PEEK's postoperative effectiveness versus traditional materials.
- This review assesses PEEK cage efficacy against alternatives in various spinal fusion procedures.
Purpose of the Study:
- To systematically compare the efficacy of PEEK cages with traditional fusion materials.
- To evaluate PEEK's impact on fusion rates, postoperative outcomes, and long-term success.
- To guide material selection based on surgical context and patient needs.
Main Methods:
- Systematic literature search of major databases (PubMed, CINAHL, Scopus, Embase, Web of Science) up to October 2024.
- Included randomized controlled trials (RCTs) comparing PEEK with titanium, silicon nitride, and coated PEEK cages.
- Assessed article quality using GRADE criteria.
Main Results:
- 25 RCTs with 2046 patients were analyzed; fusion rates varied by material and procedure.
- Titanium cages showed higher fusion rates than PEEK in ACDF (100% vs. 94%).
- Coated PEEK demonstrated potential benefits over uncoated PEEK in posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) (75% vs. 71% and 94% vs. 84%).
Conclusions:
- Spinal fusion cage material choice should be individualized to surgical needs and patient factors.
- Titanium and PEEK cages are effective, but performance differs across surgical contexts.
- Further research into novel materials and surface modifications is warranted for improved outcomes.
