PEEK Versus Titanium in Spinal Surgery

PEEK or titanium? That has been a question that surprisingly has not been extensively explored in head-to-head clinical research. Nevertheless a pair of completed studies and a third designed to randomly compare PEEK, Titanium and ceramic cages that is now under way provide some basis for comparison.

In a 2012 German study in the BioMed Central Musculoskeletal Disorders Cabraja, Oexdemir, et al, compared titanium (TTN) and polyetheretherketone (PEEK) cages in 154 patients who underwent single level anterior cervical discectomy and fusion (ACDF) performed between 2002 and 2007.

They found that TTN performed better in terms of arthrodesis, while PEEK cages performed better in terms of subsidence. They found no significant difference between the two groups in terms of neck and arm pain relief.

Overall they concluded that ACDF with TTN or PEEK cages did not appear to make a significant difference in outcomes. They noted that TTN-implants provide good osseointegration and greater resistance to microbial adhesion. On the other hand PEEK’s elasticity is close to that of cortical bone and allows for more accurate assessment of osseous fusion on radiological imaging.

More recently a 2013 study in the European Spine Journal by Chinese researchers compared outcomes of titanium and PEEK cage reconstruction for treatment of cervical spondylotic myelopathy (CSM). There were 80 patients randomly treated with titanium or PEEK and followed for an average of 99.7 months (8 years).

They found no significant differences between the two groups in Cobb angles and intervertebral height, with both providing significantly increased intervertebral height. However, there was more loss of Cobb angles and intervertebral height in the titanium group compared to the PEEK group over the follow-up period.

Using the Japanese Orthopedic Association (JOA) score, widely used to assess the severity of clinical symptoms in patients with cervical compressive myelopathy, showed significantly improved outcomes in both groups. The JOA score increased from 9.6 to 12.8 in the titanium group vs. 9.8 to 14.2 in the PEEK group.

Measured by the Neck Disability Index (NDI), an indicator of pain relief, showed similar outcomes for both groups with NDI scores decreasing from 36.2 to 21.6 in the titanium group and from 35.4 to 15.2 in the PEEK group.

According to the Odom criteria, a qualitative measure of a patient’s improvement, the percentage of patients with excellent and good clinical outcomes was 55.2 % in the titanium group compared to 74.2 % in the PEEK group.

Overall, the researchers concluded that for multilevel CSM the PEEK cages were superior to titanium for maintenance of intervertebral height, and clinical outcomes in a long-term follow-up.

Taken together two studies do not conclusively answer the question of which material is better. More research will be needed to thoroughly compare all aspects of these two implant materials including effectiveness, durability, osseointegration and complications.

At Clariance we are dedicated to producing spine products that create favorable conditions to optimize patient outcomes in a range of spinal disease conditions from degenerative disc disease, severe spondylolisthesis, neurologic impairment, fracture, dislocation and scoliosis.  Our PEEK-OPTIMA high-performance implant-grade polymer devices deliver the highest performance characteristics including strength, durability, radiolucence for accurate image monitoring, and

optimized bone fusion, to improve both immediate and long-term patient outcomes.

Source: BMC Musculoskelet Disord. 2012; 13: 172. and Eur Spine J (2013) 22:1539–1546


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