Titanium-coated polyetheretherketone cages vs. polyetheretherketone cages in lumbar interbody fusion: A systematic review and meta-analysis

Fusion material is one of the key factors in the success of lumbar interbody fusion surgery. The present meta-analysis compared the safety and efficacy of titanium-coated (Ti) polyetheretherketone (PEEK) and PEEK cages. Published literature on the use of Ti-PEEK and PEEK cages in lumbar interbody fusion was systematically searched on Embase, PubMed, Central, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases. A total of 84 studies were retrieved and seven were included in the present meta-analysis. Literature quality was assessed using the Cochrane systematic review methodology. After data extraction, meta-analysis was performed using the ReviewManager 5.4 software. Meta-analysis showed that, compared with that in the PEEK cage group, the Ti-PEEK cage group showed a higher interbody fusion rate at 6 months postoperatively (95% CI, 1.09-5.60; P=0.03) and improved Oswestry Disability Index (ODI) scores at 3 months postoperatively [95% CI, -7.80-(-0.62); P=0.02] and visual analog scale (VAS) scores of back pain at 6 months postoperatively [95% CI, -0.8-(-0.23); P=0.0008]. However, there were no significant differences in intervertebral bone fusion rate (12 months after surgery), cage subsidence rate, ODI score (6 and 12 months after surgery) or VAS score (3 and 12 months after surgery) between the two groups. The results of the meta-analysis showed that the Ti-PEEK group had an improved interbody fusion rate and higher postoperative ODI score in the early postoperative period (<= 6 months).