Introduction: Anterior Cervical Discectomy and Fusion(ACDF) is one of the core procedures in spinal surgery. As graft material choices continue to expand, which material provides optimal outcomes remains controversial. Comparing polyether-ether-ketone(PEEK) and titanium(Ti), we sought to demonstrate compatible surgical, radiographic, and patient-reported outcomes.
Methods: We performed a retrospective review of consecutive ACDFs performed at a single institution between 2014-2019. We included adult patients with degenerative etiology and at least 1-year follow-up. We excluded patients with pre-existing Posterior Cervical Fusion(PCF), or who underwent planned 2-stage front/back surgery. Patient demographics and operative characteristics were collected. Previously prospectively collected PRO data were collected and compared. Lateral radiographs were examined for pre/post-operative cervical sagittal parameters, and radiographs and computed tomography were used to assess fusion.
Results: PEEK was used in 118 patients/193 levels, while Ti was implanted in 119 patients/226 levels. There were no statistical differences between the groups in regard to patient demographics or preoperative parameters. Additionally, the only statistically significant difference in operative characteristics was that Ti constructs encompassed more cervical levels(𝘱=.02). Regarding complication rates, including 90-day return to emergency or operating room rate, there was no statistical difference. Though there was a significant difference in follow-up time(28.2±13.7v21.2±10.0 months,𝘱 <.001), neither the radiographic pseudarthrosis rate nor the need for pseudarthrosis revision surgery was significantly different. However, subsidence was significantly greater when using PEEK cages(11.9%v2.5%,𝘱=.005). While patients’ postoperative sagittal parameters were not significantly different, the ability to achieve MCID for Numerical Rating Scale for Neck Pain(NRS Neck) significantly favored PEEK over Ti(67.2%v49.4%,𝘱=.02).
Conclusion : Here we presented a large comparative cohort study of both clinical and radiographic outcomes. While subsidence was significantly greater when using PEEK as compared to Ti(11.9%v2.5%,𝘱=.005), a greater ability to achieve NRS Neck was demonstrated by PEEK(67.2%v49.4%,𝘱=.02). These served as the only significant outcomes observed, and each favored a different interbody graft choice. While extensive research has been performed into the best graft material, a single optimal choice may not exist; more likely, as our study demonstrates, each material may have specific benefits and risks that must be weighed by the surgeon and patient.
