Titanium-Coated Polyetheretherketone Cages Versus Uncoated Polyetheretherketone Cages for Lumbar Spinal Fusion: A Systematic Review and Meta-Analysis

Study Design: Systematic review and meta-analysis. Objective: A systematic review and meta-analysis of comparative studies was performed to compare the fusion rates, functional outcomes, and complications between Titanium-Coated Polyetheretherketone (TiPEEK) and polyetheretherketone (PEEK) cages. Methods: Four databases were systematically searched according to PRISMA. Adult patients who underwent one- or two-level lumbar fusion with TiPEEK or PEEK cages were included in the study. Studies that reported radiographic fusion and functional or complication outcomes were also included. Study quality was assessed using the Cochrane Risk of Bias tool and MINORS criteria. The meta-analysis was performed using Review Manager 5.4. Heterogeneity was assessed using I², and random effects were used to analyze the heterogeneity. Results: 8 studies (n = 670) were analyzed. TiPEEK showed a significantly higher overall fusion rate (OR 1.83, 95% CI: 1.18-2.83). TiPEEK cages presented significantly higher fusion rates at 6 months (OR 2.52, 95% CI: 1.11 to 5.72), but there were no significant differences at 12 months (OR 1.33, 95% CI: 0.65 to 2.73). No differences were observed in the global ODI (SMD -0.04, 95% CI: −0.15-0.06). There were no significant differences regarding overall subsidence (OR 0.72, 95% CI: 0.48 to 1.07), screw complications (OR 1.25, 95% CI: 0.30-5.27) or reoperations (OR 0.61, 95% CI: 0.11-3.37). Conclusions: The results from this study suggest that TiPEEK cages may demonstrate earlier fusion as compared to PEEK cages, particularly at 6 months. However, the functional outcomes and safety profiles were comparable.