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Evolution of polyetheretherketone (PEEK) and titanium interbody devices for spinal procedures: a comprehensive review of the literature

European Spine Journal (2022)Cite this article

Abstract

Introduction

Interbody fusion is commonly utilized for arthrodesis and stability among patients undergoing spine surgery. Over the last few decades, interbody device materials, such as titanium and polyetheretherketone (PEEK), have been replacing traditional autografts and allografts for interbody fusion. As such, with the exponential growth of bioengineering, a large variety cage surface technologies exist. Different combinations of cage component materials and surface modifications have been created to optimize interbody constructs for surgical use. This review aims to provide a comprehensive overview of common surface technologies, their performance in the clinical setting, and recent modifications and material combinations.

Materials and Methods

We performed a comprehensive review of the literature on titanium and PEEK as medical devices between 1964 and 2021. We searched five major databases, resulting in 4974 records. Articles were screened for inclusion manually by two independent reviewers, resulting in 237 articles included for review.

Conclusion

Interbody devices have rapidly evolved over the last few decades. Biomaterial and biomechanical modifications have allowed for continued design optimization. While titanium has a high osseointegrative capacity, it also has a high elastic modulus and is radio-opaque. PEEK, on the other hand, has a lower elastic modulus and is radiolucent, though PEEK has poor osseointegrative capacity. Surface modifications, material development advancements, and hybrid material devices have been utilized in search of an optimal spinal implant which maximizes the advantages and minimizes the disadvantages of each interbody material.

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Fig. 1
Fig. 2

Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71)

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Authors and Affiliations

  1. School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Nallammai Muthiah

  2. Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA

    Nallammai Muthiah, Nima Alan, David Kojo Hamilton & Alp Ozpinar

  3. Department of Neurosurgery, The Mayo Clinic, Rochester, MN, USA

    Yagiz Ugur Yolcu

  4. Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Nitin Agarwal

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Muthiah, N., Yolcu, Y.U., Alan, N. et al. Evolution of polyetheretherketone (PEEK) and titanium interbody devices for spinal procedures: a comprehensive review of the literature. Eur Spine J (2022). https://doi.org/10.1007/s00586-022-07272-1

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Keywords

  • Cervical
  • Lumbar
  • 3D printing
  • Porous
  • Technology