Radiological and clinical outcomes of novel Ti/PEEK combined spinal fusion cages: a systematic review and preclinical evaluation

Yusuf Assem, Ralph J. Mobbs*, Matthew H. Pelletier, Kevin Phan, William R. Walsh

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

33 Citations (Scopus)


Purpose: The primary objective of this paper was to provide a systematic review of the available clinical studies of Ti/PEEK combined cages in spinal interbody fusion surgeries, focusing on their radiological and clinical outcomes. A secondary aim was to provide a review and evaluation of the in vitro and preclinical studies reported on Ti/PEEK-coated implants. Methods: A systematic search of the literature was performed in March 2015 via three databases: Medline, Embase and Cochrane library. The following key search terms were combined with synonyms to identify relevant articles: “spinal fusion,” “PEEK,” “titanium” and “cage.” Results: The novelty of this intervention translates into a paucity of clinical trials, albeit the results of the seven clinical studies that met the criteria for inclusion are promising. All studies reported rate of fusion as a primary outcome. Two studies reported slightly improved fusion in the experimental Ti/PEEK combination cohort, one study identical fusion (91.7 %) and three studies excellent fusion (96, 100 and 94 %) in the Ti/PEEK cohort, although no differences reached statistical significance. Conclusions: Clinical studies at this early stage demonstrate that Ti/PEEK implants are safe and efficacious, exhibiting similar fusion rates and clinical outcomes compared to the current standard PEEK. There is clinical evidence substantiating the improved radiographic fusion of Ti/PEEK, albeit the differences were not significant. This field is promising, gaining substantial popularity, and further clinical trials are needed in the future to establish Ti/PEEK cages as a mainstay of clinical practice.

Original languageEnglish
Pages (from-to)593-605
Number of pages13
JournalEuropean Spine Journal
Issue number3
Publication statusPublished - Mar 2017
Externally publishedYes


  • spinal fusion
  • cage
  • ttanium
  • PEEK
  • Ti/PEEK


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