Titanium-Coated Polyetheretherketone Cages Vs Full Titanium Cages for Stand-Alone 1- or 2-Level Anterior Cervical Discectomy and Fusion: A Comparative Study

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Immediate postoperative lateral x-ray image (A) depicts single-level surgery with a titanium cage. The same image at the last follow-up (B) shows slight subsidence; however, successful osseous fusion posterior to the cage is evident. The lateral x-ray image of a 2-level surgery with titanium-coated polyether-ether-ketone cages (C) also demonstrates successful osseous fusion at the last follow-up, both within and posterior to the cage (D). Abbreviation: FU, follow-up.

Table 1

Patient demographics and operative variables by implant type.

Variable	TTN (N = 16)	TCPEEK (N = 29)
Demographics
Age, y, mean (range)	56.0 (47–79)	56.9 (38–83)
Sex, F:M	7:9	12:17
Smoker, n (mean PY)	3 (15)	4 (36)
Regular alcohol use, n (mean dL/d)	1 (2)	1 (5)
Levels operated, n
Total operated levels	21	37
Levels in 2-level ACDF	10	16
Levels in 1-level ACDF	11	21
Operated Level, n
C3-4	2	2
C4-5	4	1
C5-6	12	20
C6-7	3	14

Abbreviations: ACDF, anterior cervical discectomy and fusion; F, female; M, male; PY, pack years; TCPEEK, titanium-coated polyether-ether-ketone; TTN, titanium.

Table 2

Overall changes in radiographic parameters from pre- to postoperative.

Radiological Parameters	Change Pre- to Postoperative, median (IQR)	P
Cervical lordosis (°)	2.2 (0.20; 5.2)	<0.001
Segmental lordosis (°)	1.0 (0.4; 2.1)	<0.001
C2–C7 SVA, mm	2.8 (-2.1; 7.7)	0.018
Disc height operated level, mm	2.0 (0.8; 3.3)	<0.001
Disc height adjacent level above, mm	-0.1 (-0.3; 0.0)	<0.001
Disc height adjacent level below, mm	-0.1 (-0.3; 0.0)	< 0.001

Table 3

Radiographic parameters from pre- to postoperative by implant type.

Radiological Parameters	TTN, median (IQR)	% Change	TCPEEK, median (IQR)	% Change	P
Cervical Lordosis (°)
Preoperative	14.0 (5.6; 23.3)		14.9 (7.1; 19.4)		0.94
Postoperative	15.3 (7.8; 27.4)		16.0 (9.6; 26.1)		0.70
Change	2 (0.3; 4.4)	+14.3	2.3 (0; 5.8)	+15.4	0.49
Segmental Lordosis (°)
Preoperative	1.6 (1.2; 2.4)		1.8 (-0.6; 3.4)		0.72
Postoperative	2.2 (1.8; 3.4)		2.8 (0.7; 6.3)		0.92
Change	0.6 (0.4; 1.1)	+37.5	1.4 (0.3; 2.9)	+77.8	0.10
C2-C7 SVA, mm
Preoperative	29.4 (15.2; 31.5)		26.3 (17.7; 30)		0.83
Postoperative	25 (20.1; 31.5)		29.1 (21.5; 33.3)		0.19
Change	3.8 (-3.2; 9.2)	+12.9	2.7 (-2; 6.6)	+10.3	0.77
Disc Height Operated Level, mm
Preoperative	3.3 (2.0; 4.1)		3.2 (2.5; 3.8)		0.90
Postoperative	5.2 (4.0; 5.8)		5.8 (4.6; 6.6)		0.18
Change	1.4 (0.2; 3.3)	+42.4	2.4 (1.3; 3.2)	+75.0	0.90
Disc Height Adjacent Level Above, mm
Preoperative	4.8 (3.6; 5.1)		3.9 (3.4; 4.3)		0.04
Postoperative	4.5 (3.4; 5.1)		3.7 (3.3; 4.3)		0.03
Change	-0.1 (-0.3; 0.0)	-2.1	-0.1 (-0.3; 0.0)	-2.6	0.70
Disc Height Adjacent Level Below, mm
Preoperative	4.2 (2.9; 5.9)		4.3 (3.5; 4.9)		0.80
Postoperative	4.1 (2.8; 5.6)		4.3 (3.5; 4.9)		0.69
Change	-0.1 (-0.3; 0)	-2.4	-0.1 (-0.2; 0)	-2.3	0.87

Abbreviations: IQR, interquartile range; SVA, sagittal vertical axis; TCPEEK, Titanium-coated polyether-ether-ketone; TTN, Titanium.
Level of significance p<0.05

Table 4

Subsidence, fusion, and ASD compared between both cage groups.

Radiological Parameters	TTN	TCPEEK	P
Subsidence
Subsidence >1 mm, No. of subsided levels/total subsided levels (%)	11/21 (52.4)	21/37 (56.8)	0.79
Subsidence, mm, median (IQR)	1.3 (0.3; 2.3)	1.2 (0.6; 1.7)	0.51
Fusion
Radiologically fused, No. of fused levels/total operated levels (%)	19/21 (90.5)	32/37 (86.5)	0.89
Fused single-level surgeries, No. of fused levels/total single-level operated levels (%)	9/11 (81.8)	19/21 (90.5)	0.59
Fused double-level surgeries, No. of fused levels/total double-level operated levels (%)	10/10 (100)	13/16 (81.3)	0.26
Adjacent Segment Degeneration	0/21 (0)	2/37 (5.4)	0.53

Abbreviations: ASD, adjacent segment degeneration; IQR, interquartile range; TCPEEK, titanium-coated polyether-ether-ketone; TTN, titanium.