RCT Favors Titanium Over PEEK Cages for TLIF

This robust trial evaluated mainly radiographic endpoints, but differences were dramatic enough that we speculate they'll likely result in clinical differences over time.

Smart Practice: If you’re choosing between a PEEK cage and an activated titanium cage for your TLIF, particularly in a patient at higher risk for pseudarthrosis, this randomized trial might nudge you toward the latter.

What’s the Claim?

A nice (if industry-supported) randomized trial found that an activated titanium cage resulted in a higher likelihood of fusion at six months than did a polyetheretherketone (PEEK) cage for 1- or 2-level transforaminal lumbar interbody fusions (84% vs 21%), as well as less subsidence. There were no differences in patients’ outcomes scores in this very short-term trial.

How’s It Stack Up?

PEEK has many advantages, and certainly one would expect that more than one in five patients treated with a lordotic PEEK cage would achieve fusion over time. Still, the difference favoring titanium cages at six months here was noteworthy. We aren’t aware of other randomized trials on this topic.

Funding for this study came from a company that manufactured both devices being analyzed, rather than only one of them. That mitigates but doesn’t eliminate the concerns most reasonable people have when reading industry-funded work. It will be nice to see the findings here validated by independent investigators.

What’s Our Take?