ReviewJournal of orthopaedics2026
Titanium-coated PEEK versus 3D-printed porous titanium cages in transforaminal lumbar interbody fusion: A meta-analysis.
Review in Journal of orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Transforaminal lumbar interbody fusion (TLIF) is a common procedure for degenerative spinal conditions. While polyetheretherketone (PEEK) and titanium (Ti) are established cage materials, titanium-coated PEEK (Ti-PEEK) was developed to combine PEEK's favorable modulus with Ti's osteoconductive surface. This meta-analysis compares the radiographic and clinical outcomes of modern 3D-printed porous titanium (3D-Ti) and Ti-PEEK cages in TLIF. Methods: A systematic search of PubMed, Embase, and Google Scholar was conducted up to April 2025 following PRISMA guidelines. Studies comparing 3D-Ti and/or Ti-PEEK cages in TLIF, reporting outcomes of fusion, subsidence, reoperation, or visual analogue scale (VAS) scores with a minimum 6-month follow-up were included. Given the scarcity of direct comparisons, an indirect comparison was performed using single-arm random-effects meta-analyses for each material, followed by meta-regression to estimate differences. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and ROBINS-I for observational studies. Results: Twelve studies (4 RCTs, 8 cohorts) comprising 627 patients and 812 fused levels were included. Single-arm analyses showed high and comparable fusion rates (3D-Ti: 91%, Ti-PEEK: 88%) and similar subsidence (3D-Ti: 19%, Ti-PEEK: 20%) and reoperation rates. Indirect meta-regression found no statistically significant differences between materials for fusion (OR 0.68, 95% CI 0.30-1.50; p = 0.335), subsidence (OR 1.04, 95% CI 0.33-3.22; p = 0.951), reoperation (OR 1.23, 95% CI 0.29-5.24; p = 0.777), or VAS-back (mean difference -0.88, 95% CI -2.49 to 0.73; p = 0.286). Residual heterogeneity was substantial for subsidence (I Conclusion: This meta-analysis found no significant differences in radiographic or key clinical outcomes between 3D-Ti and Ti-PEEK cages at intermediate-term follow-up. The evidence suggests clinical equivalence, supporting that cage selection can be guided by factors such as surgeon familiarity, cost, and specific patient imaging needs rather than material properties alone.
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