title: Polyetheretherketone (PEEK) cages in cervical applications: a systematic review.
abstract: BACKGROUND
  Polyetheretherketone (PEEK) cages have been widely used during the past decade in patients with degenerative disorders of the cervical spine. Their radiolucency and low elastic modulus make them attractive attributes for spinal fusion compared with titanium and bone graft. Still, limitations are seen such as pseudoarthrosis, subsidence, and migration of the cages. Limited evidence on the clinical outcome of PEEK cages is found in the literature other than noncomparative cohort studies with only a few randomized controlled trials.
  
  
  OBJECTIVE
  To assess the clinical and radiographic outcome of PEEK cages in the treatment of degenerative disc disorders and/or spondylolisthesis in the cervical spine.
  
  
  METHODS
  Systematic review of all randomized controlled trials and prospective and retrospective nonrandomized comparative studies with a minimum follow-up of 6 months and all noncomparative cohort studies with a long-term follow-up of more than 5 years.
  
  
  METHODS
  The primary outcome variable was clinical performance. Secondary outcome variables consisted of radiographic scores.
  
  
  METHODS
  The MEDLINE, EMBASE, and Cochrane Library databases were searched according to the Preferred Reporting Items of Systematic reviews and Meta-Analyses statement and Meta-analysis Of Observational Studies in Epidemiology guidelines. No conflict of interest reported. No funding received.
  
  
  RESULTS
  A total of 223 studies were identified, of which 10 studies were included. These comprised two randomized controlled trials, five prospective comparative trials, and three retrospective comparative trials.
  
  
  CONCLUSIONS
  Minimal evidence for better clinical and radiographic outcome is found for PEEK cages compared with bone grafts in the cervical spine. No differences were found between PEEK, titanium, and carbon fiber cages. Future studies are needed to improve methodology to minimize bias. Publication of lumbar interbody fusion studies needs to be promoted because differences in clinical and/or radiographic scores are more likely to be demonstrated in this part of the spine.
authors.affiliation: Department of Orthopaedics, Clinical Orthopaedic Research Center midden-Nederland (CORC-mN), Diakonessenhuis Hospital Utrecht/Zeist, PO Box 80250, 3508 TG Utrecht, The Netherlands. Electronic address: rkersten@diakhuis.nl.
authors.forename: Roel Frederik Mark Raymond
authors.initials: RF
authors.lastname: Kersten
authors.affiliation: Department of Orthopaedics, Clinical Orthopaedic Research Center midden-Nederland (CORC-mN), Diakonessenhuis Hospital Utrecht/Zeist, PO Box 80250, 3508 TG Utrecht, The Netherlands.
authors.forename: Steven M
authors.initials: SM
authors.lastname: van Gaalen
authors.affiliation: Department of Orthopaedics, Clinical Orthopaedic Research Center midden-Nederland (CORC-mN), Diakonessenhuis Hospital Utrecht/Zeist, PO Box 80250, 3508 TG Utrecht, The Netherlands.
authors.forename: Arthur
authors.initials: A
authors.lastname: de Gast
authors.affiliation: Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: F Cumhur
authors.initials: FC
authors.lastname: Öner
mesh_terms: D001577:Benzophenones; D001672:Biocompatible Materials; D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007659:Ketones; D011092:Polyethylene Glycols; D011108:Polymers; D011183:Postoperative Complications; D019736:Prostheses and Implants; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001577:Benzophenones; D001672:Biocompatible Materials; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols
keywords: Clinical outcomes; Degenerative disc disorders; Interbody fusion; PEEK; Radiological outcomes; Systematic review