title: Radiological and clinical outcomes of novel Ti/PEEK combined spinal fusion cages: a systematic review and preclinical evaluation.
abstract: 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.
  
  
  
  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."
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia.|Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, UNSW, Sydney, Australia.|Neurospine Clinic, Prince of Wales Private Hospital, Barker St, Randwick, NSW, 2031, Australia.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Assem
authors.affiliation: Neurospine Clinic, Prince of Wales Private Hospital, Barker St, Randwick, NSW, 2031, Australia. ralphmobbs@hotmail.com.|NeuroSpine Surgery Research Group (NSURG), Sydney, Australia. ralphmobbs@hotmail.com.|Department of Spine Surgery, Prince of Wales Private Hospital, Barker St, Sydney, 2031, Australia. ralphmobbs@hotmail.com.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
authors.affiliation: Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, UNSW, Sydney, Australia.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Pelletier
authors.affiliation: Neurospine Clinic, Prince of Wales Private Hospital, Barker St, Randwick, NSW, 2031, Australia.|NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, UNSW, Sydney, Australia.
authors.forename: William R
authors.initials: WR
authors.lastname: Walsh
mesh_terms: D001577:Benzophenones; D020099:Coated Materials, Biocompatible; D006801:Humans; D007659:Ketones; D011092:Polyethylene Glycols; D011108:Polymers; D019736:Prostheses and Implants; D011474:Prosthesis Design; D013123:Spinal Fusion / Q000295:instrumentation*; D014025:Titanium
chemical_list: D001577:Benzophenones; D020099:Coated Materials, Biocompatible; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols; D014025:Titanium
keywords: Cage; PEEK; Spinal fusion; Ti/PEEK; Titanium