Comparison of PEEK vs 3D printed titanium cage for ACDF- Is there any difference in subsidence?

Author(s): Dr. Harshadkumar A. Patel, MD, Francine Zeng, MD, Dr. Hardeep Singh, MD, Dr. Scott S. Mallozzi, MD, Mark Cote, P.T, Dr. Isaac L. Moss, MD


To compare the subsidence between PEEK vs new 3D printed titanium cage(3DTC) for ACDF surgery.


Retrospective cohort study Setting: Single academic spine center.

Methods/Outcome Measures:

All patients underwent a standard ACDF surgery with respective PEEK and 3DTC interbodies. Cage subsidence was measured as the change in adjusted intervertebral height (aIVH) in immediate post-operative and subsequent follow-up neutral radiographs at 6 months and ≥1-year visits. Severe subsidence was defined as ≥3 mm of aIVH loss on follow up. Basic demographic information and post-operative complications were also measured. Mixed effects linear models were constructed to evaluate difference in subsidence. A total of 26 patients (44 levels) in the PEEK group and 31 patients (48 levels) in the 3DTC group were available for review at minimum 6 months follow up.


There was no difference in demographic variables, including Charleston co-morbidity index, BMI and smoking status between groups. The overall average subsidence was 1.17 mm (95% CI : 0.82 – 1.51, p<0.001) at 6 months and 1.42 mm (95% CI: 1.07- 1.78, p<0.001) at 1-year follow up. The 3DTC group had significantly lower subsidence compared to the PEEK group at 6 months (0.84 mm vs 1.59 mm, p <0.05) and at 1 year (0.85 mm vs 1.92 mm, p<0.05). Severe subsidence rates were 9.37% for 3DTC group versus 19.04% for the PEEK group at 1 year.(P>0.05)


3DTC leads to overall minor, but significant reduction in subsidence compared to PEEK cages in ACDF surgery. 3DTC has comparable severe subsidence rate to PEEK cage

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