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Clinical Research
Uncorrected Proof. Available online 2 March 2026

Clinical and radiological outcomes of ACDF using titanium-screw PEEK cages: A retrospective series

Resultados clínicos y radiológicos de la ACDF utilizando jaulas de PEEK con tornillos de titanio: una serie retrospectiva
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Francisco Verdú Lópeza, Vicente Vanaclochab,
Corresponding author
vivava@uv.es

Corresponding author.
, Alejandra Hernández-Validoc, David Aliagac, José-María Gallego-Sánchezc, Ana-María Morales-Codinaa
a Unidad de Columna, Hospital Universitario Dr. Peset, Valencia, Spain
b Servicio de Neurocirugía, Universidad de Valencia, Spain
c Servicio de Neurocirugía, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Abstract
Objective

To evaluate the clinical and radiological outcomes of anterior cervical discectomy and fusion (ACDF) using titanium-screw PEEK cages, focusing on fusion rates, cervical alignment, pain relief, and complications.

Methods

Retrospective observational study of 40 consecutive patients treated between May 2017 and December 2018. Outcomes included Neck Disability Index (NDI), Numerical Rating Scale (NRS) for cervical and radicular pain, and radiological parameters (fusion status, Cobb angles, disk height). Complications were systematically documented, and longitudinal changes were analyzed using the Friedman test for repeated measures.

Results

At 2-year follow-up, all patients achieved radiological fusion (Bridwell grades I–II). Median NDI improved from 56% to 20% (p<0.001). Cervical and radicular pain scores decreased significantly (median NRS from 8 to 2 and 7 to 1; p<0.001). Cervical alignment and disk height improved and remained stable. Dysphagia and dysphonia occurred in 5% and 2.5% of cases, respectively, resolving spontaneously.

Conclusions

ACDF using titanium-screw PEEK cages is safe and effective, providing high fusion rates, significant clinical improvement, and low complication rates. These zero-profile hybrid devices offer a reliable alternative to traditional cage-plate constructs.

Keywords:
Anterior cervical discectomy and fusion
Cervical vertebrae
Intervertebral disk
Spinal fusion
Polyetheretherketone
Titanium
Resumen
Objetivo

Evaluar los resultados clínicos y radiológicos de la discectomía cervical anterior con fusión (ACDF) utilizando cajas intersomáticas de PEEK con tornillos de titanio, analizando tasas de fusión, alineación cervical, alivio del dolor y complicaciones.

Métodos

Serie retrospectiva de 40 pacientes intervenidos entre mayo de 2017 y diciembre de 2018. Se valoraron el Índice de Discapacidad Cervical (NDI), la Escala Numérica del Dolor (NRS) para dolor cervical y radicular, y parámetros radiológicos (estado de fusión, ángulos de Cobb, altura discal). Se registraron las complicaciones.

Resultados

A los 2 años, todos los pacientes presentaron fusión radiológica (grados I–II de Bridwell). El NDI mediano mejoró del 56% al 20% (p <0,001). Las puntuaciones NRS para dolor cervical y radicular disminuyeron significativamente (de 8 a 2 y de 7 a 1; p <0,001). La alineación cervical y la altura discal mejoraron y se mantuvieron estables. La disfagia y la disfonía ocurrieron en el 5% y el 2,5% de los casos, respectivamente, resolviéndose espontáneamente.

Conclusiones

La ACDF con cajas híbridas PEEK-titanio atornilladas es segura y eficaz, con altas tasas de fusión, mejoría clínica significativa y baja incidencia de complicaciones. Estos dispositivos representan una alternativa fiable a los sistemas convencionales de caja y placa.

Palabras clave:
Discectomía cervical anterior y fusión
Vértebras cervicales
Disco intervertebral
Fusión espinal
Polieteretercetona
Titanio

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