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Vol. 37. Issue 5.
(September - October 2026)
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Vol. 37. Issue 5.
(September - October 2026)
Clinical Research

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,
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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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References
[1]
G.W. Smith, R.A. Robinson.
The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion.
J Bone Joint Surg Am, 40-A (1958), pp. 607-624
[2]
R.B. Cloward.
The anterior approach for removal of ruptured cervical disks.
J Neurosurg, 15 (1958), pp. 602-617
[3]
R.B. Cloward.
The treatment of ruptured lumbar intervertebral discs by vertebral body fusion I. Indications, operative technique, after care.
J Neurosurg, 10 (1953), pp. 154-168
[4]
M.F. Shriver, D.J. Lewis, V.R. Kshettry, B.P. Rosenbaum, E.C. Benzel, T.E. Mroz.
Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis.
Spine J Off J North Am Spine Soc, 15 (2015), pp. 2016-2027
[5]
F.C.S. Altorfer, C.J. Laux, D. Graf, et al.
Titanium-coated polyetheretherketone cages vs full titanium cages for stand-alone 1- or 2-level anterior cervical discectomy and fusion: a comparative study.
Int J Spine Surg, 18 (2024), pp. 287-294
[6]
N. D’Antonio, M.J. Lambrechts, J. Heard, et al.
Effect of interbody composition on the development of pseudarthrosis following anterior cervical discectomy and fusion.
Asian Spine J, 17 (2023), pp. 518-528
[7]
D. Leven, S.K. Cho.
Pseudarthrosis of the cervical spine: risk factors, diagnosis and management.
Asian Spine J, 10 (2016), pp. 776-786
[8]
R. Arregui, J. Aso, J.V. Martínez Quiñones, C. Sebastián, F. Consolini, A. Aso Vizan.
Follow-up of a new titaniumcoated polyetheretherketone cage for the cervical spine.
Orthop Rev, 12 (2020),
[9]
Y. Nakanishi, K. Naito, T. Yamagata, et al.
Safety of anterior cervical discectomy and fusion using titanium-coated polyetheretherketone stand-alone cages: multicenter prospective study of incidence of cage subsidence.
J Clin Neurosci Off J Neurosurg Soc Aust, 74 (2020), pp. 47-54
[10]
A. Kotsias, S. Mularski, B. Kühn, M. Hanna, O. Suess.
Does partial coating with titanium improve the radiographic fusion rate of empty PEEK cages in cervical spine surgery? A comparative analysis of clinical data.
Patient Saf Surg, 11 (2017), pp. 13
[11]
K. Phan, M.H. Pelletier, P.J. Rao, W.J. Choy, W.R. Walsh, R.J. Mobbs.
Integral fixation titanium/polyetheretherketone cages for cervical arthrodesis: evolution of cage design and early radiological outcomes and fusion rates.
Orthop Surg, 11 (2019), pp. 52-59
[12]
M.T. Reis, P.M. Reyes, N.R. Crawford.
Biomechanical assessment of anchored cervical interbody cages: comparison of 2-screw and 4-screw designs.
Neurosurgery, 10 (2014), pp. 412-417
[13]
I. Njoku, M. Alimi, L.Z. Leng, et al.
Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study: clinical article.
J Neurosurg Spine, 21 (2014), pp. 529-537
[14]
Y. Assem, R.J. Mobbs, M.H. Pelletier, K. Phan, W.R. Walsh.
Radiological and clinical outcomes of novel Ti/PEEK combined spinal fusion cages: a systematic review and preclinical evaluation.
Eur Spine J, 26 (2017), pp. 593-605
[15]
S. Kapetanakis, T. Thomaidis, G. Charitoudis, P. Pavlidis, P. Theodosiadis, G. Gkasdaris.
Single anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life.
J Spine Surg Hong Kong, 3 (2017), pp. 312-322
[16]
P.C. Gerszten, E. Paschel, H. Mashaly, H. Sabry, H. Jalalod’din, K. Saoud.
Outcomes evaluation of zero-profile devices compared to stand-alone PEEK cages for the treatment of three- and four-level cervical disc disease.
Cureus, 8 (2016), pp. e775
[17]
K.H. Bridwell, L.G. Lenke, K.W. McEnery, C. Baldus, K. Blanke.
Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?.
Spine, 20 (1995), pp. 1410-1418
[18]
A.M. Ashour, I. Abdelmohsen, M.E. Sawy, A.F. Toubar.
Stand-alone polyetheretherketone cages for anterior cervical discectomy and fusion for successive four-level degenerative disc disease without plate fixation.
J Craniovertebr Junct Spine, 11 (2020), pp. 118-123
[19]
J.M. McDonnell, S. Youssef, T.D. Ross, et al.
The efficacy of anchored stand-alone spacers in comparison to conventional cage and plate in anterior cervical discectomy and fusion surgery: a meta-analysis of randomised controlled trials for clinical and radiological outcomes.
Brain Spine, 4 (2024), pp. 102748
[20]
Y. Zhang, J. Ju, J. Wu.
Zero-profile anchored spacer versus conventional plate-cage construct in bilevel anterior cervical discectomy and fusion: a systematic review and meta-analysis.
J Orthop Surg, 18 (2023), pp. 644
[21]
Z. Sun, Z. Liu, W. Hu, Y. Yang, X. Xiao, X. Wang.
Zero-profile versus cage and plate in anterior cervical discectomy and fusion with a minimum 2 years of follow-up: a meta-analysis.
World Neurosurg, 120 (2018), pp. e551-e561
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