European Spine Journal - 2026-07-10 - Journal Article
Anterior cervical discectomy and fusion without anchoring: a multicenter comparison of stand-alone porous titanium versus anchored PEEK interbody cages.
Colonna S, Panico F, Gatto A, Dell'Accio FM, Ceroni L, Bavaresco E, Zullo N, Bozzaro M, Petrone S, Ajello M, Marengo N, Garbossa D, Cofano F
Topics
Key Takeaway
Stand-alone 3D-printed porous titanium cages achieved 88.4% fusion versus 92.3% for anchored PEEK cages (non-significant) with 27-minute shorter operative time in single- and two-level ACDF.
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Summary
This multicenter retrospective study compared stand-alone 3D-printed porous titanium cages versus anchored zero-profile PEEK cages in 265 consecutive ACDF patients (1–2 levels, 2020–2024). Fusion rates (88.4% vs. 92.3%), subsidence rates (5.7% vs. 4.1%), sagittal alignment, and complication rates were statistically equivalent between groups. Stand-alone titanium demonstrated significantly shorter operative time (85 vs. 112 min) and greater magnitude of NRS pain reduction, while SF-12 improvement was comparable.
Key Limitation
Fusion assessment relied solely on static radiographs at 12 months rather than CT, which systematically overestimates fusion rates and prevents meaningful differentiation of the 88.4% versus 92.3% rates between groups.
Original Abstract
PURPOSE
To compare clinical and radiological outcomes of ACDF performed using stand-alone 3D-printed porous titanium cages versus anchored polyetheretherketone (PEEK) interbody cages in patients with degenerative cervical spine disease.
METHODS
This multicenter retrospective study included consecutive adult patients who underwent single- or two-level ACDF between January 2020 and October 2024. Patients were treated with either stand-alone porous titanium cages or anchored zero-profile PEEK cages. Clinical outcomes were assessed using the NRS and the SF-12 questionnaire. Radiological outcomes included intersomatic fusion, cage subsidence, and sagittal alignment parameters. Fusion was evaluated on static cervical radiographs at 12 months. Complications and revision surgeries were recorded.
RESULTS
A total of 265 patients were included (121 stand-alone; 144 anchored). Baseline demographic and clinical characteristics were comparable between groups. Operative time was significantly shorter in the stand-alone group (85 vs. 112 min). Both groups showed significant postoperative improvement in pain and functional scores. The magnitude of pain reduction was greater in the stand-alone cohort, while SF-12 improvement was comparable. Fusion rates (88.4% vs. 92.3%), subsidence rates (5.7% vs. 4.1%), complication rates, and sagittal alignment parameters did not differ significantly between groups. Osteoporosis was the only factor associated with an increased risk of cage subsidence.
CONCLUSION
In this multicenter study, stand-alone 3D-printed porous titanium cages achieved clinical and radiological outcomes comparable to anchored PEEK cages in ACDF, with shorter operative times, preserved sagittal alignment, and similar complication, fusion, and subsidence rates. These findings support their use as a safe and efficient alternative in appropriately selected patients.