{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T23:18:45Z","timestamp":1785280725470,"version":"3.55.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Nonunion and significant subsidence after anterior cervical discectomy and fusion (ACDF) are associated with poor clinical outcomes, which occasionally lead to revision surgery. Allograft and polyetheretherketone (PEEK) cages are the two most commonly used interbody spacer devices for ACDF. Although studies have been conducted to compare the efficacies of these two interbody materials, the question remains regarding the superiority of one over the other. Therefore, the authors conducted a systematic review and meta-analysis to compare nonunion, subsidence, and reoperation rates after ACDF using allograft and PEEK cages as interbody devices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In this systematic review and meta-analysis, the authors systematically searched the MEDLINE, EMBASE, and Cochrane Library databases for studies published prior to November 2023 that compared the efficacy and safety of allograft and PEEK cages for ACDF. A pooled analysis was designed to identify differences in nonunion, subsidence, and reoperation rates between the two interbody devices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Ten studies involving 1462 patients (allograft, 852 patients; PEEK cage, 610 patients) were included. The pooled analysis demonstrated that allograft had a significantly lower rate of nonunion compared to that of PEEK cages (OR 0.33, 95% CI 0.14\u20130.79; p = 0.01). Furthermore, the reoperation rate due to nonunion was significantly higher with PEEK cages compared to that with allograft (OR 0.28, 95% CI 0.11\u20130.71; p &lt; 0.01), whereas the reoperation rate due to overall causes did not display significant results (OR 0.38, 95% CI 0.11\u20131.29; p = 0.12). The incidence of significant subsidence (OR 0.66, 95% CI 0.28\u20131.55; p = 0.34) and the mean amount of subsidence (standard mean difference 0.03, 95% CI \u22120.42 to 0.47; p = 0.90) did not demonstrate significant differences between allograft and PEEK cages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Overall, the current meta-analysis suggests the advantages of allograft over PEEK cages used for ACDF, due to an enhanced fusion rate and minimized revision risk, with no increase in the risk of subsidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.4.spine24187","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T21:54:08Z","timestamp":1722030848000},"page":"453-463","source":"Crossref","is-referenced-by-count":3,"title":["Which interbody device minimized nonunion, subsidence, and reoperation after anterior cervical discectomy and fusion? A systematic review and meta-analysis comparing allograft versus polyetheretherketone cage"],"prefix":"10.3171","volume":"43","author":[{"given":"Chul-Ho","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Ju","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Hwan","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sehan","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Asian Spine J","first-page":"213","article-title":"Update of the natural history, pathophysiology, and treatment strategies of degenerative cervical myelopathy: a narrative review","volume":"17","author":"Kim MW","year":"2023","unstructured":"Kim MW, Kang CN, Choi SH. Update of the natural history, pathophysiology, and treatment strategies of degenerative cervical myelopathy: a narrative review. Asian Spine J. 2023;17(1):213\u2013221."},{"issue":"3","key":"b2","series-title":"Asian Spine J","first-page":"582","article-title":"Anterior decompression and fusion for the treatment of cervical myelopathy caused by ossification of the posterior longitudinal ligament: a narrative review","volume":"17","author":"Park S","year":"2023","unstructured":"Park S, Lee DH, Lee CS, Hwang CJ, Yang JJ, Cho JH. Anterior decompression and fusion for the treatment of cervical myelopathy caused by ossification of the posterior longitudinal ligament: a narrative review. Asian Spine J. 2023;17(3):582\u2013594."},{"issue":"6","key":"b3","series-title":"Global Spine J","first-page":"775","article-title":"Structural allograft versus PEEK implants in anterior cervical discectomy and fusion: a systematic review","volume":"10","author":"Jain A","year":"2020","unstructured":"Jain A, Marrache M, Harris A,  Structural allograft versus PEEK implants in anterior cervical discectomy and fusion: a systematic review. Global Spine J. 2020;10(6):775\u2013783."},{"issue":"15","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"1043","article-title":"Prospective, randomized, blinded clinical trial comparing PEEK and allograft spacers in patients undergoing anterior cervical discectomy and fusion surgeries","volume":"47","author":"Villavicencio AT","year":"2022","unstructured":"Villavicencio AT, Nelson EL, Rajpal S, Beasley K, Burneikiene S. Prospective, randomized, blinded clinical trial comparing PEEK and allograft spacers in patients undergoing anterior cervical discectomy and fusion surgeries. Spine (Phila Pa 1976). 2022;47(15):1043\u20131054."},{"key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"127","article-title":"Impact of type of graft on patient reported outcomes and costs following anterior cervical discectomy and fusion","volume":"2016","author":"Chotai S","year":"2016","unstructured":"Chotai S, Parker SL, Kim E,  Impact of type of graft on patient reported outcomes and costs following anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2016;2016:127."},{"issue":"1","key":"b6","series-title":"J Neurosurg Spine","first-page":"46","article-title":"Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion","volume":"30","author":"Krause KL","year":"2018","unstructured":"Krause KL, Obayashi JT, Bridges KJ, Raslan AM, Than KD. Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion. J Neurosurg Spine. 2018;30(1):46\u201351."},{"issue":"12","key":"b7","series-title":"Spine J","first-page":"1790","article-title":"Fate of pseudarthrosis detected 2 years after anterior cervical discectomy and fusion: results of a minimum 5-year follow-up","volume":"23","author":"Lee DH","year":"2023","unstructured":"Lee DH, Park S, Seok SY,  Fate of pseudarthrosis detected 2 years after anterior cervical discectomy and fusion: results of a minimum 5-year follow-up. Spine J. 2023;23(12):1790\u20131798."},{"issue":"6","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"384","article-title":"Cages in ACDF are associated with a higher nonunion rate than allograft: a stratified comparative analysis of 6130 patients","volume":"44","author":"Pirkle S","year":"2019","unstructured":"Pirkle S, Kaskovich S, Cook DJ, Ho A, Shi LL, Lee MJ. Cages in ACDF are associated with a higher nonunion rate than allograft: a stratified comparative analysis of 6130 patients. Spine (Phila Pa 1976). 2019;44(6):384\u2013388."},{"issue":"1","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"E23","article-title":"What is the fate of pseudarthrosis detected 1 year after anterior cervical discectomy and fusion?","volume":"43","author":"Lee DH","year":"2018","unstructured":"Lee DH, Cho JH, Hwang CJ,  What is the fate of pseudarthrosis detected 1 year after anterior cervical discectomy and fusion? Spine (Phila Pa 1976). 2018;43(1):E23\u2013E28."},{"key":"b10","series-title":"J Clin Neurosci","first-page":"118","article-title":"Comparison of allograft and polyetheretherketone (PEEK) cage subsidence rates in anterior cervical discectomy and fusion (ACDF)","volume":"38","author":"Yson SC","year":"2017","unstructured":"Yson SC, Sembrano JN, Santos ERG. Comparison of allograft and polyetheretherketone (PEEK) cage subsidence rates in anterior cervical discectomy and fusion (ACDF). J Clin Neurosci. 2017;38:118\u2013121."},{"issue":"13","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"944","article-title":"Morphologic change of corticocancellous allograft used for anterior cervical discectomy and fusion","volume":"47","author":"Yang JJ","year":"2022","unstructured":"Yang JJ, Ryu B, Moon JW, Kim T, Park S. Morphologic change of corticocancellous allograft used for anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2022;47(13):944\u2013953."},{"issue":"1","key":"b12","series-title":"Neurosurgery","first-page":"94","article-title":"Nonunion rates after anterior cervical discectomy and fusion: comparison of polyetheretherketone vs structural allograft implants","volume":"89","author":"Ryu WHA","year":"2021","unstructured":"Ryu WHA, Richards D, Kerolus MG,  Nonunion rates after anterior cervical discectomy and fusion: comparison of polyetheretherketone vs structural allograft implants. Neurosurgery. 2021;89(1):94\u2013101."},{"key":"b13","series-title":"J Clin Neurosci","first-page":"328","article-title":"Characterizing the fusion order and level-specific rates of arthrodesis in 3-level anterior cervical discectomy and fusion: a radiographic study","volume":"81","author":"Nichols NM","year":"2020","unstructured":"Nichols NM, Jamieson A, Wang M, Chou D, Mummaneni PV, Tan LA. Characterizing the fusion order and level-specific rates of arthrodesis in 3-level anterior cervical discectomy and fusion: a radiographic study. J Clin Neurosci. 2020;81:328\u2013333."},{"issue":"4","key":"b14","series-title":"J Neurosurg Spine","first-page":"562","article-title":"Anterior cervical discectomy and fusion performed using structural allograft or polyetheretherketone: pseudarthrosis and revision surgery rates with minimum 2-year follow-up","volume":"32","author":"Wang M","year":"2019","unstructured":"Wang M, Chou D, Chang CC,  Anterior cervical discectomy and fusion performed using structural allograft or polyetheretherketone: pseudarthrosis and revision surgery rates with minimum 2-year follow-up. J Neurosurg Spine. 2019;32(4):562\u2013569."},{"issue":"1","key":"b15","series-title":"Syst Rev","first-page":"1","article-title":"Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher D","year":"2015","unstructured":"Moher D, Shamseer L, Clarke M,  Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1."},{"key":"b16","series-title":"BMC Med Res Methodol","first-page":"10","article-title":"Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews","volume":"7","author":"Shea BJ","year":"2007","unstructured":"Shea BJ, Grimshaw JM, Wells GA,  Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10."},{"issue":"7","key":"b17","series-title":"PLoS Med","first-page":"e1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher D","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097."},{"issue":"4","key":"b18","series-title":"Afr Health Sci","first-page":"557","article-title":"Clinical \"case series\": a concept analysis","volume":"12","author":"Abu-Zidan FM","year":"2012","unstructured":"Abu-Zidan FM, Abbas AK, Hefny AF. Clinical \"case series\": a concept analysis. Afr Health Sci. 2012;12(4):557\u2013562."},{"issue":"9","key":"b19","series-title":"ANZ J Surg","first-page":"712","article-title":"Methodological index for non-randomized studies (minors): development and validation of a new instrument","volume":"73","author":"Slim K","year":"2003","unstructured":"Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712\u2013716."},{"issue":"Pt 1","key":"b20","series-title":"Br J Math Stat Psychol","first-page":"97","article-title":"Fixed- versus random-effects models in meta-analysis: model properties and an empirical comparison of differences in results","volume":"62","author":"Schmidt FL","year":"2009","unstructured":"Schmidt FL, Oh IS, Hayes TL. Fixed- versus random-effects models in meta-analysis: model properties and an empirical comparison of differences in results. Br J Math Stat Psychol. 2009;62(Pt 1):97-128."},{"key":"b21","series-title":"Version 5.1.0. The Cochrane Collaboration","article-title":"Cochrane Handbook for Systematic Reviews of Interventions","year":"2011","unstructured":"Higgins JPT, Green S, eds.Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. The Cochrane Collaboration;2011.Accessed May 16, 2024. https:\/\/handbook-5-1.cochrane.org\/"},{"issue":"6","key":"b22","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis","volume":"50","author":"Bergin SM","year":"2021","unstructured":"Bergin SM, Wang TY, Park C,  Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis. Neurosurg Focus. 2021;50(6):E6."},{"issue":"4","key":"b23","series-title":"J Spine Surg","first-page":"670","article-title":"Symptomatic pseudarthrosis requiring revision surgery after 1- or 2-level ACDF with plating: PEEK versus allograft","volume":"6","author":"Buyuk AF","year":"2020","unstructured":"Buyuk AF, Onyekwelu I, Gaffney CJ. Symptomatic pseudarthrosis requiring revision surgery after 1- or 2-level ACDF with plating: PEEK versus allograft. J Spine Surg. 2020;6(4):670\u2013680."},{"issue":"1","key":"b24","series-title":"BMC Musculoskelet Disord","first-page":"331","article-title":"A comparison of contiguous two-level anterior cervical discectomy and fusion using a structural allograft versus a Polyetheretherketone (PEEK) cage: the results of a three-year follow-up","volume":"21","author":"Moo IH","year":"2020","unstructured":"Moo IH, Kam CJW, Lai MWS, Yeo W, Soh RCC. A comparison of contiguous two-level anterior cervical discectomy and fusion using a structural allograft versus a Polyetheretherketone (PEEK) cage: the results of a three-year follow-up. BMC Musculoskelet Disord. 2020;21(1):331."},{"issue":"5","key":"b25","series-title":"J Neurosurg Spine","first-page":"696","article-title":"PEEK interbody devices for multilevel anterior cervical discectomy and fusion: association with more than 6-fold higher rates of pseudarthrosis compared to structural allograft","volume":"32","author":"Teton ZE","year":"2020","unstructured":"Teton ZE, Cheaney B, Obayashi JT, Than KD,  PEEK interbody devices for multilevel anterior cervical discectomy and fusion: association with more than 6-fold higher rates of pseudarthrosis compared to structural allograft. J Neurosurg Spine. 2020;32(5):696\u2013702."},{"issue":"45","key":"b26","series-title":"Medicine (Baltimore)","first-page":"e17935","article-title":"Clinical and radiological results comparison of allograft and polyetheretherketone cage for one to two-level anterior cervical discectomy and fusion: a CONSORT-compliant article","volume":"98","author":"Yang S","year":"2019","unstructured":"Yang S, Yu Y, Liu X,  Clinical and radiological results comparison of allograft and polyetheretherketone cage for one to two-level anterior cervical discectomy and fusion: a CONSORT-compliant article. Medicine (Baltimore). 2019;98(45):e17935."},{"issue":"5","key":"b27","series-title":"Global Spine J","first-page":"410","article-title":"ACDF graft selection by surgeons: survey of AOSpine members","volume":"7","author":"Yoon ST","year":"2017","unstructured":"Yoon ST, Konopka JA, Wang JC,  ACDF graft selection by surgeons: survey of AOSpine members. Global Spine J. 2017;7(5):410\u2013416."},{"key":"b28","series-title":"J Clin Neurosci","first-page":"142","article-title":"Fusion rate following three- and four-level ACDF using allograft and segmental instrumentation: a radiographic study","volume":"62","author":"Wewel JT","year":"2019","unstructured":"Wewel JT, Kasliwal MK, Adogwa O, Deutsch H, O\u2019Toole JE, Traynelis VC. Fusion rate following three- and four-level ACDF using allograft and segmental instrumentation: a radiographic study. J Clin Neurosci. 2019;62:142\u2013146."},{"issue":"13","key":"b29","series-title":"Spine (Phila Pa 1976)","first-page":"E776","article-title":"Asymptomatic ACDF nonunions underestimate the true prevalence of radiographic pseudarthrosis","volume":"45","author":"Crawford CH III","year":"2020","unstructured":"Crawford CH III, Carreon LY, Mummaneni P, Dryer RF, Glassman SD. Asymptomatic ACDF nonunions underestimate the true prevalence of radiographic pseudarthrosis. Spine (Phila Pa 1976). 2020;45(13):E776\u2013E780."},{"issue":"9","key":"b30","series-title":"PLoS One","first-page":"e0184495","article-title":"In vivo experimental study of anterior cervical fusion using bioactive polyetheretherketone in a canine model","volume":"12","author":"Shimizu T","year":"2017","unstructured":"Shimizu T, Fujibayashi S, Yamaguchi S,  In vivo experimental study of anterior cervical fusion using bioactive polyetheretherketone in a canine model. PLoS One. 2017;12(9):e0184495."},{"issue":"3","key":"b31","series-title":"Spine J","first-page":"265","article-title":"Osteoblasts exhibit a more differentiated phenotype and increased bone morphogenetic protein production on titanium alloy substrates than on poly-ether-ether-ketone","volume":"12","author":"Olivares-Navarrete R","year":"2012","unstructured":"Olivares-Navarrete R, Gittens RA, Schneider JM,  Osteoblasts exhibit a more differentiated phenotype and increased bone morphogenetic protein production on titanium alloy substrates than on poly-ether-ether-ketone. Spine J. 2012;12(3):265\u2013272."},{"key":"b32","series-title":"Surg Neurol Int","first-page":"556","article-title":"Review of anterior cervical diskectomy\/fusion (ACDF) using different polyetheretherketone (PEEK) cages","volume":"13","author":"Epstein NE","year":"2022","unstructured":"Epstein NE, Agulnick MA. Review of anterior cervical diskectomy\/fusion (ACDF) using different polyetheretherketone (PEEK) cages. Surg Neurol Int. 2022;13:556."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/43\/4\/article-p453.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/43\/4\/article-p453.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/43\/4\/article-p453.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T15:40:00Z","timestamp":1764862800000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/43\/4\/article-p453.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":32,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2024.4.spine24187","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}