This ceramic material has long been used in orthopedic applications, particularly hip implants. 5, 13, 14 A cervical TDR was designed with commercially pure, titanium-coated PEEK endplates and a biconvex zirconia-toughened alumina ceramic core. However, this has been addressed in many implants by adding a textured porous coating, often titanium, a material with favorable osseointegrative properties. Another concern with PEEK is the bioinert surface. 10 This may be particularly problematic and cause uneven loading if the implant is not ideally positioned. 6– 12 Despite general optimism, there was concern about long-term degradation on articulating PEEK-on-PEEK surfaces. 4, 5 Though less extensive than cervical fusion cages, there has been investigation into the use of PEEK for cervical TDR. The use of polyetheretherketone (PEEK) material for spinal implants continues to increase, primarily due to its mechanical properties and lack of producing artifacts on imaging studies. Various designs followed including metal-on-metal devices and a titanium-ceramic composite device, as well as a compressible disc with metal endplates. 1– 3 The first cervical TDRs used on a large-scale basis produced motion through a ball-and-socket or mobile-bearing action, with metal endplates articulating with a plastic core. Multiple meta-analyses of these and other studies have found that TDR produces outcomes superior to ACDF. There have been multiple prospective, randomized, controlled trials comparing cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF).
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