PEEK rod systems for the spine

Andreas F. Mavrogenis, Christos Vottis, George Triantafyllopoulos, Panayiotis J. Papagelopoulos, Spyros G. Pneumaticos

Traditional materials for the spine such as titanium and stainless steel have produced satisfying long-term fusion rates, mainly due to their strength and stiffness. However, although fixation with titanium rods leads to high fusion rates, increased stiffness of titanium constructs may also contribute to stress shielding and adjacent segment degeneration. Dynamic and flexible materials such as the Dynesys system allow better stress distribution to all of the spinal columns, but increase the rate of complications including screw loosening, infection, back and leg pain, and endplate vertebral fracture. Semi-rigid instrumentation systems using rods made from synthetic polymers such as the polyetheretherketone (PEEK) have been recently introduced as an alternative biomaterial for the spine. PEEK is a fully biocompatible and inert semi-crystalline thermoplastic polymer with minimal toxicity; it has a modulus of elasticity between that of cortical and cancellous bone, and significantly lower than titanium. However, there are very few clinical studies with small sample size and short-term follow-up using PEEK rod-pedicle screw spinal instrumentation systems. Additionally, their results are conflicting. To enhance the literature, this review discusses the effect of this medical for the spine and summarizes the results of the most important related series.