Background/Objectives: Utilization of polyetheretherketone (PEEK) cages for spinal fusion has surged in the U.S., yet comprehensive comparisons evaluating its postoperative effectiveness with alternative materials remain limited. This systematic review investigates the efficacy of PEEK cages against traditional fusion materials across various surgery types, elucidating PEEK’s impact on fusion rates, postoperative outcomes, and long-term success. Methods: A systematic search of PubMed, CINAHL, Scopus, Embase, and Web of Science was conducted through 14 October 2024. Included studies were randomized controlled trials (RCTs) comparing PEEK cages with titanium, silicon nitride, and metal-coated PEEK cages for anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF). Article quality was assessed using GRADE criteria. Results: From 288 initially screened articles, 25 RCTs involving 2046 patients (mean follow-up 23.1 ± 18.2 months) met inclusion criteria and were determined as moderate (n = 21) or high (n = 4) quality. Fusion rates by cage material for PEEK (n = 1041), Ti-PEEK (n = 291), and titanium (n = 53) were 85.63 ± 18.00%, 80.05 ± 19.9%, and 92.75 ± 11.31%, respectively. In ACDF, titanium cages achieved higher fusion rates than PEEK (100% vs. 94%). In PLIF and TLIF, coated PEEK outperformed uncoated PEEK (75% vs. 71% and 94% vs. 84%, respectively). Uncoated PEEK achieved fusion rates of 94.04 ± 5.04% for ACDF, 71.21 ± 21.93% for PLIF, and 83.50 ± 24.66% for TLIF, with titanium outperforming PEEK in early fusion outcomes. Coated PEEK demonstrated potential improvements in fusion rates over uncoated PEEK in PLIFs and TLIFs. Conclusions: Selection of cage material for spinal fusions should be tailored to surgical requirements and patient needs. While titanium and PEEK are effective, their performance varies across contexts. New materials and surface modifications may enhance these outcomes further, warranting future research in long-term studies and development of novel materials. These findings can help surgeons choose cage materials according to procedure type, patient characteristics, and imaging needs.

Background/Objectives: The success of lumbar interbody fusion depends on the implant design and the surgical approach used. This study evaluated the clinical and radiographic outcomes of lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF) using a 3D-printed porous titanium interbody cage system. Methods: A retrospective, single-center review of 48 patients treated for degenerative lumbar spine disease was conducted. Patients underwent LLIF, ALIF, or a combination of both using a 3D-printed titanium cage system (J&J MedTech, Raynham, MA, USA). The Oswestry disability index (ODI) and Patient-Reported Outcomes Measurement Information System (PROMIS) metrics were assessed after 6 weeks, 3 months, 6 months, and 12 months. Linear mixed-effects models evaluated the pre- and post-operative differences. Fusion performance and complications were assessed using the Bridwell grading system over 24 months. Results: A total of 78 levels (62 LLIF and 16 ALIF) were analyzed. Fusion rates were 90.3% (56/62) for LLIF levels and 81.3% (13/16) for ALIF levels by the end of 12 months. ODI scores improved significantly after 3 months (MD −13.0, p < 0.001), 6 months (MD −12.3, p < 0.001), and 12 months (MD −14.9, p < 0.001). PROMIS Pain Interference scores improved after 3 months (MD −6.1, p < 0.001), 6 months (MD −3.4, p < 0.001), and 12 months (MD −5.8, p < 0.001). PROMIS Physical Function scores improved after 3 months (MD +3.4, p = 0.032) and 12 months (MD +4.9, p < 0.001). Conclusions: This novel interbody cage demonstrated high fusion rates, significant pain and function improvements, and a favorable safety profile, warranting further comparative studies.

Study Design: Retrospective cohort study. Objective: This study presents an initial case series evaluating the safety, feasibility, and early recovery outcomes of biportal endoscopic posterior cervical foraminotomy (UBE-PCF) for single-level decompression. Summary of Background Data: While endoscopic approaches have gained traction in the lumbar spine, their application in the cervical spine remains limited. Biportal endoscopic cervical decompression may improve visualization and maneuverability while minimizing tissue disruption. Methods: A retrospective review was performed of the first 17 patients who underwent one-level UBE-PCF at a single academic institution (CPT 63045 or 63020, 2023–2025). Data included demographics, comorbidities, operative details, discharge disposition, and patient-reported outcome measures (PROMs: EQ. 5D, VAS, PROMIS Physical Function, PROMIS Pain Interference, PROMIS Depression). PROMs were compared pre-postoperatively and postoperatively using paired t tests and Wilcoxon signed-rank tests. Results: The cohort had a mean age of 50.3 years and a mean BMI of 28.5 (64.7% female). Most patients had a mild comorbidity burden (Charlson Comorbidity Index 0–2 in 76.5%; ASA II in 64.7%). Median operative time was 74 minutes (IQR: 66–83), and median length of stay was 0.46 days (IQR: 0.38–1.29), with most patients discharged the same day. Mean follow-up was 0.57 years. Postoperative PROMs showed improvement across all domains. PROMIS Pain Interference significantly decreased (pre-op 69.6±8.9 vs. post-op 60.2±9.3, P =0.041). Improvements were observed in PROMIS Physical Function (+4.1), EQ. 5D (+7.5), NDI (−13.4) and VAS pain (−0.55), though not statistically significant. PROMIS Depression trended downward (pre-op median 56.0 vs. post-op 52.0, P =0.17). Conclusion: This retrospective case series provides preliminary evidence supporting the feasibility of UBE-PCF for single-level cervical decompression. Patients experienced short operative times, minimal hospitalization, and encouraging early improvements in PROMs. These findings contribute early clinical data on UBE-PCF and support larger prospective comparative studies with longer follow-up to better define its role.