ACDF with stand-alone PEEK cages results in shorter operative times than zero-p implantsPEEK Cages May Shorten Surgery Time for Cervical Neck Issues

Frontiers in Medicine Published September 4, 2026 DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that stand-alone PEEK cages are associated with shorter operative times but higher subsidence rates in ACDF.

This meta-analysis evaluates outcomes for patients with cervical degenerative disease undergoing anterior cervical discectomy and fusion (ACDF). The study compares the use of stand-alone PEEK cages (SA) against zero-p implants (ZP) across several clinical and radiographic metrics. The analysis included a total of 727 patients.

Key findings indicate that the SA group had significantly shorter operative times and significantly higher NDI scores compared to the ZP group. Conversely, the SA group showed significantly lower disc height, lower vertebral height, and a lower segmental Cobb angle. The SA group also demonstrated a significantly higher subsidence rate. No remarkable differences were found between the groups regarding fusion rate, VAS score, or C2-7 Cobb angle.

The authors note that the evidence is derived exclusively from observational studies, resulting in low to very low certainty. Due to these limitations, the findings should be interpreted with caution. While SA may be associated with shorter operative times, ZP may correlate with lower subsidence rates and better preservation of cervical alignment.

Researchers looked at data from 727 patients who underwent a specific type of neck surgery called anterior cervical discectomy and fusion. The study compared two types of implants: stand-alone PEEK cages and zero-p implants. The goal was to see how these different materials affected surgery time and physical outcomes for patients with cervical degenerative disease.

The results showed that patients who received the PEEK cage had significantly shorter operation times. However, the study also found that these patients had higher subsidence rates and lower disc and vertebral heights compared to those with the other implant. There were no significant differences found in fusion rates or pain scores between the two groups.

It is important to note that this information comes from observational studies, which means the evidence is of low to very low certainty. Because the data is limited, these findings show a link rather than a proven cause. Patients should discuss these specific implant options and their potential impacts on surgery time and spinal alignment with their surgeon.

What this means for you:

PEEK cages may shorten surgery time, but other implants may offer better preservation of spinal height.

Common questions

How does a PEEK cage affect surgery time?

The study of 727 patients found that using a stand-alone PEEK cage was associated with significantly shorter operative times compared to using a zero-p implant. This suggests the procedure may be faster for some patients, though the evidence is based on observational data with low certainty.

Are there differences in pain or fusion rates between these implants?

The study reported no remarkable differences in fusion rates or VAS scores, which measure pain, between the two types of implants. Both the PEEK cage and the zero-p implant performed similarly in these specific areas of recovery and surgical success.

What are the risks of using a PEEK cage?

The study found that patients with PEEK cages had significantly higher subsidence rates and lower disc and vertebral heights. Because the evidence is of low to very low certainty, you should talk to your doctor about how these factors might affect your specific case.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedSep 2026

View Original Abstract ↓

IntroductionIn recent years, stand-alone polyetheretherketone (PEEK) cages (SA) and Zero-P implants (ZP) have been widely adopted clinically in anterior cervical discectomy and fusion (ACDF) for cervical degenerative disease (CDD). However, which is superior between SA and ZP remains highly controversial. This meta-analysis was designed to conduct a head-to-head comparison of the safety, clinical efficacy, and radiological effectiveness of ACDF with ZP and SA.MethodsThis research was carried out in accordance with the PRISMA Statement. Systematic retrieval of eligible literature was completed covering three core electronic bibliographic databases: PubMed, Web of Science Core Collection, and Embase up to February 19, 2026. For dichotomous outcomes, including the fusion rate and subsidence rate, the effect sizes were calculated as the relative risk (RR) with corresponding 95% confidence intervals (CIs). For continuous outcomes, including surgical time, blood loss, disc height, vertebral height, C2-7 Cobb angle, segmental Cobb angle, VAS score, and NDI score, the effect sizes are expressed as the mean difference (MD) with 95% CIs.ResultsEight eligible studies comparing ACDF with SA and ZP for CDD treatment were ultimately included. The pooled patient cohort consisted of 727 participants in total, with 384 patients assigned to the SA group for ACDF and 343 patients allocated to the ZP group. Compared with the ZP, the SA had a significantly shorter operative time and higher NDI score. The segmental Cobb angle, disc height and vertebral height of the SA were significantly lower than those of the ZP. The SA group had a significantly higher subsidence rate than the ZP group, with no remarkable difference observed in the C2-7 Cobb angle, fusion rate, VAS score between the two cohorts.DiscussionCurrent pooled findings suggest that SA may be associated with shorter operative time, while ZP may correlate with lower subsidence rate and better preservation of cervical alignment. As all available evidence is derived exclusively from observational studies and rated as low to very low certainty, the conclusions must be interpreted with caution.Clinical Trial Registration:https://www.crd.york.ac.uk/PROSPERO/view/CRD420261325943, PROSPERO, CRD420261325943.

ACDF with stand-alone PEEK cages results in shorter operative times than zero-p implantsPEEK Cages May Shorten Surgery Time for Cervical Neck Issues

Common questions

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ACDF with stand-alone PEEK cages results in shorter operative times than zero-p implantsPEEK Cages May Shorten Surgery Time for Cervical Neck Issues

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