Ask the Expert: Choosing a Spinal Implant for Spine Fusion Surgery

There is new, recent data concerning the type of material used in the spinal implants that are part of a spine fusion surgery. We caught up with Dr. Colle to discuss his first-hand experience.

See Elements of a Spine Fusion

ALIF (Anterior Lumbar Interbody Fusion) VideoWatch this video to understand the role of implants in fusion surgeries:
ALIF (Anterior Lumbar Interbody Fusion) Video

Q and A with Dr. Colle

Veritas Health: There are a variety of implant materials available for fusions today. You have stated that you use titanium implants only. Can you explain why this is?

See Maximize the Ability to Heal After Spine Fusion Surgery

See Postoperative Care for Spinal Fusion Surgery

Dr. Colle: It's been shown in multiple studies that a solid fusion never occurs with PEEK. The interface between titanium and bone causes a bony fusion between the titanium and bone. With PEEK, you get a fibrous union, but with titanium and new surface area, the bone actually interfaces with the titanium. Orthos are already using titanium because of this.

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Veritas Health: In a recent article in Becker Spine, you stated that using titanium implants for spinal fusion decreases the number of pseudarthrosis cases, which is when the fusion does not occur.1 Can you elaborate on your experience with this?

See Obtaining a Solid Spine Fusion

Dr. Colle: I have experienced fewer cases of pseudarthrosis with titanium implants. I believe it’s because of the interface between the bone and the titanium.

Veritas Health: What do you think about titanium implants compared to PEEK implants that are sprayed with titanium?

Dr. Colle: I think titanium implants are better, as they have a good bony interface. PEEK material is inflammatory to the area, while titanium is inert. PEEK is still a highly used product—people have had solid fusions with PEEK because of good preparation of the disc space, but it doesn't lead to a fusion between the PEEK implant and the bone. The fusion occurs because of the bone graft that’s in there.

Veritas Health: We get questions from people who have had failed back surgery. What can these patients do?

See Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery

Dr. Colle: Regardless of the type of implant that has been used in a fusion, the implant does not have to be removed, because they can work. You can have failed back surgery even with titanium, if it’s pseudarthrosis, the patient can be revised with titanium.

Veritas Health :Should patients actively request that their surgeons use titanium implants?

See Spinal Fusion Surgery Recovery: Three Months and After

Dr. Colle: Sure, they can ask—it’s a matter of being educated on it. You can look through the recent literature, but titanium is just showing better bone growth and fixation. European patients are using more and more titanium than they are PEEK. It’s used more in Europe than it is here.

Learn more:

Spine Fusion Risks and Complications

Posterior Lumbar Interbody Fusion (PLIF) Surgery


  1. Olivares-Navarrete, R., Hyzy, S.L., Slosar, P.J., Schneider, J.M., Schwartz, Z., and Boyan, B.D. (2015). Implant materials generate different peri-implant inflammatory factors: PEEK promotes fibrosis and micro-textured titanium promotes osteogenic factors. Spine, Volume 40, Issue 6, 399–404. Accessed May 4, 2015.
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