Titanium-coated PEEK implants: Centinel Spine’s Ti-ACTIVE Advantage


Centinel Spine’s STALIF C and MIDLINE II now include Ti-ACTIVE, a texturized commercially pure titanium coating. Ti-ACTIVE enhances the PEEK implants by providing an integrated microporous titanium surface designed to increase the coefficient of friction for enhanced insertion stability and enable cellular attachment and proliferation to maximize opportunities for fusion.

Jessica Shellock, MD, of Texas Back Institute in Plano, TX, has used Ti-ACTIVE products since they were commercialized. She made the switch from traditional PEEK to Centinel Spine’s Ti-ACTIVE implants and has seen a clinical difference.


“I had been using traditional PEEK for a couple of years and one of the issues with PEEK was that you don’t have a great friction fit. There can be issues where the endplate can’t achieve cohesion,” Dr. Shellock said. “I can say for a fact that having implanted many Ti-ACTIVE devices, I feel much more confident about the fit and original rigidity,” says Dr. Shellock. “And one of the advantages after inserting the device is being able to visualize the edges of the implant radiographically. You are able to see through the device because PEEK is radiolucent. It’s nice to have the advantage of the PEEK to assess the fusion in clinic radiographically but still have the advantage of the titanium coating.”


Built on over 15 years of science and experience, Centinel Spine engineered their Ti-ACTIVE technology to merge the translucent and biomechanical advantages of PEEK with the hydrophilic and cell friendly properties of titanium. Ti-ACTIVE devices are 20 times rougher than uncoated PEEK devices, and the 3D topography increases the surface area in contact with the bony endplates, maximizing the potential for fusion.


“There is good evidence now that PEEK isn’t the end-all-be-all we thought it was 10 to 15 years ago. PEEK has a few properties that are beneficial in the space, but the titanium coating offers texturized properties to make the procedure more effective. I’ve also found it’s quicker in the OR for one- and two-level patients,” says John Ziewacz, MD, of Carolina Neurosurgery & Spine in Charlotte, N.C. “I do all my operations that way.”


Retrospective studies show clinically favorable outcomes for hip stems with plasma spray titanium coatings that result in excellent bony on-growth and long-term stability. Recent literature shows that 100% titanium interbody cages have more cellular attachment and proliferation properties than traditional PEEK cages. However, all-titanium cages have a higher modulus of elasticity and an increased risk of subsidence.


“When titanium is added to the PEEK implant it makes the implant conducive for cells to adhere and proliferate,” says Celeste Abjornson, PhD, project coordinator with the Integrated Spine Research Programs at Hospital for Special Surgery in New York City (HSS). The scientists at HSS recently published a paper examining the different roughness profiles of titanium coatings. When the titanium coating achieves the right roughness, the cells are able to express different growth factors and proteins.


Ti-ACTIVE technology has been shown in peer-reviewed published cellular studies to facilitate mesenchymal stem cell adhesion and proliferation, as observed on representative STALIF coupons with Ti-ACTIVE coating.1,2 This cellular attachment and proliferation increases the opportunity for fusion.


“The science is there with quite a few papers published,” says Dr. Abjornson. “There is research in the hip and knee setting, and now in spine we are putting Ti-coating on the plastic implants.”


Centinel Spine’s STALIF is a No-Profile Integrated Interbody technology that utilizes compressive lag fixation to ensure biomechanical stability and provide secure graft-endplate contact.


“What differentiates STALIF with Ti-ACTIVE from other technology is that this is a proven technology with the plasma spray,” says Dr. Abjornson. “This has been used in spine for almost 20 years and is an excellent method and technology for sustainable and durable outcomes.”


1) Yoon BJV, Xavier F, Walker BR, Grinberg S, Cammisa FP, Abjornson C. Optimizing surface characteristics for cell adhesion and proliferation on titanium plasma spray coatings on polyetheretherketone. Spine J., May 2016: http://dx.doi.org/10.1016/j.spinee.2016.05.017
2) Yoon BJV, Cammisa FP, Abjornson C. Polishing methods less a factor in cell adhesion than surface characteristics of titanium plasma spray coatings on PEEK. Paper presented at Lumbar Spine Research Society Meeting, 2015 April, Chicago, IL.


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This article is sponsored by Centinel Spine.


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