Bioactive Glass in ACDF: Can It Match Traditional Materials?

Anterior cervical discectomy and fusion (ACDF) is widely used to treat cervical spine pathology and restore stability after neural decompression. But successful fusion depends on more than the surgical technique alone. The interbody material must provide structural support while creating an environment that allows bone to form and the segment to fuse.

Traditional materials such as allograft and polyetheretherketone (PEEK) have well-established roles in ACDF, but each has limitations. Allograft can be associated with graft rejection, mechanical failure, and disease transmission, while PEEK does not directly bond with bone and may require additional bone graft material. These considerations have driven interest in materials that combine mechanical support with biological activity.

Bioactive glass (BG) is one such material. Its osteoconductive and bioactive properties have made it an area of growing interest in spinal fusion. The clinical question is straightforward: can bioactive glass provide outcomes comparable to established interbody materials in ACDF?

What This Systematic Review Evaluated

A systematic review published in the International Journal of Spine Surgery examined the comparative evidence for BG cages in ACDF. The review included 9 studies involving 542 patients: 235 treated with BG and 307 with traditional materials, including allograft and PEEK. The evidence included two randomized controlled trials and seven cohort studies, with follow-up ranging from 6 weeks to approximately 89 months. The investigators evaluated neck and upper-extremity pain, Neck Disability Index (NDI), and CT-confirmed fusion.

What the Evidence Suggests

Across the outcomes evaluated, bioactive glass performed comparably to conventional materials.

Patients treated with BG experienced similar improvements in neck and upper-extremity pain, with no statistically significant differences between groups. Functional outcomes followed the same pattern, with comparable NDI improvement and postoperative NDI scores.

The radiographic findings were consistent with the clinical outcomes. CT-confirmed fusion rates ranged from 75% to 97.8% with BG and 70.4% to 100% with traditional materials, with no statistically significant difference between groups.

Taken together, the findings suggest that bioactive glass can achieve the clinical and radiographic outcomes expected from established interbody materials. The review did not identify a compromise in pain relief, functional recovery, or fusion associated with the use of BG.

These findings support bioactive glass as a viable alternative interbody material for ACDF, providing clinical evidence alongside the biological rationale for its use.

Where Does the Evidence Go from Here?

The available comparative evidence provides a strong foundation for evaluating bioactive glass in ACDF. Across nine studies, the findings demonstrated clinical and radiographic outcomes comparable to traditional interbody materials, while future research can build on these results and further define its role in spinal fusion. Surgical techniques, follow-up duration, imaging protocols, and the specific types of bioactive glass also varied across studies.

These limitations create an opportunity for the next generation of research to build on what is already known. Larger studies, longer follow-up, and more standardized comparisons can help determine whether the biological characteristics of BG translate into additional clinical advantages across different patients and fusion settings.

For now, this review provides an important clinical reference point: bioactive glass can achieve outcomes comparable to traditional interbody materials in ACDF. Rather than changing the fundamental goals of fusion, BG offers another material approach for achieving them.

As research continues, the value of bioactive glass may be understood not simply by how it compares with established materials, but by how its biological properties can contribute to the next generation of spinal fusion strategies. 

Frequently Asked Questions

1. Why is bioactive glass being investigated for ACDF?

• Bioactive glass combines structural support with osteoconductive and bioactive properties, making it an alternative to conventional interbody materials.

2. Did bioactive glass produce better outcomes than traditional materials?

• BG demonstrated outcomes comparable to traditional materials.

3. Does this study support bioactive glass as an alternative to PEEK or allograft?

• Yes. The findings support BG as a viable alternative, while the limited number of available studies highlights the need for additional research to further establish its role and potential long-term benefits.

Reference

1. Kim G, Eskandar T, Lin R, Chung J, Dunn E, Mo K, et al. Systematic Review of Bioactive Glass Cages in Anterior Cervical Discectomy and Fusion. Int J Spine Surg. 2026.