Is stand alone PEEK cage the gold standard in multilevel anterior cervical discectomy and fusion (ACDF)? Results of a minimum 1-year follow up

This study was conducted to validate the safety and efficiency of biomimetic nanohydroxyapatite/polyamide 66 (n-HA/PA66) composite in animal model (rabbit) and report its application in anterior cervical discectomy and fusion (ACDF) for 4, 12, and 24 weeks. N-HA/PA66 composite was implanted into one-side hind femur defects and the control defects were kept empty as blank controls. A combination of macroscopic and histomorphometric studies was performed up to 24 weeks postoperatively and compared with normal healing. 60 cervical spondylosis myelopathy and radiculopathy patients who were subjected to ACDF using n-HA/PA66 and PEEK cage were involved in this study with six-month minimum follow-up. Their radiographic (cage subsidence, fusion status, and segmental sagittal alignment (SSA)) and clinical (VAS and JOA scales) data before surgery and at each follow-up were recorded and compared. Nanohydroxyapatite/polyamide 66 composite is safe and effective in animal experiment and ACDF.

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Evaluation of fusion in a PEEK cage after anterior cervical discectomy and fusion

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.221 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S49-S49

Author(s):

M Voisin ◽

F Saunders ◽

D Yen ◽

P Fenton

Keyword(s):

Bone Graft ◽

Anterior Cervical Discectomy ◽

High Rate ◽

Peek Cage ◽

Radiographic Evidence ◽

Cervical Discectomy ◽

Plain Films ◽

Graft Interface ◽

Intervertebral Cage

Anterior Cervical Discectomy and Fusion (ACDF) is the gold standard treatment for cervical spondylosis but there is a lack of consensus in the literature regarding which type of bone graft is superior: autograft or allograft. The purpose of this study is to evaluate fusion after ACDF using a stand-alone intervertebral cage packed with autologous cervical bone shavings acquired during the procedure. Twenty patients that underwent single-level ACDF from 2011 to 2014 using a stand-alone polyetheretherketone (PEEK) cage were recruited. Patients were evaluated for evidence of bone fusion by plain films and CT scan. Fusion was primarily assessed by grading the level of trabecular bridging bone across the bone-graft interface. Odom’s criteria were used to assess clinical outcome. All interbody disc spaces achieved successful fusion at follow-up. A total of 80% (16/20) of patients had radiographic evidence of trabecular bone present both within and around the cage. The other 20% exhibited bridging bone within the cage but had evidence of minor radiolucent gaps and lack of bridging bone completely surrounding the cage. Eighty percent of patients reported excellent/good clinical outcomes. ACDF using a PEEK stand-alone cage with autograft bone shavings has a high rate of fusion and avoids potential complications of classic autograft harvesting and decreased allograft fusion rates.

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A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up

European Spine Journal ◽

10.1007/s00586-016-4391-x ◽

2016 ◽

Vol 25 (7) ◽

pp. 2255-2262 ◽

Cited By ~ 25

Author(s):

Yuqiao Chen ◽

Guohua Lü ◽

Bing Wang ◽

Lei Li ◽

Lei Kuang

Keyword(s):

Retrospective Study ◽

Anterior Cervical Discectomy ◽

Peek Cage ◽

Cervical Discectomy

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PEEK Cages versus PMMA Spacers in Anterior Cervical Discectomy: Comparison of Fusion, Subsidence, Sagittal Alignment, and Clinical Outcome with a Minimum 1-Year Follow-Up

The Scientific World JOURNAL ◽

10.1155/2014/398396 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 13

Author(s):

Jan-Helge Klingler ◽

Marie T. Krüger ◽

Ronen Sircar ◽

Evangelos Kogias ◽

Christoph Scholz ◽

...

Keyword(s):

Clinical Outcome ◽

Sagittal Alignment ◽

Anterior Cervical Discectomy ◽

Ct Scans ◽

Peek Cage ◽

Disc Disease ◽

Cervical Discectomy ◽

Bony Fusion ◽

Sf 36

Purpose. To compare radiographic and clinical outcomes after anterior cervical discectomy in patients with cervical degenerative disc disease using PEEK cages or PMMA spacers with a minimum 1-year follow-up.Methods. Anterior cervical discectomy was performed in 107 patients in one or two levels using empty PEEK cages (51 levels), Sulcem PMMA spacers (49 levels) or Palacos PMMA spacers (41 levels) between January, 2005 and February, 2009. Bony fusion, subsidence, and sagittal alignment were retrospectively assessed in CT scans and radiographs at follow-up. Clinical outcome was measured using the VAS, NDI, and SF-36.Results. Bony fusion was assessed in 65% (PEEK cage), 57% (Sulcem), and 46% (Palacos) after a mean follow-up of 2.5 years. Mean subsidence was 2.3–2.6 mm without significant differences between the groups. The most pronounced loss of lordosis was found in PEEK cages (−4.1°). VAS was 3.1 (PEEK cage), 3.6 (Sulcem), and 2.7 (Palacos) without significant differences. Functional outcome in the PEEK cage and Palacos group was superior to the Sulcem group.Conclusions. The substitute groups showed differing fusion rates. Clinical outcome, however, appears to be generally not correlated with fusion status or subsidence. We could not specify a superior disc substitute for anterior cervical discectomy. This trial is registered withDRKS00003591.

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Outcome of Anterior Cervical Discectomy with PEEK Cage Fixation for Single Level Cervical Disc Disease

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v24i2.397 ◽

2020 ◽

Vol 24 (2) ◽

pp. 138-142

Author(s):

SAJID KHAN ◽

AKRAM ULLAH ◽

MUSAWER KHAN ◽

RAMZAN HUSSAIN ◽

MUMTAZ ALI

Keyword(s):

Radicular Pain ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Peek Cage ◽

Cervical Disc Disease ◽

Mri Findings ◽

Disc Disease ◽

Cervical Discectomy ◽

Prolapsed Disc

Objective: To assess the outcome of anterior cervical discectomy and fusion (ACDF) with PEEK cage. Material and Methods: This prospective study was conducted in the Departments of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar. Patients undergoing one level ACDF with PEEK cage fixation were enrolled in the study. Patients who needed multiple level ACDF or corpectomy with plating and redo cases were excluded from the study. A proforma, which included age, gender, address, level of prolapsed disc, sign and symptoms, pain score, MRI findings were filled. All patients were assessed on day of discharge and on follow-up visit after one month. Data was analyzed with SPSS version 22. Results: Total 95 patients were included out of which 58 (61%) were male and 37 (39%) were female. Range of patients` Age was from 27 years to 64 years with 50.4 years mean age. Most patients (65%) had C6 radiculopathy. 58 patients (61%) had right sided radicular pain. 5 patients (5.26%) had radiculomyelopathy. C5 – C6 was the most common level operated (68 patients). Excellent results were achieved in 75 patients (79%) while satisfactory results in the rest of patients using Odom’s criteria. Bony fusion occurred in 92% of patients at 6 months. Conclusion: ACDF with PEEK cage fixation is a safe and beneficial procedure in one level cervical prolapse disc disease

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A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

10.21203/rs.2.11416/v2 ◽

2019 ◽

Author(s):

ING HOW MOO ◽

Carmen Jia Wen Kam ◽

Maksim Wen Sheng Lai ◽

William Yeo ◽

Reuben Chee Cheong Soh

Keyword(s):

Neck Pain ◽

Clinical Outcomes ◽

Plate Fixation ◽

Neck Disability Index ◽

Anterior Cervical Discectomy ◽

Peek Cage ◽

Cervical Discectomy ◽

Structural Allograft ◽

Cage Subsidence

Abstract Background: Allografts and polyetheretherketone (PEEK) cages are the two most commonly used material in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in in two-level ACDF remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

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A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

10.21203/rs.2.11416/v1 ◽

2019 ◽

Author(s):

ING HOW MOO ◽

Carmen Jia Wen Kam ◽

Maksim Wen Sheng Lai ◽

William Yeo ◽

Reuben Chee Cheong Soh

Keyword(s):

Neck Pain ◽

Clinical Outcomes ◽

Plate Fixation ◽

Neck Disability Index ◽

Anterior Cervical Discectomy ◽

Peek Cage ◽

Cervical Discectomy ◽

Structural Allograft ◽

Cage Subsidence

Abstract Background: The effectiveness of graft type in two-level anterior cervical discectomy and fusion (ACDF) with plate fixation remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level anterior cervical decompression and fusion (ACDF) with plate fixation using either a structural allograft or a polyetheretherketone (PEEK) cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

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A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

10.21203/rs.2.11416/v3 ◽

2020 ◽

Author(s):

ING HOW MOO ◽

Carmen Jia Wen Kam ◽

Maksim Wen Sheng Lai ◽

William Yeo ◽

Reuben Chee Cheong Soh

Keyword(s):

Neck Pain ◽

Clinical Outcomes ◽

Plate Fixation ◽

Neck Disability Index ◽

Anterior Cervical Discectomy ◽

Peek Cage ◽

Cervical Discectomy ◽

Structural Allograft ◽

Cage Subsidence

Abstract Background: Allografts and polyetheretherketone (PEEK) cages are the two most commonly used material in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in in two-level ACDF remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

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A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

10.21203/rs.2.11416/v5 ◽

2020 ◽

Author(s):

ING HOW MOO ◽

Carmen Jia Wen Kam ◽

Maksim Wen Sheng Lai ◽

William Yeo ◽

Reuben Chee Cheong Soh

Keyword(s):

Neck Pain ◽

Clinical Outcomes ◽

Plate Fixation ◽

Neck Disability Index ◽

Anterior Cervical Discectomy ◽

Peek Cage ◽

Cervical Discectomy ◽

Structural Allograft ◽

Cage Subsidence

Abstract Background: Allografts and polyetheretherketone (PEEK) cages are the two most commonly used material in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in in two-level ACDF remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

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