Advantages and Disadvantages of the Use of Various Types of Interbody Implants in Cervical Spine Surgery. Critical Review of the Literature

Godlewski, Bartosz; Dominiak, Maciej

doi:10.5604/01.3001.0014.3457

Cited by 10 publications

(11 citation statements)

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“…The rate of subsidence is also influenced by implant size and the size of the adjacent endplates between which the implant is placed. Implant size should match the specific size of the adjacent endplates to reduce the risk of subsidence [1,3,21,25]. Smaller cages may be more prone to subsidence on account of the smaller area to distribute the acting forces, and the absence of support on harder bone found at the edges of vertebral endplates [1, 25-28, 29, 30].…”

Section: Discussionmentioning

confidence: 99%

Subsidence following cervical discectomy and implant-to-bone ratio

Godlewski

Bębenek

Dominiak

et al. 2022

BMC Musculoskelet Disord

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Background Implant subsidence is an undesirable effect after anterior cervical discectomy and fusion (ACDF). We investigated the relation between the rate of implant subsidence and the ratio of the implant surface area to the surface area of the adjacent bone. Methods We operated 170 disc spaces in a group of 104 patients. Two types of implants were used: 1) PEEK (polyetheretherketone) cages and 2) titanium-coated (TC) PEEK cages. Patients were randomised to receive a specific implant using a randomisation table. All implants had a surface area of 1.61 cm2. Based on computed tomography images, bone surface areas were calculated for vertebral bodies immediately adjacent to the interbody implants. The implant-to-bone surface ratio was then calculated for each disc space. Implant subsidence was assessed over 12 months of follow-up, and associations between implant subsidence, the type of implant, and the implant-to-bone surface ratio were investigated. Results Twelve months after the surgery, computed tomography was performed on 86 patients (144 disc spaces). Furthermore, in 166 disc spaces and 102 patients, conventional radiographs were obtained. Subsidence was observed in 21% of the examined intervertebral spaces, and it was more frequently associated with higher values of bone surface area and lower values of the implant-to-bone surface ratio. The type of implant (PEEK vs TC-PEEK cages) did not significantly influence the rate of implant subsidence. Conclusions Implant subsidence was significantly related to the value of a coefficient representing the ratio of the implant's surface area to the bone surface area of the adjacent vertebral bodies, with subsidence occurring significantly more rarely for coefficient values ≥ 0.37.

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Section: Discussionmentioning

confidence: 99%

Subsidence following cervical discectomy and implant-to-bone ratio

Godlewski

Bębenek

Dominiak

et al. 2022

BMC Musculoskelet Disord

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“…The use of polyetheretherketone (PEEK) material for spinal implants continues to increase, primarily due to its mechanical properties and lack of producing artifacts on imaging studies. 4,5 Though less extensive than cervical fusion cages, there has been investigation into the use of PEEK for cervical TDR. [6][7][8][9][10][11][12] Despite general optimism, there was concern about long-term degradation on articulating PEEK-on-PEEK surfaces.…”

Section: Introductionmentioning

confidence: 99%

“…However, this has been addressed in many implants by adding a textured porous coating, often titanium, a material with favorable osseointegrative properties. 5,13,14 A cervical TDR was designed with commercially pure, titaniumcoated PEEK endplates and a biconvex zirconiatoughened alumina ceramic core. This ceramic material has long been used in orthopedic applications, particularly hip implants.…”

Section: Introductionmentioning

confidence: 99%

Single-Level Cervical Disc Replacement Using a PEEK-on-Ceramic Implant: Results of a Multicenter FDA IDE Trial With 24-Month Follow-up

et al. 2021

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Background: Many early cervical total disc replacements (TDRs) produced motion through a ball-and-socket action, with metal endplates articulating with a plastic core. Polyetheretherketone (PEEK) is used increasingly for spinal implants due to its mechanical properties and lack of artifacts on imaging. A TDR was designed with titanium-coated PEEK endplates and a ceramic core. The purpose of this study was to compare this TDR with anterior cervical discectomy and fusion (ACDF) to treat single-level cervical disc degeneration.Methods: This was a prospective, nonrandomized, historically controlled, multicenter US Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trial. Patients received the PEEK-on-ceramic Simplify t Cervical Artificial Disc (n ¼ 150). The historic control group included 117 propensity-matched ACDF patients from an earlier IDE trial. The primary outcome was a composite success classification at the 24-month follow-up. Outcome measures included the Neck Disability Index (NDI), neurological status, adverse events, subsequent surgery, a visual analog scale assessing neck and arm pain, and the Dysphagia Handicap Index. Radiographic assessment included flexion/extension range of motion and heterotopic ossification. Facet joints were assessed at 24 months using MRI.Results: The success rate was significantly greater in the TDR group vs the ACDF group (93.0% vs 73.6%; P , .001). Mean NDI, neck pain, and arm pain scores improved significantly in both groups at all follow-up points. Mean NDI scores in the TDR group were significantly lower than ACDF scores at all follow-up points. There were no significant differences in the rates of serious adverse events. The range of motion of the TDR level had increased significantly by 3 months and remained so throughout follow-up. Facet joint assessment by MRI in the TDR group showed little change from preoperation.Conclusions: The TDR had an acceptable safety profile and a significantly greater composite success rate than ACDF. These results support that the PEEK-on-ceramic TDR is a viable alternative to ACDF for single-level symptomatic disc degeneration.Clinical Relevance: This study found that the PEEK-on-ceramic TDR is a viable treatment for symptoms related to cervical disc degeneration and offers similar or superior outcomes compared with fusion.

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“…Our current results contradict those conclusions. Although MRI scans can also be used to evaluate fusion, the magnetic susceptibility artefact makes this modality less reliable than CT scans [ 9 , 21 , 22 , 23 , 24 , 25 ]. In a previous article of ours, the presence of fusion was assessed according to our original method based on the combined interpretation of radiographs and CT scans [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion

Godlewski

Bębenek

Dominiak

et al. 2022

JCM

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Most surgical procedures performed on account of degenerative disease of the cervical spine involve a discectomy and interbody fixation. Bone fusion at the implant placement site is evaluated post-operatively. It is agreed that computed tomography is the best modality for assessing bone union. We evaluated the results obtained with various methods based solely on conventional radiographs in the same group of patients and compared them with results obtained using a method that is a combination of CT and conventional radiography, which we considered the most precise and a reference method. We operated on a total of 170 disc spaces in a group of 104 patients. Fusion was evaluated at 12 months after surgery with five different and popular classifications based on conventional radiographs and then compared with the reference method. Statistical analyses of test accuracy produced the following classification of fusion assessment methods with regard to the degree of consistency with the reference method, in descending order: (1) bone bridging is visible on the anterior and/or posterior edge of the operated disc space on a lateral radiograph; (2) change in the value of Cobb’s angle for a motion segment on flexion vs. extension radiographs (threshold for fusion vs. pseudoarthrosis is 2°); (3) change in the interspinous distance between process tips on flexion vs. extension radiographs (threshold of 2 mm); (4) change in the value of Cobb’s angle of a motion segment (threshold of 4°); (5) change in the interspinous distance between process bases on flexion vs. extension radiographs (threshold of 2 mm). When bone union is evaluated on the basis on radiographs, without CT evidence, we suggest using the “bone bridging” criterion as the most reliable commonly used approach to assessing bone union.

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Advantages and Disadvantages of the Use of Various Types of Interbody Implants in Cervical Spine Surgery. Critical Review of the Literature

Cited by 10 publications

References 0 publications

Subsidence following cervical discectomy and implant-to-bone ratio

Subsidence following cervical discectomy and implant-to-bone ratio

Single-Level Cervical Disc Replacement Using a PEEK-on-Ceramic Implant: Results of a Multicenter FDA IDE Trial With 24-Month Follow-up

Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion

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