Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

Chen, Yu; Wang, Xinwei; Lü, Xiaoying; Yang, Lili; Yang, Haisong; Wen, Yan; Chen, Deyu

doi:10.1007/s00586-013-2772-y

Cited by 178 publications

(143 citation statements)

References 43 publications

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“…Subsidence was measured across the entire motion segment for both single and multilevel constructs and was defined as a loss of intervertebral height greater than 3 mm. 7 Prevertebral soft-tissue thickness was determined by measuring the thickness of soft tissue from the anterior aspect of C3-7 vertebral bodies to the posterior aspect of the trachea. 1,35,42 Magnification effects were corrected for by using the Zero-P implant as a standard reference.…”

Section: Radiological Evaluationmentioning

confidence: 99%

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Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Njoku

Alimi

Leng

et al. 2014

SPI

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Object Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia. Methods Using a surgical database, the authors conducted a retrospective analysis of all patients who had undergone ACDF between August 2008 and October 2011. All patients received a Zero-P implant (DePuy Synthes Spine). The Neck Disability Index (NDI) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, and subsidence were assessed as well. Results Twenty-two male and 19 female consecutive patients, with a mean age of 58.4 ± 14.68, underwent ACDF (66 total operated levels) in the defined study period. The mean clinical follow-up in 36 patients was 18.6 ± 9.93 months. Radiological outcome in 37 patients was assessed at a mean follow-up of 9.76 months (range 7.2–19.7 months). There were significant improvements in neck and arm VAS scores and the NDI following surgery. The neck VAS score improved from a median of 6 (range 0–10) to 0 (range 0–8; p < 0.001). The arm VAS score improved from a median of 2 (range 0–10) to 0 (range 0–7; p = 0.006). Immediate postoperative dysphagia was experienced by 58.4% of all patients. Complete resolution was demonstrated in 87.8% of affected patients at the latest follow-up. The overall median Bazaz score decreased from 1 (range 0–3) immediately postoperatively to 0 (range 0–2; p < 0.001) at the latest follow-up. Prevertebral soft-tissue thickness significantly decreased across all levels from a mean of 15.8 ± 4.38 mm to 10.1 ± 2.93 mm. Postoperative lordosis was maintained at the latest follow-up. Mean subsidence from the immediate postoperative to the latest follow-up was 4.1 ± 4.7 mm (p < 0.001). Radiographic fusion was achieved in 92.6% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score. Conclusions A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.

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Section: Radiological Evaluationmentioning

confidence: 99%

“…Our subsidence rate at an average follow-up of 10 months was 22.7%, which is within the range previously reported by other authors (Table 5). 7,9,20,44,45 …”

Section: Radiological Outcomementioning

confidence: 99%

Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Njoku

Alimi

Leng

et al. 2014

SPI

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“…[3,4] After removal of the intervertebral disc, either autologous bone or a cage -with or without anterior plate fixation (APF) -are current options for fusion. [5][6][7] For single-level ACDF the use of a cage or autologous bone, with or without APF, has shown comparable clinical and radiographic results, with a tendency for better radiographic outcome in patients with APF. [8,9] However, for more than 1-level ACDF there is currently no evidence in the literature suggesting superiority of one technique over any other, especially regarding the issue of whether APF is superior to the stand-alone technique.…”

Section: Introductionmentioning

confidence: 99%

The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion

et al. 2014

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PURPOSE We aimed to identify technique-related factors influencing radiographic and patientrated outcomes after two-level anterior cervical discectomy with fusion (ACDF) using either cage or autologous bone, with or without anterior plate fixation (APF). METHODS This single center study was nested within the Eurospine Spine Tango data acquisition system. INCLUSION CRITERIA consecutive two-level ACDF patients (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) presenting with signs of degenerative cervical radiculopathy or myelopathy. Before and 12 month postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI); at 12 months postoperatively they also rated the global treatment outcome (GTO) and their satisfaction with care. Cervical lordosis and segmental height were assessed radiographically preoperatively, immediately postoperatively, and at the last follow-up (LFU) (18.2 ± 13.3 months). RESULTS One hundred and forty-four consecutive patients (113 with APF) were included. The use of APF versus stand-alone methods was associated with significantly increased segmental height (by 2.6 ± 2.6 versus 1.5 ± 2.4 mm, p = 0.04) and preservation of lordosis (by 2.7 ± 4.4°versus -1.7 ± 5°, p < 0.0001) at LFU, with comparable clinical outcome (COMI score reduction 3.1-point). Multiple regression controlling for potential confounders revealed that APF (p = 0.0004) and cage (p = 0.001) were associated with greater segmental height at LFU; APF was associated with a greater lordosis angle at LFU (p < 0.0001). Greater increase in segmental height at LFU (p = 0.02) was associated with a better GTO. CONCLUSIONS Adding APF was associated with greater segmental height and preservation of lordosis in two-level ACDF, especially using bone autograft, but also for cage. Clinical outcome was comparable for all groups. Though the surgical technique per se did not determine clinical outcome, patients achieving a greater segmental height difference showed a significantly better GTO. Keywords:Two-level anterior cervical discectomy fusion (ACDF), anterior cervical plate, stand-alone, patient-rated outcome. 2 AbstractPurpose We aimed to identify technique-related factors influencing radiographic and patientrated outcomes after two-level anterior cervical discectomy with fusion (ACDF) using either cage or autologous bone, with or without anterior plate fixation (APF).

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“…In this study, the PEEK cages were not filled with bone graft. On the other hand, Chen et al, 6 in their study using PEEK cages filled with local bone graft in 31 patients (each with 3 levels disc pathology), reported 100% fusion rate after 7 years follow up.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that this method of treatment is an effective procedure for the treatment of multiple level cervical disc disease. Chen et al, 6 came to the conclusion that in surgical treatment of multilevel degenerative cervical myelopathy, PEEK cage is superior to titanium cage in maintenance of intervertebral height and cervical lordosis, resulting in better clinical outcomes in the long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Multi-level ACDF using standalone PEEK cages for the treatment of degenerative cervical myelopathy: Clinical and radiological assessment.

Allam

Al-Feki

2014

Egyptian Spine Journal

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Background Data: Degenerative cervical myelopathy is a complex neurologic disorder that usually develops insidiously, although abrupt deterioration in function can occur. The natural history of cervical myelopathy is highly variable, with some patients having progressive disability, whereas others have a mild course. The treatment of cervical myelopathy may be conservative or surgical, depending on the severity of symptoms at initial examination. Purpose: The aim of this work is to assess the clinical improvement as well as the bony fusion in patients with cervical myelopathy treated by multi-level ACDF using stand-alone PEEK cages. Study design: Clinical study Patients and Methods: The material of this study consisted of 20 patients with cervical myelopathy. The mean age was 52 years. 55% of the patients were males. The patients were assessed pre-operatively and post-operatively using the European Myelopathy Scoring (EMS). Fusion was assessed by X-ray at the end of follow up. Results: The mean operative time per level was 70 minutes. The mean blood loss was 150 ml. There were no intraoperative complications. The mean preoperative EMS was 8 points (6-11). At the end of follow up, the mean EMS improved to 14 points (11-18).The difference between the pre-operative and end follow up EMS was statistically significant (P < 0.001). 2 levels (3.3%) out of 60 showed x-ray evidence of pseudoarthrosis. Conclusions: Multi-level ACDF using stand-alone PEEK cages filled with local bone graft has many advantages in treating patients with degenerative cervical myelopathy. These include; minimal intraoperative and postoperative complications (including complications of anterior plating), avoidance of donor site morbidity, satisfactory clinical outcomes, and high fusion rate. (2014ESJ061)

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Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

Cited by 178 publications

References 43 publications

Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion

Multi-level ACDF using standalone PEEK cages for the treatment of degenerative cervical myelopathy: Clinical and radiological assessment.

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