Correlation of Clinical and Radiological Outcome After Anterior Cervical Discectomy and Fusion With a Polyetheretherketone Cage

Abstract

BackgroundAnterior cervical discectomy and fusion (ACDF) with a polyetheretherketone (PEEK) cage is considered as the gold standard for patients with cervical disc disease. However, there are limited in vivo data on the impact of ACDF on the cervical kinematics and its association with patient-reported clinical outcomes. The purpose of this study was to investigate the impact of altered cervical sagittal alignment (cervical lordosis) and sagittal range of motion (ROM) on patients’ self-reported pain and functional disability, after ACDF with a PEEK cage.MethodsWe prospectively studied 74 patients, who underwent single-, or consecutive two-level ACDF with a PEEK interbody cage. The clinical outcomes were assessed by using the pain numeric rating scale (NRS) and the neck disability index (NDI). Radiological outcomes included cervical lordosis and C2-C7 sagittal ROM. The outcome measures were collected preoperatively, at the day of patients’ hospital discharge, and also at 6 and 12 months postoperatively.ResultsThere was a statistically significant reduction of the NRS and NDI scores postoperatively at each time point (P < 0.005). Cervical lordosis and also ROM significantly reduced until the last follow-up (P < 0.005). There was significant positive correlation between NRS and NDI preoperatively, as well as at 6 and 12 months postoperatively (P < 0.005). In regard to the ROM and the NDI scores, there was no correlation preoperatively (P = 0.199) or postoperatively (6 months, P = 0.322; 12 months, P = 0.476). Additionally, there was no preoperative (P = 0.134) or postoperative (6 months, P = 0.772; 12 months, P = 0.335) correlation between the NDI scores and cervical lordosis.ConclusionsIn our study, reduction of cervical lordosis and sagittal ROM did not appear to significantly influence on patients’ self-reported disability. Such findings further highlight the greater role of pain level over the mechanical limitations of ACDF with a PEEK cage on patients’ own perceived recovery.

Exploration on sagittal alignment and clinical outcomes after consecutive three-level hybrid surgery and anterior cervical discectomy and fusion: a minimum of a 5-year follow-up

“…Neurologic function and quality of life reflected by NDI and JOA of all patents were improved after surgeries and a further promotion at final follow-up, which was attributed to a better adaption of postoperative status, the further edema-elimination and a progressed repairment of nerve root as well as the regular functional training [7,27]. The key objective of either HS or ACDF surgery was to remove compression of spinal cord and neurological function recovery.…”

Clinical and radiological outcomes of a cervical cage with integrated fixation

“…Despite not being able to compare the data because of different measurement methods, other studies have also reported obvious improvements compared with the preoperative status. [35,38,39] The ACDF with anterior plating is also thought by many to hasten degenerative changes in adjacent segments, but it is open to debate as to whether incidence of adjacent segment degeneration is related to natural degeneration or increased biomechanical stress resulting from adjacent fusion. [21,35,40,41] While Bucci et al reported, in a study of 110 patients, 1 sub-surgery for adjacent segment (0.9%) [16], Hofstetter et al reported a rate of 5.7% [27], both using the present device.…”

Review of anterior cervical diskectomy/fusion (ACDF) using different polyetheretherketone (PEEK) cages

“…Seventeen studies focused on the safety/efficacy between different ACDF PEEK cage constructs with occasional comparisons to "routine" ACDF controls [Table 1]. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] 1]. [4] PEEK ACDF cages resulted in comparable fusion rates, the same increases in foraminal area, and similar outcomes vs. ACDF/IA.…”

“…eir various designs include; Stand Alone (SA) or Zero Profile (ZP) cages with/without screws, cages filled with demineralized bone matrix (DBM) and/or autograft, and PEEK cages coated with hydroxyapatite or titanium [Table 1]. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Here, we reviewed 17 papers comparing the relative safety/efficacy of different single to 3 and 4-level PEEK cage ACDF constructs, with select comparisons to "routine" ACDF controls (i.e. typically using iliac autograft or allograft, and plates).…”