Effectiveness of a Fully Impregnated Hydroxyapatite Polyetheretherketone Cage on Fusion in Anterior Cervical Spine Surgery

Chin, Kingsley R.; Gohel, Nishant; Aloise, Daniel M.; Seale, Jason; Pandey, Deepak; Pencle, Fabio

doi:10.7759/cureus.17457

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…Chin et al [120] have evaluated the intervertebral cage composed of 80% PEEK and 20% calcium hydroxyapatite in ACDF, as shown in Table 1. In VAS and NDI scores, they have observed significant improvement in the HAp PEEK group.…”

Section: Hydroxyapatite/peek Cagesmentioning

confidence: 99%

“…Therefore, HAp PEEK cages can be effectively and safely used in ACDF with better outcomes in comparison to the PEEK cages alone. [93,113,115] difficulty in radiographic assessment, stress shielding effect [93,113] PEEK Cage Polyetheretherketone 88-100% [94] 7-8 months [120] From 9.8% to 14.3% [115] lack of osteointegration of the cage, difficulty in radiographic assessment [94] Hydroxyapatite cages nHA/PA66 Cage Nanohydroxyapatite infiltrating into polyamide 66 97%-98% [113,115,118] -From 2 to 10.6% [38,113,[115][116][117][118] difficult radiographic assessment of solid fusion, but easier compared with TMC [113] Hydroxyapatite/ PEEK Cage Composite of 80% PEEK and 20% calcium hydroxyapatite ~100% [120] 3-5 months [120] lack of clinical studies, difficulty in radiographic assessment…”

Section: Hydroxyapatite/peek Cagesmentioning

confidence: 99%

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Hydroxyapatite Use in Spine Surgery—Molecular and Clinical Aspect

et al. 2022

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Hydroxyapatite possesses desirable properties as a scaffold in tissue engineering: it is biocompatible at a site of implantation, and it is degradable to non-toxic products. Moreover, its porosity enables infiltration of cells, nutrients and waste products. The outcome of hydroxyapatite implantation highly depends on the extent of the host immune response. Authors emphasise major roles of the chemical, morphological and physical properties of the surface of biomaterial used. A number of techniques have been applied to transform the theoretical osteoconductive features of HAp into spinal fusion systems—from integration of HAp with autograft to synthetic intervertebral implants. The most popular uses of HAp in spine surgery include implants (ACDF), bone grafts in posterolateral lumbar fusion and transpedicular screws coating. In the past, autologous bone graft has been used as an intervertebral cage in ACDF. Due to the morbidity related to autograft harvesting from the iliac bone, a synthetic cage with osteoconductive material such as hydroxyapatite seems to be a good alternative. Regarding posterolateral lumbar fusion, it requires the graft to induce new bone growth and reinforce fusion between the vertebrae. Hydroxyapatite formulations have shown good results in that field. Moreover, the HAp coating has proven to be an efficient method of increasing screw fixation strength. It can decrease the risk of complications such as screw loosening after pedicle screw fixation in osteoporotic patients. The purpose of this literature review is to describe in vivo reaction to HAp implants and to summarise its current application in spine surgery.

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Section: Hydroxyapatite/peek Cagesmentioning

confidence: 99%

Section: Hydroxyapatite/peek Cagesmentioning

confidence: 99%

Hydroxyapatite Use in Spine Surgery—Molecular and Clinical Aspect

et al. 2022

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“…Several 1-level PEEK ACDF studies showed good/excellent postoperative results with high fusion rates [ Table 1 ]. [ 3 , 5 ] Faldini et al . (2011) looked at 25 patients undergoing 1-level PEEK ACDF with a 2-year follow-up; there was nearly a 100% fusion rate at 5 postoperative months leading the authors to conclude that single-level PEEK ACDF constructs were safe and effective.…”

Section: Introductionmentioning

confidence: 99%

“…improvement) with the addition of HA at 2 postoperative years. [ 3 ] There was also a “trend” toward faster fusion with HA PEEK ACDF cages (i.e. as early as 3-5 postoperative months) vs. slower fusion rates (i.e.…”

Section: Introductionmentioning

confidence: 99%

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

Epstein¹,

Agulnick

2022

Surgical Neurology International

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Background: Multiple anterior cervical diskectomy/fusion (ACDF) techniques now use a variety of Polyehteretherketone (PEEK) cages; stand-alone (SA) and zero-profile (ZP) with/without screws, cages filled with demineralized bone matrix/autograft, and cages coated with hydroxyapatite or titanium. We compared the safety/ efficacy between different PEEK ACDF cage constructs in 17 studies, and in some cases, additionally contrasted results with “routine” ACDF (i.e. series/historical data performed with combinations of iliac autograft/allograft and plates). Methods: We focused on the clinical outcomes, fusion rates, postoperative radiographic changes/lordosis/ subsidence, and/or reoperation rates for various PEEK ACDF constructs vs. “routine” ACDF. Results: One to 3 and 4-level PEEK ACDF cages demonstrated high fusion rates, few cage failures, and low reoperation rates. Subsidence for PEEK ACDF cages did not reduce fusion rates or diminish the quality of postoperative outcomes. Further, titanium-coated (T-C) PEEK cages lowered fusion rates in one study (i.e. 44.1% fusions vs. 88.2% for routine PEEK ACDF) while ACDF PEEK cages coated with hydroxyapatite (HA) showed only a “trend” toward enhanced arthrodesis. Conclusion: One to 3-4 multilevel ACDF PEEK cage constructs demonstrated comparable safety/efficacy when compared with each other, or in select cases, with “routine” ACDF (i.e. using autograft/allograft and plates).

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