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

Kim, You-Sub; Park, Jae Young; Moon, Bong Ju; Kim, Sang-Deok; Lee, Jung-Kil

doi:10.1016/j.jocn.2017.10.022

Cited by 30 publications

(24 citation statements)

References 19 publications

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“…In humans, less than 2 to 3 mm of implant subsidence is considered minor. 34 The surgery was complicated in dog 2 due to the addition of keels to the implant and difficulty creating slots to accommodate them. The keels did not appear to reduce implant shift (►Fig.…”

Section: Discussionmentioning

confidence: 99%

Development of a Customized Interbody Fusion Device for Treatment of Canine Disc-Associated Cervical Spondylomyelopathy

Joffe

Parr

Tan

et al. 2019

Vet Comp Orthop Traumatol

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Objectives The main purpose of this study was to design, manufacture and implant a customized three-dimensional (3D) printed, intervertebral spacer to treat disc-associated cervical spondylomyelopathy (DACSM) in dogs. This study also used advanced imaging to assess implant movement, subsidence and interbody fusion. Animals Two client-owned dogs with DACSM. Method Customized interbody devices were designed and 3D printed in titanium alloy. The devices were implanted in dogs diagnosed with DACSM. The dogs were evaluated at time points 0, 2 and 6 months to determine clinical outcome, degree of interbody fusion, implant migration and subsidence. Results Progressive fusion was noted across the affected intervertebral space by 6 months. Implants mildly shifted cranially in the 2-month interim. There was no subsidence of the intervertebral device through the vertebral end plates in dog 1 and minimal in dog 2 (∼0.5 mm). Clinically, the neurological status improved in both dogs. Conclusions The customized interbody devices restored the intervertebral space and resulted in a degree of interbody fusion and resolution of clinical signs. Clinical Significance This report illustrates preliminary outcomes of DACSM treated with a customized, end plate conforming, intervertebral device. Collaboration between clinicians and engineers with advanced manufacturing technologies can provide a cutting-edge standard of care for patients suffering from DACSM.

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Section: Discussionmentioning

confidence: 99%

Development of a Customized Interbody Fusion Device for Treatment of Canine Disc-Associated Cervical Spondylomyelopathy

Joffe

Parr

Tan

et al. 2019

Vet Comp Orthop Traumatol

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“…The authors recommended against the use of empty PEEK cages in ACDF, and filling cages with bone graft was advocated. In two retrospective studies by Klingler et al [19] and Cabraja et al [21], and a case series by Kim et al [20], standalone cages had lower fusion of 65%, 81.3%, and 88.1% respectively. Furthermore, the subsidence rate ranged from 14.3 to 48.3% across these studies.…”

Section: Fusion and Subsidence Ratesmentioning

confidence: 94%

“…Cho et al [14] utilized radiographs to assess fusion without any further details on how fusion was objectively measured. Three studies determined fusion through evaluating motion on lateral cervical radiographs and bone bridging on computed tomography (CT) scan [20,23,30]. Zhou et al [15], Liao et al [16], and Klingler et al [19] evaluated fusion by using CT scans only.…”

Section: Introductionmentioning

confidence: 99%

“…Three studies defined subsidence as the radiographic change of at least 3 mm in the interbody space [13,17,24,25], whereas another two studies considered subsidence as a change of at least 2 mm in the interbody distance [21,22]. Kim et al [20] defined subsidence as a decrease of interbody height by more than 2.5 mm on lateral radiographs. Klingler et al [19] measured subsidence by comparing pre-and post-operative total segmental heights without a predefined threshold for subsidence.…”

Section: Introductionmentioning

confidence: 99%

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The outcomes of stand alone polyetheretherketone cages in anterior cervical discectomy and fusion

Ahmed

Dosari

Kuwari

et al. 2020

International Orthopaedics (SICOT)

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The procedure of anterior cervical discectomy and fusion is considered as the treatment of choice in degenerative disc disease, which material provides the best clinical and radiological fusion and other outcomes remains heavily debated. Materials that augment the process of fusion consist of bone grafting, titanium, polyetheretherketone (PEEK), or carbon cages. The application of PEEK cages has been recommended as it is radiolucent, and it has a modulus of elasticity that is similar to cortical bone. PEEK cages can be either filled with various materials or unfilled cages. Filled PEEK cages can include bone autografts, bone allografts, demineralized bone matrix, and other materials that facilitate fusion. This narrative review highlights that standalone filled PEEK cages were likely to have better radiological outcomes and satisfactory clinical outcomes for myelopathy when compared with standalone unfilled PEEK cages.

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“…Furthermore, they suggest this incomplete fusion may lead to reduced improvement in pain and possible disability. Finally, Kim et al retrospectively evaluated 68 patients who underwent two and three-level ACDF with PEEK packed with demineralized bone matrix [57]. At an average follow-up of 28 months, PEEK demonstrated 81% overall fusion rate, which is less than reported levels for both autograft and structural allograft.…”

Section: Figure 6 (A) Structural Interbody Spacer With Cancellous Bomentioning

confidence: 99%

Allograft Structural Interbody Spacers Compared to PEEK Cages in Cervical Fusion: Benchtop and Clinical Evidence

Carter¹,

Gianulis²,

Moore³

2021

Clinical Implementation of Bone Regeneration and Maintenance

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Cervical degenerative disc disease (CDDD) can lead to radiculopathy and myelopathy, resulting in pain, lack of function, and immobility. Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment modality for advanced CDDD. ACDF involves removal of the affected disc(s) followed by replacement with a bone or synthetic graft. Historically, autograft has been considered the gold standard for interbody fusion. However, it is often associated with limitations, including donor site morbidity and limited quality and supply, prompting surgeons to seek alternatives. Two of the most common alternatives are structural bone allografts and polyetheretherketone (PEEK) synthetic cages. Both, advantageously, have similar mechanical properties to autologous bone, with comparable elastic modulus values. However, a lack of osseointegration of PEEK cages has been reported both pre-clinically and clinically. Reported fusion rates assessed radiographically are higher with the use of structural bone allografts compared to PEEK cages, while having a lower incidence of pseudarthrosis. This book chapter will discuss in detail the pre-clinical and clinical performance of structural allografts in comparison to conventional PEEK cages.

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

Cited by 30 publications

References 19 publications

Development of a Customized Interbody Fusion Device for Treatment of Canine Disc-Associated Cervical Spondylomyelopathy

Development of a Customized Interbody Fusion Device for Treatment of Canine Disc-Associated Cervical Spondylomyelopathy

The outcomes of stand alone polyetheretherketone cages in anterior cervical discectomy and fusion

Allograft Structural Interbody Spacers Compared to PEEK Cages in Cervical Fusion: Benchtop and Clinical Evidence

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