Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone

Abstract

BackgroundIn an effort to avoid the morbidity associated with autogenous bone graft harvesting, cervical cages in combination with allograft bone are used to achieve fusion. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and interbody fusion (ACDF) using a PEEK anatomical cervical cage in the treatment of patients affected by single-level cervical degenerative disease.Methods and materialsTwenty-five patients affected by single-level cervical degenerative pathology between C4 and C7 were enrolled in this study. The clinical findings were assessed using the Neck Disability Index and the Visual Analog Scale. Surgical outcomes were rated according to Odom’s criteria at last follow-up. Fusion was graded as poor, average, good or excellent by assessing the radiographs. Cervical spine alignment was evaluated by sagittal segmental alignment and sagittal alignment of the whole cervical spine preoperatively, 6 months postoperatively and at the last follow-up.ResultsTwenty-five patients underwent ACDF using a PEEK anatomical cervical cage. All patients had a minimum 2 years of follow-up. The operative levels were C4–C5 in 5 patients, C5–C6 in 12 patients and C6–C7 in 8 patients. Preoperatively, average NDI was 34, 13 at 6 months, and 10 at latest follow-up. The mean preoperative VAS was 7; the mean postoperative VAS at latest follow-up was 3. Good or excellent fusion was achieved in all patients within 10 months (mean 5 months). Preoperatively, average sagittal segmental alignment (SSA) was 0.2° and average sagittal alignment of the cervical spine (SACS) 15.8°. Six months after surgery, average SSA was 1.8° and average SACS 20.9°, and at last follow-up, average SSA was 1.6° and average SACS 18.5°.ConclusionAnterior cervical discectomy and interbody fusion using PEEK anatomical cervical cages can be considered a safe and effective technique to cure cervical disc herniation with intractable pain or neural deficit in cases where conservative treatment failed.

A prospective clinical and radiographic 12-month outcome study of patients undergoing single-level anterior cervical discectomy and fusion for symptomatic cervical degenerative disc disease utilizing a novel viable allogeneic, cancellous, bone matrix (trinity evolution™) with a comparison to historical controls

“…This fusion rate, although not statistically evaluated, is comparable to that reported for single level ACDFs using standalone autografts (97 %) and other allografts (87 %) at 12 months per radiographic evidence [3]. In addition the results compare favorably to fusion rates for other single level ACDF studies using PEEK cages filled with hydroxyapatite (61 and 100 % at 6 and 12 months, respectively) [12], various allografts (100 % at 10-12 months, but not including higher risk patients) [13,14], and carbon fiber reinforced polymer (CFRP) packed with bone marrow-saturated collagen/hydroxyapatite wafers (100 % at 12 months) [20]. In addition, some of these studies [3,14] only used bridging bone as the fusion criteria thus potentially achieving more favorable fusion rates compared to a more stringent criteria.…”

“…When stratifying the 31 patients into high-risk groups it was found that the fusion rates ranging from 70 to 100 % at 6 months to 85-100 % at 12 months were still comparable to the literature where no high-risk patients were included, in particular at 12 months (92-100 %) [10,11,13,14,22]. Having a comparable fusion rates to other PEEK/allograft ACDF studies that have less stringent fusion criteria and do not include a majority of high risk patients indicates that Trinity Evolution may help negate any physiological barrier to fusion during ACDF that is associated with high risk factors.…”

“…In addition the results compare favorably to fusion rates for other single level ACDF studies using PEEK cages filled with hydroxyapatite (61 and 100 % at 6 and 12 months, respectively) [12], various allografts (100 % at 10-12 months, but not including higher risk patients) [13,14], and carbon fiber reinforced polymer (CFRP) packed with bone marrow-saturated collagen/hydroxyapatite wafers (100 % at 12 months) [20]. In addition, some of these studies [3,14] only used bridging bone as the fusion criteria thus potentially achieving more favorable fusion rates compared to a more stringent criteria. As evident by the many studies mentioned there remains an intense search for an autograft replacement which will encompass the three important autograft components, namely viable osteogenic cells, an osteoconductive matrix and osteoinductive growth factors.…”

“…PEEK cages for ACDF surgeries have the added advantages of increased cervical lordosis, immediate biomechanical support, increased intervertebral height and easy fusion assessment through X-ray and/or CT. In order to aid in fusion for high risk patients PEEK interbody devices are often combined with autografts, allografts or bone graft substitutes such as hydroxyapatite for single and multi-level ACDFs [12][13][14][15][16]. While there currently are a number of products on the market to minimize or replace the use of autografts for ACDFs, few of these products contain all three essential bone-forming elements of autografts (osteogenicity, osteoconductivity, and osteoinductivity [17]) in a single, standalone product.…”

Effect of spa therapy after intervertebral disc surgery in the cervical spine

“…In spite of that, about 20 % of patients are not completely satisfi ed with the postoperative overall results (11,12) because of persisting diffi culties.…”