Anterior Cervical Discectomy and Fusion with Polyether ether Ketone Cage
Authors: Sayyahmelli S. , Alipanahi R. , Sayyahmelli S. 
Published: May 2014

Introduction

The use of polyether ether ketone (PEEK) cage prosthetic devices in anterior cervical discectomy with fusion (ACDF) has increased rapidly. The authors present preliminary outcomes data on the PEEK cage. This study is intended to provide adjunct data for surgeons who are using or are considering the use of these devices. Patients in a single institute were studied prospectively as part of a short-term assessment of outcomes. Data were collated and analyzed by an independent researcher.

Materials and Methods

PEEK cages were used in consecutive candidates ( n = 108) for ACDF. Success at 6 months after surgery was determined using the major patient-reported outcome measures, visual analog scales (VAS) for arm and neck pain. Perioperative complications and number of vertebral levels were also compared among the study. Fusion and subsidence were evaluated.

Results

A total of 137 cages were implanted in the 108 patients. At 6-month follow-up, 83% of patients reported successful arm pain relief (VAS scores below 5). Neck pain relief was in 81%. The outcomes were similar to published studies using other cages. All operated disks exhibited at least some degree of height loss. For this comparison, a Student t-test for independent variables was used, and there was a significant difference between preoperative and postoperative values ( p = 0.001). Mean VAS before treatment was 8.65 ± 1.22 and after treatment was 2.13 ± 1.07 ( p < 0.05).

Conclusion

As is the case for other allografts, artificial or bone, the main advantage is elimination of donor site complications, and the disadvantages include potential for cage subsidence. The high fusion rate, low subsidence, stability provided by the cage, and facilitation of radiological assessment are the result of the physical properties of the PEEK material as well as the design of the cage. Disclosure of Interest None declared References Moreland DB, Asch HL, Clabeaux DE, et al. Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft. Spine J 2004;4(2):184-191, discussion 191 Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 1995;20(9):1055–1060 Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 1955;96:223–224 Kulkarni AG, Hee HT, Wong HK. Solis cage (PEEK) for anterior cervical fusion: preliminary radiological results with emphasis on fusion and subsidence. Spine J 2007;7(2):205–209 van den Bent MJ, Oosting J, Wouda EJ, van Acker RE, Ansink BJ, Braakman R. Anterior cervical discectomy with or without fusion with acrylate. A randomized trial. Spine 1996;21(7):834-839, discussion 840 Gaudinez RF, English GM, Gebhard JS, Brugman JL, Donaldson DH, Brown CW. Esophageal perforations after anterior cervical surgery. J Spinal Disord 2000;13(1):77–84 Oda I, Cunningham BW, Buckley RA, et al. Does spinal kyphotic deformity influence the biomechanical characteristics of the adjacent motion segments? An in vivo animal model. Spine 1999;24(20):2139–2146 Moore R, Beredjiklian P, Rhoad R, et al. A comparison of the inflammatory potential of particulates derived from two composite materials. J Biomed Mater Res 1997;34(2):137–147 Song KJ, Choi BW, Kim GH, Song JH. Usefulness of polyetheretherketone (PEEK) cage with plate augmentation for anterior arthrodesis in traumatic cervical spine injury. Spine J 2010;10(1):50–57 Mastronardi L, Ducati A, Ferrante L. Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir (Wien) 2006;148(3):307-312, discussion 312 Kandziora F, Schollmeier G, Scholz M, et al. Influence of cage design on interbody fusion in a sheep cervical spine model. J Neurosurg 2002;96(3, Suppl)321–332 Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A. A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine 2002;27(16):1694–1701 Byval'tsev VA, Sorokovikov VA, Kalinin AA, Belykh EG. [Analysis of anterior cervical spondylodesis using plate cage PCB Evolution for a 2 year period]. Vopr Neirokhir 2013;77(1):37-45, discussion 45 Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S. Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 2012;13:172 Miller LE, Block JE. Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery. Spine 2011;36(24):2045–2050 Angevine PD, Zivin JG, McCormick PC. Cost-effectiveness of single-level anterior cervical discectomy and fusion for cervical spondylosis. Spine 2005;30(17):1989–1997 Park HW, Lee JK, Moon SJ, Seo SK, Lee JH, Kim SH. The efficacy of the synthetic interbody cage and Grafton for anterior cervical fusion. Spine 2009;34(17):E591–E595 Lotfinia I, Sayyahmelli S, Gavam M. Efficacy of anterior cervical discectomy and fusion on adjacent disc height. Neurosurgery Quarterly 2011;21(2):137–142 Wu WJ, Jiang LS, Liang Y, Dai LY. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study. Eur Spine J 2012;21(7):1374–1382