J Korean Orthop Assoc.  2011 Oct;46(5):364-371.

Comparison According to Fusion Level in ACDF Using PEEK Cage Alone for Degenerative Cervical Disease

• Song KJ
• Lee KB
• Kim KB

Abstract

PURPOSE
This study examined the clinical efficacy of an anterior cervical discectomy and fusion (ACDF) with PEEK (polyetheretherketone) cage alone with regard to the clinical and radiological outcomes, as well as the risk factors for the cage subsidence.
MATERIALS AND METHODS
A total of 128 patients who underwent group A (1-level, n=48), group B (2-levels, n=57), group C (3-levels, n=23) ACDF using a PEEK cage alone were enrolled in this study. The fusion rate, segmental kyphosis were assessed by radiographs. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and Neck Disability Index (NDI). The risk factors for cage subsidence were analyzed according to the difference in incidence between the subsidence group and non-subsidence group.
RESULTS
Solid fusion was achieved in 93.8% (45/48), 71.9% (41/57) and 69.6% (15/23) of subjects in group A, B and C, respectively. Segmental kyphosis was observed in 22.9% (11/48), 43.9% (25/57) and 47.8% (11/23) of subjects in group A, B and C, respectively. The VAS scores changed from 7.79+/-1.01 in group A, 7.74+/-1.09 in group B, 7.91+/-0.79 in group C preoperatively to 4.23+/-1.29 in group A, 5.25+/-1.34 in group B and 5.35+/-1.07 in group C at the last follow up. In addition, the NDI was also improved at the last follow up. The VAS score and NDI at the last follow up were similar in the subsidence and non-subsidence group. The 3-level ACDF (p=0.05), osteoporosis (p=0.01), and old age (p=0.01) were the risk factors for cage subsidence.
CONCLUSION
Only 1 level ACDF with PEEK cage alone was similar in clinical and radiologic (solid fusion rate, local kyphosis) outcomes compared to ACDF with published other modalities. Old age, 3 fusion level, osteoporosis, and C6-7 fusion were risk factors for the cage subsidence with higher complication rates.

Keyword

anterior cervical discectomy and fusion; cage alone; cage subsidence

MeSH Terms

Diskectomy
Follow-Up Studies
Humans
Incidence
Ketones
Kyphosis
Neck
Osteoporosis
Polyethylene Glycols
Risk Factors
Ketones
Polyethylene Glycols

Figure

• 

  Figure 1 A 52-year-old male status post ACDF with PEEK (Solis) cage alone at C6-C7, (A) postoperative plain lateral radiograph; (B) plain lateral radiograph 1.5 months postsurgery showing bone bridging; (C) plain lateral radiograph 2 years postsurgery showing normal alignment, no collapse and good consolidation of bone graft in the cage; (D) coronal CT image at 2 years postsurgery showing bony bridging (connection) and definite consolidation of graft-bone in the cage; (E) sagittal CT image at 2 years postsurgery.

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  Figure 2 Mean lordotic angle of fusion segment.

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  Figure 3 A 47-year-old male status post ACDF with PEEK (Solis) cage alone at C4-C5, 5-6, 6-7, (A) postoperative plain lateral radiograph; (B) plain lateral radiograph 2 years postsurgery showing cage subsidence and no bony consolidation of bone graft in the cage; (C) coronal CT image at 2 years postsurgery and (D) sagittal CT image at 2 years postsurgery showing no bony bridging (connection) in the graft-bone, and a vacant space in the cage (no bony tissue).

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  Figure 4 The trend of VAS score at the different follow up period.

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  Figure 5 The trend of NDI at the different follow up period.

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