Results of the Use of Peek Cages in the Treatment of Basilar Invagination by Goel Technique

Abstract

Objective: Analysis of the use of polyetheretherketone (PEEK) cages for atlantoaxial facet realignment and distraction for treatment of basilar invagination by Goel technique. Method: Retrospective descriptive statistical analysis of the neurological status, pain, presence of subsidence and bone fusion with the use of PEEK cages in 8 atlantoaxial joints of 4 patients with basilar invagination. All patients were treated with atlantoaxial facet distraction and realignment and subsequent arthrodesis C1-C2 by the technique of Goel modified by the use of PEEK cage. Results: All patients showed improvement in Nurick neurological assessment scale and Visual Analogue Scale (VAS) of pain. There were no cases of subsidence, migration, or damage to the vertebral artery during the insertion of the cage. All joints evolved with bone fusion, assessed by dynamic radiographs, and computed tomography. Two patients developed neuropathic pain in dermatome of C2 and one patient had unilateral vertebral artery injury during C2 instrumentation treated with insertion of pedicle screw to control the bleeding. Conclusion: The results of the treatment of basilar invagination by the Goel technique with the use of PEEK cages shown to be effective and safe although further studies are needed to confirm this use.Keywords: Platybasia; Skull base; Atlanto-axial joint. RESUMO

A novel classification and algorithmic-based management of craniovertebral junction osteoarthrosis

“…These PEEK cages provide good distraction, less subsidence, increased fusion rate, and better visualization on radiological exams. [ 8 9 ] Occasionally, it is not possible to place PEEK due to the lack of availability in smaller sizes, in those circumstances, we either use customized titanium mesh (around 2.5 mm in height) or autologous bone graft to fill the facet joint. A previous study[ 19 ] has shown that a cage of 2.5 mm in height used in subaxial spine stabilization with good biomechanical outcomes, and we chose the same height while customizing titanium mesh for C1–C2 facet distraction.…”

“…Therefore, if it is not possible to open and manipulate the C1–C2 facet joint enough to insert the PEEK cage, we use customized titanium mesh cage or autologous bone graft to fill the joint. [ 8 9 10 ]…”

Three-dimensional biomodel use in the surgical management of basilar invagination with congenital cervical scoliosis; correction by unilateral C1-C2 facet distraction

“…On the left side, joint-jamming was achieved using osteotomes and then turning 90° inside, in order to introduce a PEEK cage of 5 mm × 11 mm × 14 mm with autologous bone graft. [ 13 14 15 ] During these steps, the biomodel was very useful to identify the anatomical structures [ Figure 4 ]. On this same (left) side, we placed a screw in the lateral mass of the atlas and another one translaminar with Wright technique in C2.…”

Rheumatoid Arthritis of the Craniovertebral Junction: Surgical Strategies, Current Approach and Proposal of a New Therapeutic Algorithm

“…By modifying the technique, we now came to use titanium materials for both lateral mass screws in C1 and pedicular screws in C2, as well as titanium mesh spacers, which provide a better radiologic control of soft parts through NMR [26]. Most recently, aiming to avoid subsidence due to the use of titanium mesh spacers and a better control of osseointegration, we've been using Polyetheretherketone (PEEK) cages in this technique, with consolidation rates in 100 percent of patients and absence of subsidence [27]. Figure 2 and Figure 3 illustrate the case of a patient with RA and basilar invagination associated to subluxation in C4-C5 and subaxial myelopathy.…”