Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cages

Abstract

BackgroundTitanium (TTN) cages have a higher modulus of elasticity when compared with polyetheretherketone (PEEK) cages. This suggests that TTN-cages could show more frequent cage subsidence after anterior cervical discectomy and fusion (ACDF) and therefore might lead to a higher loss of correction. We compared the long term results of stand-alone PEEK- and TTN-cages in a comparable patient collective that was operated under identical operative settings.MethodsFrom 2002 to 2007 154 patients underwent single-level ACDF for degenerative disc disease (DDD). Clinical and radiological outcome were assessed in 86 eligible patients after a mean of 28.4 months. 44 patients received a TTN- and 42 patients a PEEK-cage.ResultsSolid arthrodesis was found in 93.2% of the TTN-group and 88.1% of the PEEK-group. Cage subsidence was observed in 20.5% of the TTN- and 14.3% of the PEEK-group. A significant segmental lordotic correction was achieved by both cage-types. Even though a loss of correction was found at the last follow-up in both groups, it did not reach the level of statistical significance. Statistical analysis of these results revealed no differences between the TTN- and PEEK-group.When assessed with the neck disability index (NDI), the visual analogue scale (VAS) of neck and arm pain and Odom’s criteria the clinical data showed no significant differences between the groups.ConclusionsClinical and radiological outcomes of ACDF with TTN- or PEEK-cages do not appear to be influenced by the chosen synthetic graft. The modulus of elasticity represents only one of many physical properties of a cage. Design, shape, size, surface architecture of a cage as well as bone density, endplate preparation and applied distraction during surgery need to be considered as further important factors.

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

“…They described how PEEK spacers reduce the stresses in the adjacent endplates as well as subsidence, and facilitate bony fusion. However, there are several studies on interbody fusion that have demonstrated contradictory results regarding the superiority of PEEK over titanium as the cage material 18,19) . PEEK cage teeth are reported to be less sharp than those of titanium cages 20) .…”

Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

“…Recently, two studies compared clinical and radiological results of titanium and PEEK cages, but discrepant results were reported [6,24]. Cabraja et al [6] concluded that there was no difference between titanium and PEEK cages in the treatment singlelevel cervical disc degenerative disorders.…”

“…Recently, two studies compared clinical and radiological results of titanium and PEEK cages, but discrepant results were reported [6,24]. Cabraja et al [6] concluded that there was no difference between titanium and PEEK cages in the treatment singlelevel cervical disc degenerative disorders. However, Niu et al [24] study showed the PEEK implants are superior in maintaining cervical interspace height and achieving radiographic fusion, but the rates of successful clinical outcomes were comparable between two groups in 1 and 2-level ACDF patients.…”

Anterior Cervical Discectomy and Fusion (ACDF) using StandAlone Polyetheretherketone (PEEK) Cage Packed with Local Autologous Bone Graft

“…Radiological evaluations involved preoperative& postoperative plain radiography & functional radiography 17 . It included the preoperative and postoperative measurement of Interbody height& Segmental angle and the occurrence of bone bridging anteriorly & posteriorly at operated segment during final follow up.…”