Anterior cervical discectomy and fusion solely with peek cages in multilevel cervical spondylotic radiculomyelopathy: single center clinical experience with 58 consecutive patients

Abstract

Aim of this study was to evaluate the efficacy and safety of fusion solely with polyetheretherketone (PEEK) cages without plates and autogenous bone graft to provide fusion in multilevel cervical spondylosis in selected cases. 58 patients with cervical discogenic disorders in 3-4 levels (38 and 20 patients respectively) underwent multilevel anterior cervical discectomy and fusion (ACDF) operations with PEEK cages for a total of 194 levels. Minimum follow up was 24 months (24-48) postoperatively. Outcome had been established in combination with the evaluation of cervical lordosis, fusion rates and neurological improvement that was assessed by Japanese Orthopedic Association (JOA) scoring system. They were assessed by radiographs, computerized tomography and magnetic resonance imaging studies. Clinical outcomes were based on the issues including length of hospital stay, blood loss, complication rates and functional outcomes. 38 patients underwent three-level, 20 patients underwent four-level operations. Fusion rate was 89.2%. Significant improvement in the JOA scores was recorded postoperatively, and Ishihara Curvature Index (ICI) was preserved. In the follow-up period, no cage migration was experienced and reoperation was not required except for one who later underwent corpectomy and anterior fusion. ACDF with the use of PEEK cages without plates proved to yield good clinical outcome and comfortable postoperative course for the patients with acceptable fusion rates.

Stand-Alone Anterior Cervical Decompression and Fusion in Three Levels with Peek Cages: A Possible Satisfactory Alternative

“…Simsek [23] underwent a prospective study in 58 patients operated in three or four levels. Radiologically pseudarthrosis appeared in 13 patients of whom none was operated again, and fusion rate was 89.2%.…”

Short-Term Outcomes and Clinical Features Analysis of Anterior Cervical Discectomy; Effect of Non-Instrumented Vs. Instrumented Fusion

“…The antero-cervical approach to treating these degenerative conditions is relatively new, particularly in tertiary care settings in developing countries such as Pakistan [7][8] . The primary purpose of accessing the anterior cervical segment is to open the spinal cord and remove a triggering cause, such as a disc or osteophyte [9][10] . There are two main procedures to decompress the anterior cervical bone: the Smith-Robinson technique and the Cloward technique 11 .…”

Long-Term Results of Multiple Anterior Cervical Discectomy with Cage Fusion Technique: Results of Multiple Centre Study

“…Cage subsidence is considered a major long-term complication after insertion of a cervical intervertebral cage [1], [2]. Another important complication is the occurrence of adjacent segment failure after fusion of intervertebral disc whether it is single fusion or multiple levels [3], [4], [5], [6].…”

“…The occurrence of complications such as cage subsidence and adjacent segment failure is related to the length of follow up as their increase in percentage is directly proportional to the length of the follow up [5], [9], [10], [11], [12].…”