Biomechanical evaluation of single- and multi-level anterior cervical discectomy and fusion with polyetheretherketone cages: radiological and clinical outcomes

Abstract

Objective. The aim of this study was to analyse the outcomes of single-and multi-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages, with particular emphasis on the risk of secondary adjacent segment disease.Materials and methods. This retrospective study included 30 patients with single-or multi-level cervical disc herniation. Before the ACDF, and one year thereafter, the patients underwent clinical and radiological evaluation including determination of cervical pain severity with a numerical rating scale (NRS), and a survey with a Polish adaptation of the neck disability index questionnaire (NDI-PL). Biomechanical parameters of the cervical spine were determined using the Cobb method.Results. One year after ACDF, all patients had achieved complete fusions, and 97% showed a significant reduction of pain severity. Also, a significant decrease in all NDI-PL indices was observed. A significant decrease in overall cervical spine mobility coexisted with a significant increase in the mobility of the segment above the one operated upon and a non-significant decrease in the mobility of the segment below. No statistically significant change was found in the intervertebral disc space height (IVH) above and below the operated segment, and no evidence of degeneration within the segments adjacent to the operated one was documented. Conclusion.One-and two-level ACDF with standalone PEEK cages provided high fusion rates. Surgical spondylosis contributed to a reduction of spinal mobility despite the hypermobility in adjacent spinal segments. No degeneration in adjacent spinal segments was documented within a year of ACDF, and the treatment seemed to improve patients' quality of life.

Radiological and Clinical Outcomes after Anterior Cervical Discectomy and Fusion (ACDF) with an Innovative 3D Printed Cellular Titanium Cage Filled with Vertebral Bone Marrow

“…This 3-month fusion rate (which persists also in the 12-month follow-up) compares well to long-term fusion rates published in several international studies with different cage materials and structures and the additional use of autologous bone or bone substitutes [ 33 , 35 , 38 , 39 ].…”

“…The fusion rates of stand-alone PEEK cages range between 69 and 90% after 6 months or longer [ 24 , 33 – 35 ]. However, there is a great variability in the fusion rates as well as in the time span required for a complete and stable fusion [ 6 ].…”

Diagnostic value of diffusion tensor imaging in patients with clinical signs of cervical spondylotic myelopathy

“…On the one hand, we have physiotherapists, neurologists and anaesthetists involved in treatment at pain clinics who conduct non-surgical treatments such as physical therapy, immobilisation with orthotics, medications, and spinal injections. On the other hand, there are orthopaedic surgeons and neurosurgeons performing spinal decompression surgery with anterior or posterior stabilisation anteriorly or posteriorly [28,29]. Some studies have suggested that surgical treatment may be more advantageous than non-operative treatment [30,31].…”

“…Some studies have suggested that surgical treatment may be more advantageous than non-operative treatment [30,31]. Patients in this group have shown improvements in pain and functional status, whereas patients who were managed non-operatively were able to perform fewer activities of daily living and had progressive worsening of neurological symptoms [29]. Another study by Bond et al [32] showed that patients treated surgically for mild cervical myelopathy did not differ from those treated conservatively with respect to baseline radiographic and demographic parameters.…”

Preoperative paraspinal neck muscle characteristics predict early onset adjacent segment degeneration in anterior cervical fusion patients: A machine‐learning modeling analysis

“…Any deficits or dysfunction of these muscles may alter spinal biomechanics and heighten the risk of developing ASD early in the postoperative period 37 . Research has shown that ACDF increased the mobility of adjacent segment cephalic to the fused construct 38 . When some segments are fused, adjacent unfused segments need to increase mobility to compensate for the reduced range of motion, which may heighten the intradiscal pressure in adjacent discs and lead to development of ASD 39,40 .…”