Comparison between Two Different Cervical Interbody Fusion Cages in One Level Stand-alone ACDF: Carbon Fiber Composite Frame Cage Versus Polyetheretherketone Cage

Abstract

ObjectiveThe authors conducted a retrospective study to compare the implantation of carbon fiber composite frame cages (CFCFCs) to the implantation of polyetheretherketone (PEEK) cages after anterior cervical discectomy for cervical degenerative disc disease. In addition, the predictive factors that influenced fusion or subsidence were investigated.MethodsA total of 58 patients with single-level degenerative disc disease were treated with anterior cervical discectomy and implantation of stand-alone cages; CFCFCs were used in 35 patients, and PEEK cages were used in 23 patients. Preoperative and postoperative radiological and clinical assessments were performed.ResultsDuring the mean follow-up period of 41 months, fusion occurred in 43 patients (74.1%), and subsidence developed in 18 patients (31.0%). Pain decreased in all patients, and the patients' satisfaction rate was 75.9%. Neither fusion nor subsidence was related to the clinical outcome. There were no significant differences in the clinical and radiological outcomes between the CFCFC and the PEEK cage groups. Smoking history (p=0.023) was significantly associated with pseudarthrosis, and cage height (≥7mm) (p=0.037) were significantly associated with subsidence.ConclusionThe clinical and radiological results were similar between the CFCFC and the PEEK cage groups. Fusion or subsidence did not affect the clinical outcomes. Smoking history and cage height (≥7mm) were predictive factors for pseudarthrosis or subsidence in anterior cervical discectomy and fusion with stand-alone cages.

Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: a systematic review

“…Clinical outcome was assessed in relation to subsidence in 13 studies [ 5 , 8 , 9 , 11 , 17 , 20 , 23 – 25 , 33 , 35 , 45 , 48 ]. Of these, 7 had a low risk of bias, 5 had an intermediate risk of bias, and 1 study had a high risk of bias.…”

“…The other 10 studies did not find a correlation between clinical outcome and the occurrence of subsidence. These studies generally used a larger variety of measures to evaluate clinical outcome and collected data prospectively in 4 studies [ 5 , 9 , 17 , 33 ], and retrospectively in 6 studies [ 8 , 11 , 24 , 35 , 45 , 48 ] (Table 3 ).…”

Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages

“…However, most of the results were carried short or intermediate term data below two-year of follow-up, or a few two-year follow-up data with small population. The main stream of the published data about results after ACDF with SAC included subsidence rate as below 30% to variable and fusion rate higher than 90% mostly without significant clinical relationship, therefore, the researchers suggested that the outcome of the stand-alone cage procedure was suitable 3 5 9 10 11 15 16 17 18 20 22 23) . We previously reported one-year radiologic and clinical outcomes of 3 different construct systems for single-level ACDF using SAC, iliac graft plus plate augmentation, and cage plus plating.…”

A radiographic follow-up study of stand-alone-cage and graft-plate constructs for single-level anterior cervical discectomy and fusion

“…In one report by Lee et al , subsidence was almost 14 times more likely in those with pre-operative kyphotic alignment than in those with lordosis (15). Increased level of distraction at the operated level was suggested to a risk factor for increased subsidence while similarly an increased graft size has also been linked to increased subsidence (13,16).…”