Multilevel cervical fusion without plates, screws or autogenous iliac crest bone graft

Demircan, Mehmet; Kutlay, Ahmet Murat; Çolak, Ahmėt; Kaya, Serdar; Tekin, Tamer; Kıbıcı, Kenan; Ungoren, Kaan

doi:10.1016/j.jocn.2006.02.026

Cited by 71 publications

(64 citation statements)

References 45 publications

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“…Notably, there is no study using a PEEK cage and plate augmentation in three-or four-level fusion. Demirkan et al [17] have reported a favourable fusion rate (90.5 %, 38/42 levels) in cases that used a PEEK cage only. In that study, there were three patients with non-fusion levels, all of whom underwent three-or four-level fusion surgery rather than one-or two-level fusion surgery.…”

Section: Discussionmentioning

confidence: 97%

“…Currently, cages made of polyetheretherketone (PEEK) are primarily used for anterior cervical fusions because it has biomechanical similarities to bone. PEEK is a semicrystalline polyaromatic, linear polymer that provides a good combination of strength, stiffness, toughness, and environmental resistance with biocompatible, nonabsorbable, and corrosion-resistant abilities [17,25,26]. In addition, the PEEK cage is radiolucent and does not produce radiographic artifacts, leading to easy evaluation of fusion status on radiographs and CT scans.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the PEEK cage is radiolucent and does not produce radiographic artifacts, leading to easy evaluation of fusion status on radiographs and CT scans. Cage-assisted ACDF has proven to be a safe and effective procedure for the treatment of degenerative cervical disc disease because of its theoretical ability to prevent graft collapse, with the potential advantage of indirect foraminal decompression by restoration and preservation of intervertebral height and lordosis [5,6,12,17,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are few reports on three-or four-level anterior cervical fusion using a PEEK cage. In addition, the use of an anterior cervical plate and cage has increased fusion rates whilst avoiding donor site morbidity in multilevel ACDF, but these results have not been consistently reproduced [16,17].…”

Section: Introductionmentioning

confidence: 99%

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Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

2012

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Introduction Three-or four-level anterior cervical discectomy and fusion with autograft and plate fixation have demonstrated relatively good fusion rates and outcomes, but donor site morbidity and the limitations of autograft harvest remain problematic. The purpose of this study is to assess the radiographic and clinical outcomes of three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Methods This retrospective review included 43 consecutive patients who underwent three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct (three level: 39 cases, four level: 4 cases). The fusion rate, time to fusion, Cobb angle and disc height were assessed radiographically. Clinical outcomes were evaluated with the VAS, NDI, and SF36 scores. Complications were also recorded. Results Solid fusion was achieved in all the patients, and mean time to fusion was 13.7 ± 5.1 weeks. The postoperative Cobb angle, lordotic angle, and disc height (5.6°, 10.5°a nd 3.15 mm, respectively) increased significantly compared to preoperative values (p = 0.038, p = 0.032, and p = 0.0004, respectively), and these improvements were maintained through final follow-up. The postoperative NDI (17.2), VAS (2.8), and SF36 (13.1) scores increased significantly compared to the preoperative scores (p = 0.026, p = 0.0007 and p = 0.041, respectively). Complications included three cases of respiratory difficulty, four cases of dysphagia and one case of hoarseness. There were no cases of donor site morbidity. Conclusions Three-or four-level anterior cervical discectomy and fusion with a PEEK cage, and plate construct provide good clinical and radiographic outcomes including high fusion rates, low complication rates, low donor site morbidity, and good maintenance of the lordotic angle and disc height in the treatment of multilevel cervical spondylosis.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

2012

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“…However, rigid anterior cervical plate fixation may shield the mechanical load that is very important for fusion. On the other hand, there are some complications associated with anterior cervical plating [6]. Moreover, the cost of additional plating would increase the burden of the patient.…”

Section: Discussionmentioning

confidence: 99%

Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study

et al. 2011

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Objective Clinical outcomes of the stand-alone cage have been encouraging when used in anterior cervical discectomy and fusion (ACDF), but concerns remain regarding its complications, especially cage subsidence. This retrospective study was undertaken to investigate the long-term radiological and clinical outcomes of the stand-alone titanium cage and to evaluate the incidence of cage subsidence in relation to the clinical outcome in the surgical treatment of degenerative cervical disc disease. Methods A total of 57 consecutive patients (68 levels) who underwent ACDF using a titanium box cage for the treatment of cervical radiculopathy and/or myelopathy were reviewed for the radiological and clinical outcomes. They were followed for at least 5 years. Radiographs were obtained before and after surgery, 3 months postoperatively, and at the final follow-up to determine the presence of fusion and cage subsidence. The Cobb angle of C2-C7 and the vertebral bodies adjacent to the treated disc were measured to evaluate the cervical sagittal alignment and local lordosis. The disc height was measured as well. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for cervical myelopathy, before and after surgery, and at the final follow-up.The recovery rate of JOA score was also calculated. The Visual Analogue Scale (VAS) score of neck and radicular pain were evaluated as well. The fusion rate was 95.6% (65/68) 3 months after surgery. ResultsSuccessful bone fusion was achieved in all patients at the final follow-up. Cage subsidence occurred in 13 cages (19.1%) at 3-month follow-up; however, there was no relation between fusion and cage subsidence. Cervical and local lordosis improved after surgery, with the improvement preserved at the final follow-up. The preoperative disc height of both subsidence and non-subsidence patients was similar; however, postoperative posterior disc height (PDH) of subsidence group was significantly greater than of non-subsidence group. Significant improvement of the JOA score was noted immediately after surgery and at the final follow-up. There was no significant difference of the recovery rate of JOA score between subsidence and non-subsidence groups. The recovery rate of JOA score was significantly related to the improvement of the C2-C7 Cobb angle. The VAS score regarding neck and radicular pain was significantly improved after surgery and at the final follow-up. There was no significant difference of the neck and radicular pain between both subsidence and non-subsidence groups. ConclusionsThe results suggest that the clinical and radiological outcomes of the stand-alone titanium box cage for the surgical treatment of one-or two-level degenerative cervical disc disease are satisfactory. Cage subsidence does not exert significant impact upon the long-term clinical outcome although it is common for the stand-alone cages. The cervical lordosis may be more important for the longterm clinical outcome than cage subsidence

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Formulated Demineralized Bone Grafts for Skeletal Applications

Boyce

2016

Biomechanics and Biomaterials in Orthopedics

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Multilevel cervical fusion without plates, screws or autogenous iliac crest bone graft

Cited by 71 publications

References 45 publications

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study

Formulated Demineralized Bone Grafts for Skeletal Applications

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