Radiologic long-term results after cervical vertebral interbody fusion with Polymethyl Methacrylat (PMMA)

Abstract

Long-term results of cervical interbody fusion with PMMA were evaluated in a retrospective study. X-ray films of 83 patients were obtainable. Post-operative follow-up in this series was between 15 and 20 years. The results show that PMMA is engrafted after about 2 years. Stable vertebral interbody fusion is obtained in about 90% of cases. Development of malignoma was not observed. Resorptive bone alterations, which can be seen in about 2% of cases one to two years after operation are shown not to be progressive. This process heals and stable fusion develops.

Bone graft substitutes in anterior cervical discectomy and fusion

“…Hamburger et al investigated the clinical long-term significance of reduced osseous union in PMMA interbody fusions, and found 77.5% of 249 patients reported successful outcomes after a minimum 10-year follow-up [41]. However, fusion with PMMA has been reported to occur 15-20 years postoperatively in 90% of cases [17]. Necrosis of adjacent vertebrae and limited ventral ossification were also noted [17].…”

“…However, fusion with PMMA has been reported to occur 15-20 years postoperatively in 90% of cases [17]. Necrosis of adjacent vertebrae and limited ventral ossification were also noted [17]. Some authors have investigated the modification of PMMA into a cage structure filled with autologous cancellous bone, reporting successful fusion rates with limited donor site morbidity [24,67].…”

First experiences with a distractible titanium implant in ventral cervical disc surgery: report on 30 consecutive cases

“…The use of polymethyl methacrylate (Pala-cos) as an interbody graft is still a widespread and popular method. It is easy to handle, cheap and gives good results [3,5,13,14]. However, it has been shown that tight fusion does not take place, but only tissue consolidation that still allows movement in the "fused" segment [3,5,16].…”

“…It is easy to handle, cheap and gives good results [3,5,13,14]. However, it has been shown that tight fusion does not take place, but only tissue consolidation that still allows movement in the "fused" segment [3,5,16]. This may be seen to be favourable from a physiological point of view, but does not comply with the intention of a segmental fusion.…”

“…However, there is no real consensus on the useif at all [2,7,11 ] -of autologous [6,7,9,11,12], heterologous [16,17] or alloplastic materials [3,5,10,13,14] for the disc space graft for ventral fusion, the goal of which is either solid ossification or at least osseous fit. There is no doubt that autogenous iliac bone graft, with all the well-known disadvantages, is preferred.…”