Radiological and clinical outcomes in patients undergoing anterior cervical discectomy and fusion: Comparing titanium and PEEK (polyetheretherketone) cages

Abstract

Objectives:To study clinical and radiological outcomes in patients who had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages for cervical disc prolapse.Methods:This is a retrospective/non-randomized study which was conducted at the Combined Military Hospital Peshawar. Study interval was four years from 1st October, 2010 to 31st September, 2014. Total number of included patients were 149. All of the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages. All of the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse.Results:Most of the patients had stenosis at the C5 / C6 (PEEK cage group 63% and titanium cage group 47.6%) and C6 / C7 (PEEK cage group 15.38% and titanium cage group 19.04%) cervical level. Bi-level involvement was also seen. In the patients who complained of brachialgia, total resolution of symptoms was seen after the operation. Three (2.01%) of the patients in titanium cage group, who presented with axial neck pain, continued to complain of pain after the operation. Four (2.6%) of the patients in PEEK (polyetheretherketone) cage group and 2 (1.3%) in titanium cage group complained of pain at the donor site (iliac crest). Fusion rate was 100% with both titanium and PEEK (polyetheretherketone) cages at one year.Conclusion:Results with titanium and PEEK (polyetheretherketone) cages are excellent. There was no significant difference in clinical and radiological outcome between two groups of patients (p > 0.05). Fusion rate was 100% at one year with both cages.

Titanium (Ti) cages may be superior to polyetheretherketone (PEEK) cages in lumbar interbody fusion: a systematic review and meta-analysis of clinical and radiological outcomes of spinal interbody fusions using Ti versus PEEK cages

“…Furthermore, it provides long-term stability as Ti cages supported bone growth into and around the implant margins, with the porous structure allowing for host bone ingrowth and bone bridging through the device, hence explaining the superior fusion rates as compared to PEEK cages [22]. Most studies included in this metaanalysis showed that fusion rates of Ti cages were superior or at least similar to PEEK cages [4,5,10,11,17,[23][24][25][26], with the exception of Chou et al and Niu et al [27,28], who had found that PEEK cages achieved better fusion. In the studies by Chou and Niu et al, the PEEK cages utilized incorporated 2 titanium spikes on the upper and lower frames, which the authors hypothesize offer a fixation mechanism, hence contributing to better stability leading to fusion.…”

“…While PEEK cages were noted to have a trend towards a lower rate of subsidence in our meta-analysis, there was substantial heterogeneity amongst the 8 studies, with 2 studies showing Ti cages causing increased subsidence [5,28], 4 studies showing with no difference between both groups [4,17,26,27], and 2 studies showing no subsidence even at the final follow-up [10,24]. In patients with spondylodiscitis, Schomacher et al reported a high rate of subsidence in both groups (67% PEEK group, 75% of Ti group) [17].…”

“…In total, we found 11 eligible studies, with 3 originating from Germany, 2 from Japan, 2 from Taiwan, 1 from China, 1 from France, 1 from Italy, and 1 from Pakistan. Figure 1 provides a graphical summary of the article selection process [10][11][12][13].…”

“…However, they were only able to pool results for subsidence rates and fusion rates for all patients who underwent both cervical and lumbar fusion. Furthermore, several other studies have been published since 2017 till date [10][11][12][13]. The aim of this systematic review and meta-analysis was hence to provide a comprehensive and up-to-date comparison between the various clinical and radiological outcomes of Ti and PEEK interbody spinal cages, as well as to perform subgroup analyses to differentiate between patients who had cervical and lumbar interbody fusions.…”

Deep Learning Algorithm Based on Analysis the Effect of Posterior Cervical Vertebral Canal Decompression Angioplasty in the Treatment of Ossification of Posterior Longitudinal Ligament of Cervical Spine by CT Image

“…Some researchers have proposed that, combining pixel information of different scales can extract the best size information; some researchers believe that, reducing the size of the convolution kernel can improve the running speed of the neural network. [7][8][9][10] The CT image reconstruction algorithm can effectively remove image noise and improve image quality, assisting physicians in diagnosing diseases. With the rapid development of deep learning, many deep learning networks are used to process CT images.…”