Review of anterior cervical diskectomy/fusion (ACDF) using different polyetheretherketone (PEEK) cages

Abstract

Background: Multiple anterior cervical diskectomy/fusion (ACDF) techniques now use a variety of Polyehteretherketone (PEEK) cages; stand-alone (SA) and zero-profile (ZP) with/without screws, cages filled with demineralized bone matrix/autograft, and cages coated with hydroxyapatite or titanium. We compared the safety/ efficacy between different PEEK ACDF cage constructs in 17 studies, and in some cases, additionally contrasted results with “routine” ACDF (i.e. series/historical data performed with combinations of iliac autograft/allograft and plates). Methods: We focused on the clinical outcomes, fusion rates, postoperative radiographic changes/lordosis/ subsidence, and/or reoperation rates for various PEEK ACDF constructs vs. “routine” ACDF. Results: One to 3 and 4-level PEEK ACDF cages demonstrated high fusion rates, few cage failures, and low reoperation rates. Subsidence for PEEK ACDF cages did not reduce fusion rates or diminish the quality of postoperative outcomes. Further, titanium-coated (T-C) PEEK cages lowered fusion rates in one study (i.e. 44.1% fusions vs. 88.2% for routine PEEK ACDF) while ACDF PEEK cages coated with hydroxyapatite (HA) showed only a “trend” toward enhanced arthrodesis. Conclusion: One to 3-4 multilevel ACDF PEEK cage constructs demonstrated comparable safety/efficacy when compared with each other, or in select cases, with “routine” ACDF (i.e. using autograft/allograft and plates).

Synthetic Interbody Devices and Traditional Bone Graft Are Associated With a Similar Rate of Surgical Complications After 1-2 Level Anterior Cervical Discectomy and Fusions

“…However, titanium is less elastic than other materials 12 . In contrast, PEEK cages are made to be elastic to redistribute the axial skeletal load and are bio-inert, which reduces the risk of infection but also may lower osteogenic potential 13 . Krause et al 9 and Teton et al 14 showed a 5 and 6-fold increase in risk of pseudarthrosis with PEEK cages compared with allograft and D’Antonio et al 15 showed that PEEK cage implantation was independently associated with postoperative pseudarthrosis.…”

Drug release control and anti-inflammatory effect of biodegradable polymer surface modified by gas phase chemical functional reaction

“…Research on the use of polymers to address the unmet needs of each clinical field in terms of mechanical properties comparable to those of metals, ease of surface modification for drug delivery, and biodegradation is being conducted continuously. For example, polyetheretherketone for orthopedic cervical cages, polylactic acid (PLA) for cardiovascular bioabsorbable stents, and polyvinyl alcohol for oral mucosal adhesive drug delivery systems have been reported [28][29][30]. Among various polymers, in particular, PLA is the most commonly used biodegradable polymer in clinical applications today.…”

Surface Modification Techniques for Polyetheretherketone as Spinal Interbody Fusion Cage Material to Stimulate Biological Response: A Review

“…However, Ti cages have relatively higher elastic modulus (110 GPa) and a stress shielding effect; hence, there is an increased risk of these cages subsiding post surgery. Further, the radiopacity of these cages makes it difficult for surgeons to determine postoperative fusion [7,8]. With the advancement in material science, polyetheretherketone (PEEK) cages are extensively used for spinal fusion procedures [9].…”