Stand-Alone Anterior Cervical Decompression and Fusion in Three Levels with Peek Cages: A Possible Satisfactory Alternative

Abstract

Anterior cervical decompression and fusion (ACDF) remains the gold standard for subaxial degeneration of anterior elements. By multilevel stenosis corpectomy or instrumentation with screws and plate are supported. Their potential complications, though, should be reckoned. The use of polyetheretherketone (PEEK) cages packed with demineralized bone matrix (DBM) alone can provide good fusion rates and clinical improvement even in cases of three levels degeneration. The purpose of this paper is to present retrospectively the outcomes of 15 patients with cervical stenosis in three levels treated with cage implantation reviewing the relevant literature, too.

Stand-alone polyetheretherketone cages for anterior cervical discectomy and fusion for successive four-level degenerative disc disease without plate fixation

“…[ 41 ] In our study, the fusion rate was 92.4%, comparable to pervious similar studies in literature. [ 3 30 ] The pseudarthrosis (fusion failure) in our study represented 7.6% (20/264 levels), while Chang et al . reported 0.04% of pseudarthrosis of 440 levels.…”

“…[ 27 28 ] In multilevel ACDF an autogenous bone graft usually fail to keep the spinal stability in multilevel discectomies properly and the complications rate related to the usage of autogenous bone graft increase when compared to single level discectomy, such as graft collapse 20%–30% seen in multilevel cases. [ 3 29 30 31 ]…”

“…However, the failure rates increase as the levels of discectomies increase. [ 3 ] Multilevel cervical discectomies are usually combined with plate fixation to keep the spinal curvature and increasing the rate of fusion. [ 4 5 6 7 ] The insertion of a plate over multiple vertebral bodies requires more tissue retraction which may increase the risk of occurrence of complications, such as screw breakage, pull out, esophageal injury, and recurrent laryngeal nerve injury.…”

Short-Term Outcomes and Clinical Features Analysis of Anterior Cervical Discectomy; Effect of Non-Instrumented Vs. Instrumented Fusion

“…Cervical degenerative disorders, such as cervical disc prolapse, chronic instability, and posterior longitudinal ligament (PLL) ossification or hypertrophy often cause clinical symptoms, most notably pain, restriction of movement, and weakness 14 . The discussion about a specific surgical approach is still ongoing; however, experts agree that a minimum of 6-12 weeks of initial conservative treatment is required for spontaneous recovery [15][16] .…”