Structural Allograft Versus PEEK Implants in Anterior Cervical Discectomy and Fusion: A Systematic Review

Abstract

Study Design: Systematic literature review. Objective: Our primary objective was to compare reported fusion rates after anterior cervical discectomy and fusion (ACDF) using structural allograft versus polyetheretherketone (PEEK) interbody devices in patients with cervical spine degeneration. Our secondary objectives were to compare differences in rates of subsidence and reoperation and in patient-reported outcomes between the 2 groups. Methods: Through a systematic review of the English-language literature using various databases, we identified 4702 articles. After we applied inclusion and exclusion criteria, 14 articles (7 randomized controlled trials, 4 prospective studies, and 3 retrospective studies) reporting fusion rates of structural allograft or PEEK interbody devices were eligible for our analysis. No randomized controlled trials compared outcomes of structural allograft versus PEEK interbody devices. Extracted data included authors, study years, study designs, sample sizes, patient ages, duration of follow-up, types of interbody devices used, fusion rates, definition of fusion, reoperation rates, subsidence rates, and patient-reported outcomes. Results: Fusion rates were 82% to 100% for allograft and 88% to 98% for PEEK interbody devices. The reported data were insufficient to perform meta-analysis. Structural allograft had the highest reported rate of reoperation (14%), and PEEK interbody devices had the highest reported subsidence rate (18%). Patient-reported outcomes improved in both groups. There was insufficient high-quality evidence to compare the associations of various PEEK modifications with fusion rates. Conclusion: Fusion rates were similar between structural allograft and PEEK interbody devices when used for ACDF for cervical spine degeneration. Currently, there is insufficient high-quality evidence to assess associations of PEEK modifications with fusion rates.

A 5-Year Cost-Utility Analysis Comparing Synthetic Cage vs Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy

“…23,24 The large differences in costs of Allo versus SC may drive the primary findings from our analysis. Prior literature has demonstrated that clinical outcomes and postoperative complications are relatively similar between Allo and SC, 13,[25][26][27][28] and SC has slightly higher rates of revision and pseudoarthrosis. 13,25,29,30 Our results highlight that while SC is widely used, it is costineffective with higher monetary costs without providing additional benefit.…”

Biomaterials for Interbody Fusion in Bone Tissue Engineering

“…Because of PEEK high melting point, laser sintering is commonly used, and the mechanical properties, biocompatibility, and heat resistance of PEEK can be effectively improved by adding in other inorganic materials and polymers ( Tan et al, 2005 ). It is reported that the fusion rate of PEEK interbody devices is similar to that of allogeneic bone grafts ( Jain et al, 2020 ).…”

Cervical Arthroplasty

“…The plate and four screw construct provided a solid fixation for arthrodesis to occur. With fusion rates of up to 100% [19], this technique became the gold standard for 20+ years. While the uniplate had some early adopters [20], high pseudofusion rates were reported [21].…”