The improved bioactive n-HA/PA66 cage versus the PEEK cage in anterior cervical fusion: results from a 6-year follow-up and a case-matched study

Abstract

Background The nanohydroxyapatite/polyamide 66 (n-HA/PA66) cage, a bioactive nonmetal cage, is fabricated in a hollow cylindrical shape and has been widely used for decades with good clinical outcomes for anterior cervical fusion. However, there remain some radiological complications, such as a slightly high subsidence rate. To improve the clinical outcomes, the improved n-HA/PA66 cage now has been developed into a trapezoidal and wedge shape, a better biomechanical shape matching the cervical spine that is similar to that of the PEEK cage. However, there have been no long-term comparisons of the improved n-HA/PA66 cage and PEEK cage in anterior cervical reconstruction. Methods Fifty-eight patients who underwent single-level anterior cervical decompression and fusion (ACDF) with the improved n-HA/PA66 cage (n-HA/PA66 group) were matched with patients with the PEEK cage (PEEK group) by clinical presentation, segment, age and sex. All patients underwent a minimum of 6 years of follow-up. The radiographic parameters (cage subsidence, fusion status, cervical lordosis, and segmental sagittal alignment) and clinical parameters (10-point visual analogue scale, Neck Disability Index and Japanese Orthopedic Association scores) from patients were evaluated before surgery, immediately after surgery, and at the latest follow-up. Results The n-HA/PA66 and PEEK groups were well matched in terms of clinical presentation, segment, age, and sex at surgery. The n-HA/PA66 and PEEK cages had similar fusion rates at 6 months postoperatively (n-HA/PA66: 58.6% vs. PEEK: 51.7%, P = 0.455) and at the last follow-up (n-HA/PA66: 96.6% vs. PEEK: 93.1%, P = 0.402). The respective cage subsidence rates in the n-HA/PA66 and PEEK groups were 6.9 and 12.1% (P = 0.342). The correction of SA was similar between the groups at the final follow-up (n-HA/PA66: 4.29 ± 1.99 vs. PEEK: 3.99 ± 2.59 P = 0.464). There were no significant differences between the two groups in mean cervical lordosis, visual analogue scale scores of the neck and arm, NDI scores, JOA scores or patients’ overall satisfaction at the final follow-up. Conclusion After single-level ACDF, the improved n-HA/PA66 cage had similar excellent results in both radiological and clinical outcomes compared with the PEEK cage over 6 years of follow-up. According to these results, the improved n-HA/PA66 cage and the PEEK cage could be comparable for ACDF.

A comparison of anterior reconstruction of spinal defect using nano-hydroxyapatite/polyamide 66 cage and autologous iliac bone for thoracolumbar tuberculosis: a stepwise propensity score matching analysis

“…As a bioactive material, n-HA/PA66 has the good biocompatibility of polyamide 66 (PA66) and the good osteogenic conductivity and strong mechanical properties of nano-hydroxyapatite (HA) (similar to those of human cortical bone) (Wang et al, 2007). In recent years, n-HA/PA66 support has been more and more widely used in anterior column reconstruction surgery and achieved satisfactory clinical results (Yang et al, 2014;Hu et al, 2019;Deng et al, 2022;Li et al, 2023;Zhang et al, 2023). In this study, we retrospectively analyzed 16 patients who underwent anterior reconstruction of thoracolumbar tuberculosis using n-HA/PA66 cage and matched them with 16 patients who used ilium bone.…”

“…Artificial implants may suffer from insufficient biocompatibility and osseointegration, affecting their stability and long-term results, and may carry a higher risk of infection and complications requiring reoperation, such as loosening or fracture (Gao et al, 2017;Suya et al, 2019;Wu et al, 2021). In recent years, a new type of bone graft materialnano-hydroxyapatite/polyamide 66 (n-HA/PA66) bioactive cage has been widely used in bone graft fusion surgery, its advantages are good biocompatibility, bioactivity, can promote bone healing, but also can avoid the use of traditional methods such as autoiliac bone may exist problems (Hu et al, 2019;Deng et al, 2022;Li et al, 2023;Zhang et al, 2023). Although the advantages and disadvantages of autogenous iliac bone and n-HA/PA66 cage have been extensively studied, there is no conclusive comparison between the efficacy of the two implant materials in spinal tuberculosis bone graft fusion.…”

Long-term outcomes of the nano-hydroxyapatite/polyamide-66 cage versus the titanium mesh cage for anterior reconstruction of thoracic and lumbar corpectomy: a retrospective study with at least 7 years of follow-up

“…There were no significant differences in the ODI and VAS between the n-HA/PA66 and TMC groups at final follow-up [ 36 , 37 ]. In addition, the n-HA/PA66 cage exhibited excellent biocompatibility and osteoconductive ability [ 27 , 38 , 39 ]. Considering the lower elastic modulus with more stable correction of kyphosis and earlier bony fusion of the n-HA/PA66 group compared with the TMC group, the n-HA/PA66 seems to be an ideal cage to replace the TMC in anterior reconstruction of thoracolumbar fractures.…”

A comparison of anterior reconstruction of spinal defect using nano-hydroxyapatite/polyamide 66 cage and autologous iliac bone for thoracolumbar tuberculosis: a stepwise propensity score matching analysis

“…As a bioactive material, n-HA/PA66 has the good biocompatibility of polyamide 66 (PA66) and the good osteogenic conductivity and strong mechanical properties of nano-hydroxyapatite (HA) (similar to those of human cortical bone) [21]. In recent years, n-HA/PA66 support has been more and more widely used in anterior column reconstruction surgery and achieved satisfactory clinical results [12][13][14][15]22]. In this study, we retrospectively analyzed 16 patients who underwent anterior reconstruction of thoracolumbar tuberculosis using n-HA/PA66 cage and matched them with 16 patients who used ilium bone.…”

“…Autogenous iliac bone graft may lead to prolonged operation time, increased bleeding and increased postoperative pain, while arti cial materials may have risks of rejection [9][10][11]. In recent years, a new type of bone graft materialnano-hydroxyapatite/polyamide 66 (n-HA/PA66) bioactive cage has been widely used in bone graft fusion surgery, its advantages are good biocompatibility, bioactivity, can promote bone healing, but also can avoid the use of traditional methods such as autoiliac bone may exist problems [12][13][14][15]. Although the advantages and disadvantages of autogenous iliac bone and n-HA/PA66 cage have been extensively studied, there is no conclusive comparison between the e cacy of the two implant materials in spinal tuberculosis bone graft fusion.…”