Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

Abstract

Introduction Three-or four-level anterior cervical discectomy and fusion with autograft and plate fixation have demonstrated relatively good fusion rates and outcomes, but donor site morbidity and the limitations of autograft harvest remain problematic. The purpose of this study is to assess the radiographic and clinical outcomes of three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Methods This retrospective review included 43 consecutive patients who underwent three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct (three level: 39 cases, four level: 4 cases). The fusion rate, time to fusion, Cobb angle and disc height were assessed radiographically. Clinical outcomes were evaluated with the VAS, NDI, and SF36 scores. Complications were also recorded. Results Solid fusion was achieved in all the patients, and mean time to fusion was 13.7 ± 5.1 weeks. The postoperative Cobb angle, lordotic angle, and disc height (5.6°, 10.5°a nd 3.15 mm, respectively) increased significantly compared to preoperative values (p = 0.038, p = 0.032, and p = 0.0004, respectively), and these improvements were maintained through final follow-up. The postoperative NDI (17.2), VAS (2.8), and SF36 (13.1) scores increased significantly compared to the preoperative scores (p = 0.026, p = 0.0007 and p = 0.041, respectively). Complications included three cases of respiratory difficulty, four cases of dysphagia and one case of hoarseness. There were no cases of donor site morbidity. Conclusions Three-or four-level anterior cervical discectomy and fusion with a PEEK cage, and plate construct provide good clinical and radiographic outcomes including high fusion rates, low complication rates, low donor site morbidity, and good maintenance of the lordotic angle and disc height in the treatment of multilevel cervical spondylosis.

Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

“…To increase fusion rates, prevent subsidence and restore cervical sagittal alignment, additional anterior cervical plating has been recommended for cage fixation [29]. However, rigid anterior cervical plate fixation may shield the mechanical load that is very important for fusion.…”

Осложнения Вентральной Межтеловой Фиксации Шейных Позвонков Динамическими Пластинами

“…Перелом тела С 7 позвонка наблюдали в 2 (6,6 %) случа-ях, миграцию каудального терминаль-ного отдела аутотрансплантата кпере-ди -в 2 (6,6 %), выкручивание винтов -в 2 (6,6 %), несращение -в 4 (13,3 %). В своем исследовании Song et al [40] анализировали результаты при-менения гибридных ротационных динамических пластин «Maxima», «U&I Corporation», совместно с кейд-жами РЕЕК, «Stryker», при выполне-нии мультисегментарного переднего межтелового спондилодеза у 43 боль-ных с заболеваниями ШОП. Среди осложнений авторы отмечали тран-зиторную дисфагию у 4 (9,3 %) боль-ных, 3 (3,9 %) пациента испытывали затруднения при дыхании на протя-жении нескольких дней после опера-ции, охриплость -у 1 (2,3 %) больного.…”

“…Для стабилизации тел шейных позвонков при выполнении перед-него межтелового спондилодеза в последнее время все чаще исполь-зуют динамические пластины [34,37,40,44]. Информация о положи-тельных результатах их примене-ния в хирургическом лечении забо-леваний и повреждений шейного отдела позвоночника (ШОП) начала появляться в специализированных источниках с 1998 г.…”

Anterior Surgical Treatment of Cervical Spondylotic Myelopathy

“…Reducing the need for circumferential procedures is a significant advantage of ACDF over ACCF as these procedures have a high degree of associated morbidity. Several series report complication rates in the range of 31 to 56% for 3 level corpectomies with posterior instrumentation [8,68,62].…”

“…Prior to recent advances in anterior plating systems and grafting materials, multilevel ACDF was associated with a significantly higher non-union rate than ACCF, especially when treating multilevel disease [16,43,30]. Historically, fusion rates following non-instrumented multilevel ACDF (3 level or greater) were unacceptably low [34,62,71]. Early studies suggested that corpectomy without instrumentation was associated with much higher fusion rate than multilevel interbody grafting without instrumentation [68,11].…”