Two-level contiguous cervical disc disease treated with peek cages packed with demineralized bone matrix: results of 3-year follow-up

Abstract

Interbody cages are widely used instruments for cervical fusion operations. Long-term follow-up studies are needed to clarify if these devices are dependable. In this prospective study, 79 patients (42 women and 37 men) with a mean age of 51 years operated between January 2000 and December 2005 for treatment of degenerative cervical disc disease and spondylosis associated with radiculopathy or myelopathy were evaluated. Patients underwent two-level contiguous anterior cervical discectomy and fusion operations with standard anterior Smith-Robinson approach. To achieve fusion PEEK cages packed with demineralized bone matrix mixed with autologous blood were used. Clinical outcome was evaluated with Odom's criteria and results were evaluated as 'excellent', 'good', 'fair' and 'poor'. Spinal curves, mobility and fusion status were assessed with anterior-posterior and lateral (neutral, flexion and extension) radiographs obtained before surgery and at 3, 12, 24 and 36 months postoperatively. The Ishihara curvature index (ICI) was used for spinal curve evaluation. Lateral dynamic (flexion and extension) radiographs at postoperative 12th month revealed the fusion status classified as 1A, 1B, 2A and 2B. The radiological outcomes were classified as 'non-fusion' when 2B healing was observed, and as 'fusion' when 1A, 1B or 2A healing was observed at the levels subjected to surgery. According to Odom's criteria, clinical outcomes were classified as 'excellent' or 'good' in 69 patients (success rate: 87.3%). Eight patients were graded as 'fair' and two as 'poor'. Preoperative mean ICI was 10.4+/-3.72 and postoperative mean ICI was 10.1+/-3.14. The difference was statistically insignificant (P>0.05); therefore, preoperative lordosis was said to be preserved at final follow-up. Final fusion rate (Types 1A, 1B, and 2A) was 91.7% (145/158 levels). Radiological imaging showed no cage failure or dislodgement and reoperation due to non-fusion was not needed.

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

“…Numerous methods, such as cage augmentation [23], bone substitutes, allograft, artificial replacement [24], and bone morphogenetic protein have been developed in an effort to avoid this complication. Cage characteristics depend on the composition of the cage.…”

“…Many spinal surgeons induce bone fusion by filling the cage with autogenous iliac cancellous bone, achieving good or excellent clinical outcomes and fusion rates [5,6,23,27]. However, others have reported poor clinical outcomes and fusion rates secondary to a high rate of cage subsidence, local kyphosis, and pseudarthrosis [14,28].…”

Long Term Radiological Angles After Anterior Cervical Discectomy and Fusion Operation Made by İntervertebral Cage

“…It provides a wider angle of sight, enables removal all of the disc material and osteophytes, faciliştates bony decompression and sufficient fusion, and makes ACDF the preferred technique for the treatment of soft CDH (6,8,9,22) . Adding fusion to the ACD operation diminishes SH losses and in parallel prevents foraminal compressions (18,21) . Although autografts provide better fusion rates, because of donor site complications and the fact that it requires more time, cage and artificial grafts are preferred (7,17,20) .…”

Bioactive Scaffolds for the Controlled Formation of Complex Skeletal Tissues

“…Therefore, there is currently large clinical evidence supporting their efficacy for several orthopedic conditions (Irinakis, 2011;Y.K. Kim et al, 2010;Topuz et al, 2009). Decellularized tissue scaffolds are prepared by cell lysis, induced by physical and/or chemical treatments, followed by cell component removal treatments.…”