Use of a polymethylmethacrylate cervical cage in the treatment of single-level cervical disc disease

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Polymethylmethacrylate (PMMA) bone cement has been used as a spacer in the treatment of patients with cervical disc disease with good long-term outcomes, but solid bone fusion has not been demonstrated in all cases. To achieve cervical interbody fusion, the authors designed a modified PMMA cervical cage that they filled with spongy bone for the treatment of single-level cervical disc herniation.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Sixty-three patients underwent anterior cervical microdiscectomy and implantation of a PMMA cervical cage filled with autograft cancellous bone and were followed for a minimum of 2 years. The fusion rates were 90.5 and 100% at the 6- and 12-month follow-up examinations, respectively. The mean intervertebral disc height gain was 3.4 ± 1.9 mm when preoperative and 24-month postoperative values were compared. Neck pain, measured using the Huskissan visual analog scale (0 mm, no pain; 100 mm, worst possible pain), decreased from 71 ± 13 mm at preoperative baseline to 28 ± 17 at 6, 23 ± 19 at 12, and 31 ± 19 mm at 24 months. Based on the same scale, radicular pain decreased from 83 ± 15 mm at preoperative baseline to 24 ± 11 at 6, 27 ± 13 at 12, and 22 ± 11 mm at 24 months. The self-rated clinical outcome was excellent in 45 (71.4%) and good in 18 (28.6%) of the 63 patients.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The autograft cancellous bone—filled PMMA cage is safe and effective for cervical interbody fusion in the treatment of single-level cervical disc herniation and monoradiculopathy.</jats:p>

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

“…However, the FDA has not approved the use of BMP-2 for cervical fusion, and complications have been reported with the use of BMP-2 in cervical fusion [54]. Polymethylmethacrylate (PMMA) has been reported to produce satisfactory results in ACDF [10]. However, PMMA fails to meet the requirements for an interbody fusion device and causes necrosis of adjacent vertebrae [56].…”

Bone graft substitutes in anterior cervical discectomy and fusion

“…Necrosis of adjacent vertebrae and limited ventral ossification were also noted [17]. Some authors have investigated the modification of PMMA into a cage structure filled with autologous cancellous bone, reporting successful fusion rates with limited donor site morbidity [24,67].…”

Antibiotic-impregnated polymethylmethacrylate as an anterior biomechanical device for the treatment of cervical discitis and vertebral osteomyelitis: technical report of two cases

“…PMMA's use as a biomechanical device in anterior cervical disc decompression procedures has been well documented with stable construct rates reported between 70 and 87 percent and low complication rates (5,6,14). Additionally, the successful use of beaded AI-PMMA as a temporary prophylactic measure for infected joints and long bones has been well described in the orthopedic literature (2,3,17).…”

“…Both remain off antibiotics and have been infection free. Final postoperative C-spine radiographs were obtained for both patients showing radiographically stable constructs without subsidence, one at 36 months and the other at 18 months postoperatively (Figures 4,5,8,9).…”