C Schulz1, U M Mauer2, R Mathieu2. 1. Abt. Neurochirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland. chris.schulz@extern.uni-ulm.de. 2. Abt. Neurochirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
Abstract
BACKGROUND: Anterior cervical corpectomy and fusion (ACCF) has become a standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. In addition to the fusion technique using autogenous bone grafts and titanium implants, synthetic polyetheretherketone (PEEK) cages have been used increasingly during the last years. However, limited evidence on the clinical and radiological results of PEEK cages for ACCF exists in the literature. The study presented here is the largest series to date reporting clinical and radiological outcome as well as complication rates after one to three-level ACCF using PEEK cages augmented by an anterior plate-screw osteosynthesis. MATERIALS AND METHODS: Retrospective study on 101 patients after stand-alone PEEK cage-ACCF with a minimum follow-up of 6 months. The number of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment were analysed. The neck disability index (NDI) and the European myelopathy score (EMS) were assessed. RESULTS: Screw complications were detected in 8/101 cases and 3 cases of cage dislocation occurred, resulting in an overall implant related revision rate of 2.9 % (all revision cases showed cage dislocation). The rate of cage subsidence >3 mm was 12 % and solid fusion was achieved in 82 % of the patients. NDI, EMS and lordotic alignment improved significantly. CONCLUSIONS: PEEK cages are a safe and effective alternative to titanium cages or autogenous bone graft for ACCF. Further randomized evaluation of different fusion techniques in ACCF is still necessary.
BACKGROUND: Anterior cervical corpectomy and fusion (ACCF) has become a standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. In addition to the fusion technique using autogenous bone grafts and titanium implants, synthetic polyetheretherketone (PEEK) cages have been used increasingly during the last years. However, limited evidence on the clinical and radiological results of PEEK cages for ACCF exists in the literature. The study presented here is the largest series to date reporting clinical and radiological outcome as well as complication rates after one to three-level ACCF using PEEK cages augmented by an anterior plate-screw osteosynthesis. MATERIALS AND METHODS: Retrospective study on 101 patients after stand-alone PEEK cage-ACCF with a minimum follow-up of 6 months. The number of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment were analysed. The neck disability index (NDI) and the European myelopathy score (EMS) were assessed. RESULTS: Screw complications were detected in 8/101 cases and 3 cases of cage dislocation occurred, resulting in an overall implant related revision rate of 2.9 % (all revision cases showed cage dislocation). The rate of cage subsidence >3 mm was 12 % and solid fusion was achieved in 82 % of the patients. NDI, EMS and lordotic alignment improved significantly. CONCLUSIONS:PEEK cages are a safe and effective alternative to titanium cages or autogenous bone graft for ACCF. Further randomized evaluation of different fusion techniques in ACCF is still necessary.
Authors: Mousa K Hamad; Jessica Ryvlin; Justin Langro; Aisha S Obeidallah; Jason Marin; Rafael De La Garza Ramos; Saikiran Murthy; Seon-Kyu Lee; Reza Yassari Journal: Cureus Date: 2022-09-12