Anterior cervical discectomy and fusion by polyetheretherketon cage in degenerative disc diseases

Abstract

Background Anterior cervical discectomy has proven to be a safe and effective procedure for the treatment of degenerative disc disease. The anterior approach allows direct visualization of the entire interspace and wide decompression of the anterior aspect of cervical spinal cord and nerve roots; it may be undertaken in cases of multilevel disease and interbody fusion may be performed if required. Patients and methods A total of 20 patients aged from 20 to 65 years, 16 females and four males with symptomatic cervical disc disease, presented in the outpatient clinic, Menoufia University hospital from 2012 to 2014, were examined and followed up prospectively, The mean age was 43.25±9.06 (range: 28–60) years. There were 13 patients (65%) with radiculopathy only, two patients (10%) with mylopathy only, and five patients (10%) with radiculomylopathy; seven cases were affected by mylopathy graded according to Ranawat grading. There were 37 levels affected among the 20 patients. C5,6 was the commonly affected level 1 (40.5%), then C4,5 11 (29.7%), then C6,7 7 (18.9%), and the least one was C3,4 4 (10.8%). Five cases were operated by using a microscope. Anterior cervical discectomy and fusion (ACDF) were performed using polyetheretherketone (PEEK) cages and local bone graft. Results The mean operative time per microscopic level was 64.5 min, the nonmicroscopic level was 47 min.The only intraoperative complication was external jugular-vein ligation that occurred in two cases (nonmicroscopic). The only postoperative complication was difficulty in swallowing, which occurred in 13 cases (11 nonmicroscopic and two microscopic). The mean of preoperative interbody ratio was 1.8±0.2, 12 months postoperatively the mean was 1.9± 0.2.There was a statistically significant difference in the mean of the interbody ratio preoperative and at 12 months. The mean preoperative disc space height was 3.3±0.8 mm, 12 months postoperative was 5.8±0.9. There was a statistically significant difference in the mean disc space height preoperative and 12 months postoperative. Rate of fusion at 12 months: three levels were average fusion, 26 levels were good fusion, and eight levels were excellent fusion. Conclusion Patients receiving ACDF with local bone graft combined with a PEEK cage had significantly shorter operation time, lower perioperative complication rates, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.