Comparative Study between Fusion and Non-Fusion Techniques in Anterior Cervical Discectomy: Bone Cement Versus Cervical Cage

Abstract

Abstract Background: A prospective comparative study between fusion and non-fusion techniques in anterior cervical discec-tomy (ACD) evaluating the results achieved using polymeth-ylmethacrylate (PMMA) as a non-fusion and cervical cage (PEEK) as a fusion following single level ACD. Patients and Methods: A total of 40 patients, divided in to two groups of 20 patients each, group (A); having PMMA used for disc replacement and group (B) cervical (PEEK) cage placement after ACD. Results: Of both groups are evaluated regarding: (1) Clinical outcome according to Odom's criteria (2) Radiological outcome and inter body fusion, (3) Simplicity and postoperative morbidity of each procedure and (4) Complications related to each technique. Patients were followed up for a mean period of 10 months. Group (A) presented excellent and good clinical outcome in 85% at 6 months and 90% at 12 months. Radio-logical none fusion was noticed in 80% of patients and partial fusion occurred in 20% of cases at 12 months postoperative interval cage migration in 5% (one patient) into adjacent vertebral bodies which needed surgical removal and replaced by cage after causing partial collapse of the disc space height. No other graft related complications, progressive deformity or instability were reported. Group (B) achieved 90% excellent and good clinical outcome at 6 and 12 months respectively. Fusion rate of 85% at 6 months and increased to 95% at 12 months. No other cage related complications were reported. Conclusion: Clinical outcome in both group is related to the surgical decompression technique and preoperative neu-rological status of the patients e.g. cervical spondylotic myelopathy (CSM), cervical spondylotic radiculopathy (CSR) or both than to the use of either disc replacement by fusion (PEEK) cage or non fusion by bone cement (PMMA). The use of interbody fusion cage is preferred owing to their ability to function as load-sharing devices and to adequately fix the spine and increase segmental stiffness thus achieve acceptable fusion rate and low complication when compared with PMMA graft.