Polymethylmethacrylate (PMMA) in anterior cervical spine surgery - current situation in Germany

Abstract

In German speaking countries Polymethylmethacrylate (PMMA) is widely used as spacer material after ventral microdiscectomy of the cervical spine. With the introduction of other materials i.e. titanium, carbon and polyetheretherketone (PEEK) and upcoming reports about long term complications PMMA is currently in discussion. We present the results of an enquiry about the use of PMMA and the complications observed in Germany. - 100 German neurosurgical departments perform annually 8608 anterior cervical discectomies and fusions, 3410 (40%) with PMMA, 2373 (27%) with titanium, 2370 (27%) with bone graft, 407 (5%) with carbon and 48 (1%) without fusion materials. In 47 of the 100 departments PMMA is used on regular base, in 18 occasionally and in 35 never. The use of PMMA is limited to a single cervical segment in 12 departments, 21 are using PMMA in two and 22 in more than two segments. - Fracturing of fusion material was observed in PMMA in 13 cases (0.15% per year), in bone grafts in 33 (0.53% per year) and in carboncages in one case (0.05% per year). Dislocations of PMMA is reported in 66 cases (0.7% per year), of bone grafts in 32 (0.73% per year), of titanium spacers in 20 (0.37% per year) and of carboncages in 4 cases (0.33% per year). - In conclusion PMMA is still the most widely used spacer material after anterior cervical discectomy in Germany. An increased complication rate in comparison with other implants could not be observed.