Porous silicon nitride spacers versus PEEK cages for anterior cervical discectomy and fusion: clinical and radiological results of a single-blinded randomized controlled trial

Mark P Arts,Terry P Corbin,Jasper F C Wolfs

doi:10.1007/s00586-017-5079-6

Mark P Arts, Terry P Corbin + Show 1 more

Open Access

https://doi.org/10.1007/s00586-017-5079-6

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Abstract

PurposeAnterior cervical discectomy with fusion is a common procedure for treating radicular arm pain. Polyetheretherketone (PEEK) plastic is a frequently used material in cages for interbody fusion. Silicon nitride is a new alternative with desirable bone compatibility and imaging characteristics. The aim of the present study is to compare silicon nitride implants with PEEK cages filled with autograft harvested from osteophytes.MethodsThe study is a prospective, randomized, blinded study of 100 patients with 2 years follow-up. The primary outcome measure was improvement in the Neck Disability Index. Other outcome measures included SF-36, VAS arm pain, VAS neck pain, assessment of recovery, operative characteristics, complications, fusion and subsidence based on dynamic X-ray and CT scan.ResultsThere was no significant difference in NDI scores between the groups at 24 months follow-up. At 3 and 12 months the NDI scores were in favor of PEEK although the differences were not clinically relevant. On most follow-up moments there was no difference in VAS neck and VAS arm between both groups, and there was no statistically significant difference in patients’ perceived recovery during follow-up. Fusion rate and subsidence were similar for the two study arms and about 90% of the implants were fused at 24 months.ConclusionsPatients treated with silicon nitride and PEEK reported similar recovery rates during follow-up. There was no significant difference in clinical outcome at 24 months. Fusion rates improved over time and are comparable between both groups.

Highlights

Anterior cervical discectomy and fusion (ACDF) is a common treatment for a cervical radicular syndrome producing persistent arm pain with or without neck pain
There was no significant difference in Neck Disability Index (NDI) scores between the groups at 24 months follow-up
At 3 and 12 months the NDI scores were in favor of PEEK the differences were not clinically relevant

Summary

Introduction

Anterior cervical discectomy and fusion (ACDF) is a common treatment for a cervical radicular syndrome producing persistent arm pain with or without neck pain. The choices for anterior cervical fusion are many, and a recent literature review has described the lack of clarity on the best procedure options for ACDF [1]. Graft harvest for cervical interbody fusion can be associated with pain at the iliac crest harvest site [1]. Interbody fusion cages made of metal, plastic and most recently ceramic materials have been shown to have advantages over autograft bone blocks: (1) using a cage provides strength to support a larger axial load than bone; (2) the cage can be filled with locally harvested autograft (from osteophytes) or bone graft substitutes, eliminating the need for harvest from the iliac crest, and (3) using a cage saves time in the procedure, reduces blood loss and reduces post-operative pain compared with obtaining graft from the iliac crest.

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