Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Stand-alone Polyetheretherketone (PEEK) Cages

Abstract

Aim To evaluate long-term results after one- and two-level anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK) cages. Methods We performed a retrospective review of a consecutive patient cohort with degenerative disc disease that underwent ACDF with stand-alone PEEK cages between 2007 and 2013 with a minimum follow-up of 12 months. Radiographic follow-up included static and flexion/extension radiographs. Changes in the operated segments were measured and compared with radiographs directly after surgery. Clinical outcome was evaluated by a physical examination, pain visual analog scale (VAS) and health-related quality of life (HRQL) using the EuroQOL questionnaire (EQ-5D). Results Of 667 consecutive cases, 554 met all inclusion criteria. Follow-up data were obtained from 439 (79.2%) cases. The mean age at presentation was 55 years and 237 patients were male (54%). 220 and 219 patients had one- and two- level surgeries, respectively; 220 (50%) presented with spondylotic cervical myelopathy and 219 (50%) with cervical radiculopathy. Fusion was achieved in 85.9% and 86.3% of segments in one- and two-level surgeries, respectively. Cervical alignment was better in 37% and 40%, same 32% and 43%, worse in 30% and 17% in one- and two- level surgeries, respectively. Subsidence was observed in 27.7% and 26.5% of segments in one- and two-level surgeries, respectively. Follow-up operations for symptomatic adjacent disc disease and implant failure at index level were needed in 34 (7.7%) and 22 (5%) cases, respectively. Mean VAS declined from 5.3 ± 3.5 to 2.6 ± 2.3 ( p < 0.001) and 4.5 ± 3.7 to 2 ± 2.5 ( p < 0.001) for neck and arm pain, respectively. Health-related quality of life (HRQL) as measured by the EuroQOL questionnaire (EQ-5D) improved most cases. Conclusions One and two level ACDF with stand-alone PEEK cages achieved very high fusion rates and a low rate of follow-up operations. The rate of good clinical outcome is highly satisfactory.