Safety and Efficacy of Local Bone with PEEK Cage versus Iliac Bone Graft in Anterior Cervical Discectomy and Fusion: A Prospective Study

Abstract

IntroductionA prospective study was performed to compare the clinical and radiological results between the use of local bone graft with a PEEK cage versus an iliac bone graft in anterior cervical discectomy and fusion (ACDF). Materials and MethodsA total of 60 consecutive patients who underwent ACDF were evaluated from January 2010 to January 2013. 29 patients received an ACDF with a PEEK cage combined with local bone graft (local bone cohort) and 31patients received an ACDF with tricortical iliac bone graft (iliac bone cohort). The intraoperative and perioperative complications of both cohorts were recorded. Preoperative and postoperative radiographs were taken to calculate the ratio of interbody height to the disc height and the interbody bony fusion rate. The Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) were used to estimate postoperative clinical outcomes. ResultsThe mean follow-up time was 25.0 ± 3.8 months in the local bone cohort and 24.4 ± 3.4 months in the iliac bone cohort (p = 0.56). Although there was no statistically significant difference between the two cohorts in terms of blood loss (p = 0.17), the length of surgery was significantly less in the local bone cohort compared with that of the iliac bone cohort (p = 0.01). Postoperatively, VAS scores were significantly decreased, and JOA scores were improved in both cohorts. However, no statistically significant difference was found between the two cohorts at final follow up (p = 0.45, p = 0.93). The disc space height and segmental interbody angle at the surgical segment were greater in local bone cohort than those in the iliac bone cohort (P < 0.001 and P < 0.001). The fusion rates were 93.1% (27/29) in local bone cohort and 90.3% (28/31) in the iliac bone cohort at last follow up (p = 0.70). Perioperative complication rates in local bone cohort and iliac bone cohorts were 6.8% and 29%, respectively (p = 0.04). ConclusionsIn a prospective study of 60 patients receiving ACDF with either local bone graft with a PEEK cage or an iliac bone graft alone, the former had a statistically shorter operation time, lower perioperative complications rate, and better radiological results. Although further long-term studies will delineate whether these improved radiographic findings will translate into better clinical outcomes, the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft during the perioperative period.