Stand-alone Polyetheretherketone Research Articles

The quality of life after Anterior Cervical Discectomy and Fusion

Cervical discopathy is commonly associated with pain in the cervical spine which may affect patients’ quality of life. If conservative treatment fails to relieve the pain for at least 6 months and/or if neurological deficit progresses, the surgical treatment is taken under consideration. The aim of this study was to evaluate health-related quality of life (HRQOL) and disability of patients after single- and multi-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages. The study evaluated how ACDF influenced particular aspects of patients’ quality of life in the context of radiological outcome. The study included 30 consecutive patients with single- or multi-level cervical disc herniation. Patients underwent clinical and radiological evaluation before and one year after the ACDF procedure. For each patient, we assessed the severity of cervical pain with a numerical rating scale (NRS) and filled the neck disability index questionnaire (NDI). The health-related quality of life was assessed with the Polish version of 36-Item Short Form Survey (SF-36). A significant decrease in all NDI aspects indicates a significant improvement after surgery. The quality of life in all aspects assessed with SF-36 scale was also improved. A moderate decrease in cervical spine mobility coexisted with a good outcome of the neurosurgical procedure. In the opinion of patients, the most important aspect after the cervical spine surgery is the reduction of pain severity. ACDF surgery is an effective method to reduce the severity of pain in patients with degenerative disc disease. ACDF improves the quality of patient’s life. According to the study results the physical role improved most significantly; the least improvement was noted in role-emotional aspect. Up to 83% of patients achieved a reduction of the NDI index by 5 or more points after surgical treatment which proves the high effectiveness of the surgical treatment. No statistically significant difference was noted between patients with single and multi – level discopathy. Up to 97% of patients who underwent ACDF reported a significant decrease in pain severity measured with NRS.

Analyzing results of cervical sagittal parameters in patients operated with polyetheretherketone cages without plate.

This was a retrospective longitudinal observational study. The purpose of this study was to analyze the results of cervical sagittal parameters on preoperative and postoperative lateral radiographs in anterior cervical discectomy and fusion (ACDF). ACDF is believed to change craniocervical parameters and thus cervical curvature using polyetheretherketone (PEEK) or titanium cages with or without self-locking as well as an anterior plate, the latter of which has not been shown to provide better clinical or radiological results. Cervical spondylotic myelopathy (CSM) is a common degenerative pathology that can affect one or more levels and treatment has varied over time trying to maintain sagittal parameters within acceptable values where the ACDF is the main treatment. The study was performed in patients with CSM who underwent anterior cervical discectomy, and their pre- and postoperative radiographs were analyzed using Surgimap software a few days before and 3 months after surgery. Fifteen files were included in the study. Statistically significant sagittal balance variables were observed in cervical lordosis (CL) with an increase of 4.73° (P = 0.019) and T1 slope (T1S)-CL with a decrease of -5.93° (P = 0.007). CL and T1S-CL showed favorably modified values when performing ACDF using stand-alone PEEK cages without the need for self-blocking or an anterior plate.

Posterior lumbar interbody fusion using single PEEK cage without pedicle screw fixation for lumbar disc herniation; Initial experience in Menoufia University Hospital

BackgroundLumbar discectomy has successful initial clinical outcome; its long-term success rate decreases to 40–80% due to chronic low back pain and recurrent disc herniation.ObjectiveTo evaluate the clinical results of Posterior Lumbar Interbody Fusion with a single unilateral stand-alone PEEK (Poly-Ether-Ether-Ketone) cage without pedicle screw fixation for single level lumbar disc herniation.MethodsA retrospective study of 40 patients (24 men and 16 women) with lumbar disc herniation, was conducted in the period from January 2016 through January 2021. The follow-up continued till December 2021. All patients suffered from single level lumbar disc herniation and were treated with Posterior Lumbar Interbody Fusion with a single unilateral stand-alone PEEK cage without pedicle screw fixation.ResultsThe affected levels were L2–3 in 2 cases, L3–4 in 8 cases, L4–5 in 18 cases and L5–S1 in 12 cases. On 18th month follow-up, significant decrease in leg pain, LBP and ODI scores was detected (p < 0.001).ConclusionsThis technique produced satisfying clinical enhancement in residual LBP, accepted radiological outcome such as maintaining the proper intervertebral disc space and prevention of recurrent disc herniation.

Outcome of Multilevel Anterior Cervical Discectomy and Fusion without plating

Background &amp; objectives: The safety and efficacy profile of stand-alone polyetheretherketone cages has been questioned in the management of patients with more than one cervical disc disease. In this article, we evaluated the idea of safety of multilevel anterior cervical discectomy and fusion, without using a plate and the achieved pain relief. Methods: In this study, retrospectively we reviewed 30 patients diagnosed with multilevel cervical disc disease (total 69 segments) due to degenerative changes, disc herniation, and/or osteophyte formation. They complained of axial neck pain and/or radiculopathy not responding to non-surgical measures. All the included subjects treated for more than one-disc disease using stand-alone polyetheretherketone. With minimum 2-years of regular, clinical and radiological follow up. We have assessed the patient for criterions defined for cage subsidence and protrusion, as well as pain assessment pre and postoperatively using the visual analog score. Results: we assessed 22 patients (73.3%) for two level pathology and 8 patients (26.7%) with three level diseases. Mean age was 48.2±8.9 years. Female to male ratio was (1.1:1). The most common segment involved was C5-6 segment in 83.3%. The pre-operative visual Analogue Score for axial neck pain 6.3±3.05 and radiculopathy 6.8±2.2 was decreased post-operatively to 2±1.3 points respectively. Subsidence and protrusion assessed by measurement of serial X rays and one patient 3.3% developed subsidence in 2 adjacent levels which is statistically not significant. No incidence of cage protrusion was detected. Conclusions: Multilevel anterior cervical discectomy and fusion without plating provide good fusion, low subsidence rate, stability provided by the cage with excellent pain improvement.

Single-Level Anterior Cervical Discectomy and Interbody Fusion: A Comparison between Porous Tantalum and Polyetheretherketone Cages.

Background: Anterior cervical discectomy and interbody fusion (ACDF) may be performed with different kinds of stand-alone cages. Tantalum and polyetheretherketone (PEEK) are two of the most commonly used materials in this procedure. Few comparisons between different stand-alone implants for ACDF have been reported in the literature. Methods: We performed a comparison between patients who underwent ACDF with either a porous tantalum or a PEEK stand-alone cage, in two spine surgery units for single-level disc herniation. Clinical outcome [Neck Disability Index (NDI), Visual Analog Scale (VAS) for pain, Short Form-36 (SF-36)] and radiological outcome (lordosis, fusion and subsidence) were measured before surgery and at least one year after surgery in both groups. Results: Thirty-eight patients underwent ACDF with a porous tantalum cage, and thirty-one with a PEEK cage. The improvement of NDI and SF-36 was significantly superior in the PEEK group (p = 0.002 and p = 0.049 respectively). Moreover, the variation of the Cobb angle for the cervical spine was significantly higher in the PEEK group (p < 0.001). Conclusions: In a retrospective analysis of two groups of patients with at least one year of follow-up, a stand-alone PEEK cage showed superior clinical results, with improved cervical lordosis, compared to a stand-alone porous tantalum cage. Further studies are needed to confirm these data.

The Effect of Hounsfield Unit Value with Conventional Computed Tomography and Intraoperative Distraction on Postoperative Intervertebral Height Reduction in Patients Following Stand-Alone Anterior Cervical Discectomy and Fusion.

ObjectiveThe most common complication of anterior cervical discectomy and fusion (ACDF) is cage subsidence and maintenance of disc height affects postoperative clinical outcomes. We considered cage subsidence as an inappropriate indicator for evaluating preservation of disc height. Thus, this study aimed to consider patients with complications such as reduced total disc height compared to that before surgery and evaluate the relevance of several factors before ACDF. MethodsWe retrospectively reviewed the medical records of 40 patients who underwent stand-alone single-level ACDF using a polyetheretherketone (PEEK) cage at our institution between January 2012 and December 2018. Our study population comprised 19 male and 21 female patients aged 24–70 years. The minimum follow-up period was 1 year. Twenty-seven patients had preoperative bone mineral density (BMD) data on dual-energy X-ray absorptiometry. Clinical parameters included sex, age, body mass index, smoking history, and prior medical history. Radiologic parameters included the C2-7 cobb angle, segmental angle, sagittal vertical axis, disc height, and total intervertebral height (TIH) at the preoperative and postoperative periods. Cage decrement was defined as the reduction in TIH at the 6-month follow-up compared to preoperative TIH. To evaluate the bone quality, Hounsfield unit (HU) value was calculated in the axial and sagittal images of conventional computed tomography. ResultsLumbar BMD values and cervical HU values were significantly correlated (r=0.733, p<0.001). We divided the patients into two groups based on cage decrement, and 47.5% of the total patients were regarded as cage decrement. There were statistically significant differences in the parameters of measuring the HU value of the vertebra and intraoperative distraction between the two groups. Using these identified factors, we performed a receiver operating characteristic (ROC) curve analysis. Based on the ROC curve, the cut-off point was 530 at the HU value of the upper cortical and cancellous vertebrae (p=0.014; area under the curve [AUC], 0.727; sensitivity, 94.7%; specificity, 42.9%) and 22.41 at intraoperative distraction (p=0.017; AUC, 0.722; sensitivity, 85.7%; specificity, 57.9%). Using this value, we converted these parameters into a bifurcated variable and assessed the multinomial regression analysis to evaluate the risk factors for cage decrement in ACDF. Intraoperative distraction and HU value of the upper vertebral body were independent factors of postoperative subsidence. ConclusionInsufficient intraoperative distraction and low HU value showed a strong relationship with postoperative intervertebral height reduction following single stand-alone PEEK cage ACDF.

75. Evaluation of cage subsidence in standalone lateral lumbar interbody fusion: Novel 3D printed titanium versus polyetheretherketone (PEEK) cage

<h3>BACKGROUND CONTEXT</h3> Lateral lumbar interbody fusion (LLIF) is a common treatment for degenerative spine diseases. However, implant subsidence is a prevalent complication especially in stand-alone cases, which can negatively affect patient outcomes. The novel 3D-printed titanium (Ti) cages with porous architecture are reportedly more osteoconductive, maximize bone-to-implant contact, and have more compressive shear strength under physical force. Nevertheless, the subsidence rate of these new Ti cages compared to polyetheretherketone (PEEK) cages has not been investigated in standalone cases. <h3>PURPOSE</h3> This study aims to compare the early subsidence rate (6-12 months) of standalone Ti vs PEEK interbody cages after LLIF. <h3>STUDY DESIGN/SETTING</h3> Retrospective study. <h3>PATIENT SAMPLE</h3> A total of 113 patients and 186 levels. <h3>OUTCOME MEASURES</h3> Early cage subsidence. <h3>METHODS</h3> A retrospective study of 113 patients (186 levels) who underwent LLIF surgery with Ti or PEEK cages was conducted. Early subsidence was measured in each treated level using the Marchi et al. classification in radiographs or CT scans acquired at 6-12 months follow-up. Multivariate logistic regression analyses with generalized mixed models, setting subsidence as the outcome variable and including cage type (Ti vs PEEK) as well as significant and trending variables (p<0.10) in univariate analyses, was conducted. <h3>RESULTS</h3> In total, 51 female and 62 male patients were analyzed. The median (IQR) age at surgery was 60.0 (51.0-70.0) years. Of the 186 levels, 119 levels were treated using PEEK and 67 levels with Ti cages. The overall subsidence rate for Grades I-III was significantly less in the Ti vs the PEEK group (p=0.003). For high-grade subsidence (Grade II or III), Ti cages also demonstrated a subsidence rate (3.0%) that was significantly less compared to PEEK cages (18.5%)(p= 0.002). Multivariate analysis showed that patients treated with Ti cages were less likely to develop severe subsidence compared to those treated with PEEK (OR= 0.05, 95%CI= 0.01, 0.30)(p= 0.001). <h3>CONCLUSIONS</h3> Our study demonstrated that 3D-printed novel Ti cages had a significantly lower early subsidence rate compared to PEEK cages in standalone LLIF patients. <h3>FDA DEVICE/DRUG STATUS</h3> Titanium and PEEK Cage (Approved for this indication).

Comparative Study between Anterior Cervical Discectomy and Fusion by Standalone Polyetheretherketone Cages and Tricortical Bone Graft with Anterior Plate Fixation for Cervical Spondylotic Myeloradiculopathy

Background: Cervical spondylotic myeloradiculopathy is a common cause of neck pain and radiating arm pain. It develops when one or more of the intervening discs in the cervical spine starts to break down by wear and tear due to its degeneration. Multiple fixation modalities are used in Anterior Cervical Discectomy and interbody Fusion (ACDF), with their positive and negative sides Objectives: The objective of the study is to compare the safety and efficacy of ACDF by standalone Polyetheretherketone (PEEK) cages with tricortical bone graft with anterior plate fixation for cervical spondylotic myeloradiculopathy. Methods: This prospective observational study was conducted in the Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2017 to June 2020. Forty patients with cervical spondylotic myeloradiculopathy diagnosed on the basis of presenting complaints, clinical examination, and investigations were enrolled in this study. Modified Odom’s criteria, visual analog scale (VAS), Nurick Grading, and Bridwell criteria for cervical spondylotic myelopathy was used for evaluation of the results. Result: Male were predominant in this study. Male-female ratio was 2.9: 1. Most of the patients were farmer (30%), C5/6 (55%) was the most commonly involved disc level. Most of the patients had clinical features of neck pain, gait difficulty, and myelopathy sign. Regarding perioperative complications transient dysphagia was seen in 5 (12.5%) patients and transient paraparesis was observed in 2 (5%) patients. Post-operative complications were paresthesia and wound infection seen in significant number of patients of both groups who were recovered within 3–6 months. According to Bridwell’s grade of fusion, Grade I fusion was observed in 16 patients (80%) in cage group and 18 patients (90%) in tricortical Indocyanine Green (ICG) with plate group. According to VAS, postoperatively pain was gradually decline and after 12 months, 12 patients (60%) patients were found in no pain group and 11 patients (55%) were found in no pain group of the tricortical ICG with plate group. There was no significant difference between the two groups (P = 0.04). According to modified Odom’s criteria functional outcome after 12 months was excellent in 18 patients (90%) and good in 2 patients (10%) in cage group and excellent in 17 patients (85%) and good in 3 patients (15%) in tricortical ICG with plate group. There was no statistically significant difference between two groups (P = 0.432). Conclusion: ACDF is the ideal technique for the treatment of cervical spondylotic myeloradiculopathy with excellent functional outcome and good fusion which could be achieved by either standalone PEEK cage or tricortical ICG with plate and there is no significant difference between two techniques. Keywords: Cervical spondylotic myeloradiculopathy, Tricortical bone graft, Anterior cervical discectomy and fusion.

EVALUATION OF CLINICAL OUTCOME OF FOUR LEVELS ANTERIOR CERVICAL DISCECTOMY

Background: The modern paradigm for managing cervical disc diseases uses both ventral and dorsal approaches, with ventral procedures being more common. The ventral procedures consist primarily of discectomy, followed by fusion. The symptoms and syndromes of cervical disc diseases can be mimicked by a number of other neurological disorders. Objective: To evaluate the efficacy of polyetheretherketone (PEEK) cage only in four levels anterior cervical discectomy as one of surgical option other than anterior cervical corpectomy, fixation by plat or posterior approach for cervical laminectomy, and assessment of post spinal surgery pain. Patients and Methods: This was a prospective study including twenty adult patients with symptomatic four levels cervical disc disease operated upon by anterior cervical discectomy with inter-body cage fusion in the Neurosurgery Department at Al-Hussein University Hospital and Sednawy Health Insurance Hospital. The study was performed through the period from January 2018 to June 2020, and the follow up period was 24 months. Results: At the time of diagnosis, the most common symptoms presented were neck pain, brachialgia, heaviness of the lower limbs, and urinary incontinence. All patients were managed by anterior cervical discectomy and fusion by stand-alone PEEK cages for four levels. The mean preoperative visual analogue score (VAS) was 6.05± 1.14 and reached 2.15 ± 0.58 by the 24th month postoperative. Conclusion: The procedure of multi-level anterior cervical discectomy with PEEK inter body cage fusion without plate fixation at four levels appeared safe and efficient, with improvement in long-term outcomes for pain and myelopathy, short inpatient hospital stay, and potentially short procedure duration.

Anterior Cervical Microdiscectomy and Fusion using Stand-Alone Polyetheretherketone Cage: A Retrospective Study

Introduction: Anterior Cervical Discectomy and Fusion (ACDF) constitutes the standard mode of treatment for cervical disc herniation due to degeneration. Stand-alone cage can be considered as effective treatment for single and two level disc prolapse. Aim: To examine the clinical outcomes of ACDF using stand- alone Polyetheretherketone (PEEK) cage in a single centre. Materials and Methods: This retrospective study was conducted from July 2015 to Dec 2020 in 224 consecutive patients who underwent successful ACDF using self-locking stand-alone PEEK cage, study was done at Shri Dharmasthala Manjunatheshwara tertiary care hospital, Dharwad, Karnataka, India for radiculopathy or myelopathy due to cervical degenerative disc disease. Data analysis was done upto March 2021. The patients were analysed with Visual Analogue Scale (VAS) pain score for neck and arm pain and Nurick grade preoperatively and at 3 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological evaluation. This study was statistically analysed using the Statistical Package for the Social Sciences (SPSS version 13.0) (IBM, Chicago, IL). Results: Out of 244, (73%)164 patients underwent single level ACDF and sixty (27%) two-level ACDF. The mean age of patients was 45.86±12.07. It included 146 (65.2%) males and 78 (34.8%) female patients. In this study, the mean VAS neck score preoperatively was 4.04 and at 3 months postoperatively was 1.66 which was statistically significant (p&lt;0.001). Even in VAS arm scores, there was a statistical significant difference (p&lt;0.001) between preoperative (7.25) and 3 months postoperative (1.63) scores. The mean Nurick grade preoperatively was 1.46 vs 0.40 postoperatively which was statistically significant (p&lt;0.001). No implant related complications or adjacent level disease was noted. Conclusion: This study demonstrated that treatment of cervical degenerative disc disease by ACDF withstand alone PEEK cage is an effective and safe method.

Evaluation of Bone Fusion and Clinical Outcome of a Stand-Alone Polyether Ether Ketone Cage Filled with Biphasic Calcium Phosphate Used in One Level Anterior Cervical Discectomy and Fusion

Evaluation of Bone Fusion and Clinical Outcome of a Stand-Alone Polyether Ether Ketone Cage Filled with Biphasic Calcium Phosphate Used in One Level Anterior Cervical Discectomy and Fusion

Cervical stand-alone PEEK cage versus anchored cage with screws in single-level anterior cervical discectomy and fusion: A prospective cohort study

Background: Anterior cervical discectomy and fusion (ACDF) is a gold standard procedure for surgical management of symptomatic cervical degenerative disc disease. Traditionally, iliac crest bone graft was used as a strut graft to fill the disc space after discectomy. However, several complications have been observed, including donor site hematoma, infection, and pain. A cage can be used as an alternative, but cage dislodgement can be a devastating complication. Some surgeons advocate plate application to augment the cage construct, but the incidence of dysphagia is much higher with longer operative times. An anchored cage with screws could reduce postoperative dysphagia and simultaneously fix the cage. This study compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage with the anchored cage with screws for single-level ACDF. Methods: This prospective study was conducted in 50 patients who underwent single-level ACDF for cervical degeneration, with radiculopathy or myelopathy, from January, 2012, to January, 2014, at a single institution. Follow-up was 2 yr. Twenty-one patients were allocated to the stand-alone cage group (group 1) and 29 to the anchored cage with screws group (group 2). The Neck Disability Index (NDI), Visual Analogue Scale (VAS) of the arm and neck, radiographic segmental cervical angle (CA), and disc height assessments were done preoperatively, at 6 mo, and at 2 yr postoperatively. Results: Clinical outcomes showed improvement in both groups. The change between final follow-up (24 mo) and 6 mo postoperative CA (P=0.01) and disc height (P=0.02) showed statistically better outcomes for the anchored cage group (group 2) than the stand-alone cage group (group 1). The VAS showed significant pain improvement in the stand-alone group (group 1) than in the anchored cage with screws group (group 2) at 2 yr. The NDI difference was highly significant (P=0.001) preoperatively and at 6 mo postoperatively in favor of group 2, but this did not persist at 2-year follow-up. Conclusions: For one-level ACDF, the anchored cage with screws has some advantage compared to the stand-alone PEEK cage in avoiding dysphagia and restoring disc space height and cervical lordosis. We suggest the anchored spacer may be a good substitute for the stand-alone cage in one-level ACDF. Level of Evidence: Level II

Stand-alone polyetheretherketone cages for anterior cervical discectomy and fusion for successive four-level degenerative disc disease without plate fixation.

Background:Anterior cervical discectomy with fusion became the most frequently performed technique for the treatment of symptoms related to cervical disc prolapse. Multilevel anterior cervical discectomy has been combined with anterior cervical plate application to help maintain the cervical lordosis and enhance fusion. This was associated with more soft-tissue separation and retraction with increased incidence of surgically related complications and postoperative dysphagia.Aim of the Study:The aim of this study is to evaluate the safety and efficacy of the stand-alone cervical polyetheretherketone (PEEK) cages in four-level discectomy and to determine if it is possible to avoid anterior plate fixation and to achieve satisfactory outcomes.Methodology:This is a retrospective study which was performed between June 2011 and December 2018 at one institute. The clinical and radiological data were collected from patients who underwent successive four-level anterior cervical discectomy and fusion with PEEK cages for degenerative cervical disc disease without plate fixation.Results:This study included 66 patients, 35 males and 31 females. The follow-up period was 24 months. Mean Japanese Orthopedic Association scores were 13.3 ± 1.41 preoperative and 15.9 ± 0.86 postoperative (P = 0.046). The cervical curvature index “Ishihara” (ICI) was 9.9 ± 5.90 preoperative and the mean of ICI was 10.5 ± 6.65 postoperative, which is insignificant, P = 0.7). The lordotic curvature according to these results was preserved till the end of the year and half of the follow-up period postoperative.Conclusion:Consecutive four-level anterior discectomy with PEEK cage interbody fusion without plate and screw is a safe and effective procedure in the absence of instability, and it may be a reliable alternative for the treatment of multilevel cervical disc.

Biomechanical evaluation of single- and multi-level anterior cervical discectomy and fusion with polyetheretherketone cages: radiological and clinical outcomes.

The aim of this study was to analyse the outcomes of single- and multi-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages, with particular emphasis on the risk of secondary adjacent segment disease. This retrospective study included 30 patients with single- or multi-level cervical disc herniation. Before the ACDF, and one year thereafter, the patients underwent clinical and radiological evaluation including determination of cervical pain severity with a numerical rating scale (NRS), and a survey with a Polish adaptation of the neck disability index questionnaire (NDI-PL). Biomechanical parameters of the cervical spine were determined using the Cobb method. One year after ACDF, all patients had achieved complete fusions, and 97% showed a significant reduction of pain severity. Also, a significant decrease in all NDI-PL indices was observed. A significant decrease in overall cervical spine mobility coexisted with a significant increase in the mobility of the segment above the one operated upon and a non-significant decrease in the mobility of the segment below. No statistically significant change was found in the intervertebral disc space height (IVH) above and below the operated segment, and no evidence of degeneration within the segments adjacent to the operated one was documented. One- and two-level ACDF with standalone PEEK cages provided high fusion rates. Surgical spondylosis contributed to a reduction of spinal mobility despite the hypermobility in adjacent spinal segments. No degeneration in adjacent spinal segments was documented within a year of ACDF, and the treatment seemed to improve patients' quality of life.

Stand-Alone Cervical Cages in 2-Level Anterior Interbody Fusion in Cervical Spondylotic Myelopathy: Results from a Minimum 2-Year Follow-up.

Study DesignA retrospective review of patients who underwent 2-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages for cervical spondylotic myelopathy (CSM).Purpose To evaluate the efficacy of stand-alone PEEK cage in 2-level cervical interbody fusion for CSM.Overview of LiteratureACDF is a standard surgical procedure to treat degenerative disc disease. However, the use of additional anterior plating for 2-level ACDF remains controversial.MethodsWe reviewed outcomes of patients who underwent 2-level ACDF with stand-alone PEEK cages for CSM over a 7-year period (2007–2015) in a regional hospital. Japanese Orthopaedic Association (JOA) score, fusion rate, subsidence rate, cage migration, and cervical alignment by the C2–7 angle as well as the local segmental angle (LSA) of the cervical spine were assessed.ResultsIn total, 31 patients (mean age, 59 years; range, 36–87 years) underwent 2-level ACDF with a cage-only construct procedure between 2007 and 2015. The minimum follow-up was 24 months; mean follow-up was 51 months. C3–5 fusion was performed in 45%, C4–6 fusion in 32%, and C5–7 fusion in 23%. Mean JOA score improved from 10.1±2.2 to 13.9±2.1 (p<0.01) at the 24-month follow-up. Fusion was achieved in all patients. Subsidence occurred in 22.5% of the cages but was not associated with differences in JOA scores, age, sex, or levels fused. Lordosis of the C2–7 angle and LSA increased after surgery, which were maintained for up to 1 year but subsequently disappeared after 2 years, yet the difference was not statistically significant. No cage migration was noted; two patients developed adjacent segment disease requiring posterior laminoplasty 3 years after ACDF.ConclusionsThe use of a stand-alone PEEK cage in a 2-level cervical interbody fusion achieves satisfactory improvements in both clinical outcomes and fusion.

Cervical sagittal alignment as a predictor of adjacent-level ossification development.

PurposeTo explore the role of cervical sagittal alignment in the occurrence of adjacent-level ossification development (ALOD) in patients who underwent anterior cervical discectomy fusion with self-locking stand-alone polyetheretherketone cage, and the relationship between cervical sagittal alignment and clinical outcomes.BackgroundBecause of its advantages, anterior cervical plating systems have been used as the classic surgical method in the treatment of patients with cervical disc herniation. However, the proximity (<5 mm) of the plate to the adjacent disc space has proven to be a critical risk factor for ALOD. How cervical sagittal alignment influences the development of ALOD is unknown and its role in ALOD needs clarification.Patients and methodsOne hundred and eighteen adults who underwent anterior cervical discectomy fusion with self-locking stand-alone polyetheretherketone cage for cervical radiculopathy or myelopathy between December 2013 and December 2015 were retrospectively recruited. Of these, 15 patients developed ALOD and 103 patients did not, representing two groups for comparison. The cervical sagittal parameters were measured, including C2–C7 Cobb angle (Cobb), fused segment angle, cervical tilt (CT), T1 slope (T1S) and C2–C7 sagittal vertical axis. Clinical outcomes and efficacy were evaluated using a visual analog scale, Japanese Orthopedic Association (JOA) score and neck disability index (NDI) score before and after surgery.ResultsThere were no significant differences in patient demographics between the two groups. Cobb value (P<0.05), CT (P<0.05) and T1S (P<0.05) were significantly different between the two groups, while fused segment angle (P>0.05) and C2–C7 sagittal vertical axis (P>0.05) showed no difference. Compared with preoperative scores, improvement was seen in postoperative visual analog scale, JOA and NDI scores at each time point (P<0.05). However, the postoperative scores at 24 months in the NO-ALOD group indicated greater improvements compared with the ALOD group (P<0.05). There were significant correlations between Cobb and CT (r=0.607, P<0.05) and CT and T1S (r=0.681, P<0.05). Also, T1S was significantly correlated with clinical outcomes (JOA: r=0.689, P<0.05; NDI: r=−0.710, P<0.05).ConclusionMaintaining a lordotic cervical sagittal alignment was related to a lower risk of ALOD and improved clinical outcomes.

Comparative Study of Functional Outcome of Anterior Cervical Decompression and Interbody Fusion With Tricortical Stand-Alone Iliac Crest Autograft Versus Stand-Alone Polyetheretherketone Cage in Cervical Spondylotic Myelopathy.

Study Design:Retrospective analysis of prospectively collected data.Objective:The aim of the study was to compare the outcome of anterior cervical decompression and fusion (ACDF) with stand-alone tricortical iliac crest autograft versus stand-alone polyetheretherketone (PEEK) cage in cases of cervical spondylotic myelopathy.Methods:Prospectively collected data of 60 patients in each group were compared.Results:There was statistically significant improvement noted in postoperative Modified Japanese Orthopaedic Association (MJOA) follow-up scores with comparison pairs of preoperative versus 6 months, preoperative versus 1 year, and 3 months versus 6 months, 3 months versus 1 year in both groups. But improvements in MJOA scores were statistically insignificant between 6 months and 1 year (P = .0639) for the autograft group when compared with PEEK cage group (P = 0001). The mean loss of segmental lordosis on follow-up X-ray for the autograft group was (5.89 ± 2.90°), which was significantly higher (1.88 ± 2.77°) than the mean loss seen in the PEEK cage group (P = .01). This was most evident between 6 months and 1 year, resulting in plateauing of the improvement in MJOA score between 6 months to 1 year in the autograft group. While there was no statistical difference between fusion rates between the groups for 1 and 2 levels of ACDF, overall fusion rates were significantly better for 1-level ACDF (95.74%) when compared with 2-level ACDF (76.00%).Conclusion:ACDF with PEEK cage is the fusion technique of choice for cervical fusion with fewer complications and better functional recovery in the treatment of cervical spondylotic myelopathy.

No correlation between radiological and clinical outcome 1year following cervical arthrodesis.

To correlate clinical and radiological outcome following one- and two-level anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK) cages filled with demineralized bone matrix (DBM). We performed a retrospective review of a consecutive patient cohort with degenerative disc disease that underwent ACDF with stand-alone PEEK cages filled with demineralized bone matrix (DBM) between 2010 and 2013 with a minimum follow-up of 12months. Changes in the operated segments were measured and compared to radiographs directly after surgery. Clinical outcome was evaluated by a physical examination, pain by visual analog scale (VAS) for arm and neck. Health-related quality of life was measured using the EuroQOL questionnaire (EQ-5D). Of 282 consecutive cases, follow-up data were obtained from 194 (69%) cases. The median age at presentation was 54years and 91 patients were male (46%). Ninety-eight and 96 patients had one- and two-level surgeries, respectively. Mean VAS pain was reduced from 5.2 ± 3.6 to 2.6 ± 2.4 (p < 0.001) and from 5.8 ± 3.3 to 2.1 ± 2.7 (p < 0.001) in the myelopathy and radiculopathy group, respectively. Fusion was achieved in 79 and 82% of segments in one- and two-level surgeries, respectively. Cervical alignment was better in 10 and 1%, similar in 68 and 76%, worse in 23 and 23% in one- and two-level surgeries, respectively. Subsidence was observed in 44 and 34% of segments in one- and two-level surgeries, respectively. Follow-up operations due to symptomatic adjacent disc disease or implant failure were needed in 13 (7%) and 15 (8%) of cases, respectively. Subsidence, adjacent disc disease, and cervical alignment all had no influence on the clinical outcome. The clinical outcome after ACDF with PEEK cages filled with demineralized bone matrix is highly satisfactory. Radiological signs of non-fusion, subsidence, and cervical alignment have no influence on clinical outcome.

The mini-open anterolateral lumbar interbody fusion (MO-ALLIF) with self-anchored stand-alone cage in lumbar revision surgery

Objective To evaluate the safety and efficacy of the mini-open anterolateral lumbar interbody fusion (MO-ALLIF) in lumbar revision surgery. Methods Seventeen patients, seven male and ten female, who underwent revision lumbar surgeries using MO-ALLIF with self-anchored stand-alone polyetheretherketone (PEEK) cage in a single center between April 2013 and April 2016 were studied retrospectively. There were 14 of sing-level cases and 3 of double-level cases. Among them, 11 cases were L4, 5, 4 cases were L3, 4, 5 cases were L5S1. There were 2 cases of cage migration, 3 cases of pseudarthrosis, 6 cases of recurrent lumbar disc herniation of the same level, and 6 cases of lumbar disc herniation on the adjacent level. The average age was 53.9±7.2 years (range, 41-65 years). The clinical manifestation was low back pain and/or leg pain. The operation time, blood loss, and perioperative complications were evaluated. Oswestry disability index (ODI) and visual analog scale (VAS) score of leg and back pain were analyzed preoperatively and at each time point of follow-up postoperatively. Radiological evaluation including fusion, global lumbar lordosis, disc height on the operation level, foraminal height on the operation level, and subsidence were assessed. Results The average follow-up time was 22.7±8.6 months (12-48 months) . Among the seventeen patients that participated in this study with a total of 20 segments, only one patient suffered from peritoneal rupture, but no symptom was observed after suturing. No other approach-related complications were found in all cases. The mean operation time was 74.0±15.5 minutes. The average blood loss was 122.4±28.8 ml. All patients involved achieved solid fusion at the last follow-up (12 months post-operation) with no cage migration. Significant differences were observed between the pre- and post-operation status, with respect to the back pain VAS, leg pain VAS and ODI scores. The post-operative lumbar lordosis, disc height on the operation level and foraminal height on the operation level, were also significantly improved when compared with the pre-operative ones. Conclusion MO-ALLIF with self-anchored stand-alone PEEK cage is a modification of both anterior lumbar interbody fusion and oblique lumbar interbody fusion, which is safe and effective in some revision lumbar surgery with minor surgical trauma, low access-related complication rates, and satisfactory clinical and radiological results. Key words: Lumbar vertebrae; Treatment failure; Reoperation; Spinal fusion

Is stand alone PEEK cage the gold standard in multilevel anterior cervical discectomy and fusion (ACDF)? Results of a minimum 1-year follow up

IntroductionThis study was designed to evaluate the clinical and radiologic results of stand-alone synthetic polyetheretherketone (PEEK) cages for two- or three-level anterior cervical discectomy and fusion (ACDF), with a focus on subsidence. Materials and methodsWe retrospectively reviewed a total of 68 patients who underwent two- or three-level ACDF with a stand-alone PEEK cage between April 2005 and August 2016. Radiologic parameters were assessed on lateral radiographs, and fusion was assessed on computed tomography scans. For the evaluation of clinical outcomes, visual analogue scale, neck disability index, and modified Japanese Orthopedic Association scores were measured. ResultsAmong the total of 68 patients with a total of 144 segments, ACDF at two and three levels was performed in 60 and 8 patients, respectively, with a mean follow-up duration of 27.6 months. The overall fusion rate was 81.3% (117 of 144 segments), and subsidence occurred in 63 segments (43.8%) at the last follow-up. There was no statistically significant difference between the subsidence group and the nonsubsidence group in terms of fusion rate, radiologic outcomes, and clinical outcomes (p > .05). ConclusionSubsidence might be an inevitable course and only a radiologic phenomenon with no effect on the clinical and radiologic outcomes of the use of stand-alone cages.