Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Anterior Cervical Discectomy and Fusion Using a Stand-Alone Polyetheretherketone Cage Packed with Local Autobone : Assessment of Bone Fusion and Subsidence

  • Park, Jeong-Ill (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Cho, Dae-Chul (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Kim, Kyoung-Tae (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Sung, Joo-Kyung (Department of Neurosurgery, Kyungpook National University Hospital)
  • Received : 2013.03.29
  • Accepted : 2013.09.08
  • Published : 2013.09.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : It remains debatable whether cervical spine fusion cages should be filled with any kind of bone or bone substitute. Cortical and subcortical bone from the anterior and posterior osteophytes of the segment could be used to fill the cage. The purposes of the present study are to evaluate the clinical outcomes and radiological outcomes including bone fusion and subsidence that occurred after anterior cervical discectomy and fusion using a stand-alone cage packed with local autobone graft. Methods : Thirty-one patients who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage packed with local autobone graft from July 2009 to december 2011 were enrolled in this study. Bone fusion was assessed by cervical plain radiographs and computed tomographic scan. Nonunion was evaluated according to the absence of bony bridge on computed tomographic scan. Subsidence was defined as a ${\geq}2$ mm decrease of the interbody height at the final follow-up compared to that measured at the immediate postoperative period. Results : Subsidence was observed in 7 patients (22.6%). Of 7 patients with subsidence greater 2 mm, nonunion was developed in 3. Three patients with subsidence greater 2 mm were related with endplate damage during intraoperative endplate preparation. Solid bone fusion was achieved in 28 out of 31 patients (90.3%). Conclusion : With proper patient selection and careful endplate preparation, anterior cervical discectomy and fusion (ACDF) using a stand-alone PEEK cage packed with local autobone graft could be a good alternative to the standard ACDF techniques with plating.

Keywords

References

  1. Ba Z, Zhao W, Wu D, Shen B, Yu B, Wang Z : Box cages packed with local decompression bone were efficient in anterior cervical discectomy and fusion : five- to 10-year follow-up. Spine (Phila Pa 1976) 37 : E1260-E1263, 2012 https://doi.org/10.1097/BRS.0b013e318265df75
  2. Banwart JC, Asher MA, Hassanein RS : Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine (Phila Pa 1976) 20 : 1055-1060, 1995 https://doi.org/10.1097/00007632-199505000-00012
  3. Barsa P, Suchomel P : Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 16 : 1395-1400, 2007 https://doi.org/10.1007/s00586-006-0284-8
  4. Bartels RH, Donk R, van Azn RD : Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage. J Neurosurg 95 (1 Suppl) : 40-42, 2001
  5. Bartels RH, Donk RD, Feuth T : Subsidence of stand-alone cervical carbon fiber cages. Neurosurgery 58 : 502-508; discussion 502-508, 2006 https://doi.org/10.1227/01.NEU.0000197258.30821.50
  6. Castro FP Jr, Holt RT, Majd M, Whitecloud TS 3rd : A cost analysis of two anterior cervical fusion procedures. J Spinal Disord 13 : 511-514, 2000 https://doi.org/10.1097/00002517-200012000-00008
  7. Cloward RB : The anterior approach for removal of ruptured cervical disks. J Neurosurg 15 : 602-617, 1958 https://doi.org/10.3171/jns.1958.15.6.0602
  8. Fürderer S, Schöllhuber F, Rompe JD, Eysel P : [Effect of design and implantation technique on risk of progressive sintering of various cervical vertebrae cages]. Orthopade 31 : 466-471, 2002 https://doi.org/10.1007/s00132-001-0289-2
  9. Ha SK, Park JY, Kim SH, Lim DJ, Kim SD, Lee SK : Radiologic assessment of subsidence in stand-alone cervical polyetheretherketone (PEEK) cage. J Korean Neurosurg Soc 44 : 370-374, 2008 https://doi.org/10.3340/jkns.2008.44.6.370
  10. Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr : Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50 : 229-236; discussion 236-238, 2002
  11. Kast E, Derakhshani S, Bothmann M, Oberle J : Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial. Neurosurg Rev 32 : 207-214; discussion 214, 2009 https://doi.org/10.1007/s10143-008-0168-y
  12. Kulkarni AG, Hee HT, Wong HK : Solis cage (PEEK) for anterior cervical fusion : preliminary radiological results with emphasis on fusion and subsidence. Spine J 7 : 205-209, 2007 https://doi.org/10.1016/j.spinee.2006.03.002
  13. Lee CH, Hyun SJ, Kim MJ, Yeom JS, Kim WH, Kim KJ, et al. : Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion : stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech 26 : 112-118, 2013 https://doi.org/10.1097/BSD.0b013e318274148e
  14. Min WK, Bae JS, Park BC, Jeon IH, Jin HK, Son MJ, et al. : Proliferation and osteoblastic differentiation of bone marrow stem cells : comparison of vertebral body and iliac crest. Eur Spine J 19 : 1753-1760, 2010 https://doi.org/10.1007/s00586-010-1424-8
  15. Odom GL, Finney W, Woodhall B : Cervical disk lesions. J Am Med Assoc 166 : 23-28, 1958 https://doi.org/10.1001/jama.1958.02990010025006
  16. Papavero L, Zwönitzer R, Burkard I, Klose K, Herrmann HD : A composite bone graft substitute for anterior cervical fusion : assessment of osseointegration by quantitative computed tomography. Spine (Phila Pa 1976) 27 : 1037-1043, 2002 https://doi.org/10.1097/00007632-200205150-00008
  17. Payer M, May D, Reverdin A, Tessitore E : Implantation of an empty carbon fiber composite frame cage after single-level anterior cervical discectomy in the treatment of cervical disc herniation : preliminary results. J Neurosurg 98 (2 Suppl) : 143-148, 2003
  18. Pechlivanis I, Thuring T, Brenke C, Seiz M, Thome C, Barth M, et al. : Non-fusion rates in anterior cervical discectomy and implantation of empty polyetheretherketone cages. Spine (Phila Pa 1976) 36 : 15-20, 2011 https://doi.org/10.1097/BRS.0b013e3181cbf870
  19. Peelle MW, Rawlins BA, Frelinghuysen P : A novel source of cancellous autograft for ACDF surgery : the manubrium. J Spinal Disord Tech 20 : 36-41, 2007 https://doi.org/10.1097/01.bsd.0000211230.89554.5c
  20. Pitzen T, Kiefer R, München D, Barbier D, Reith W, Steudel WI : Filling a cervical spine cage with local autograft : change of bone density and assessment of bony fusion. Zentralbl Neurochir 67 : 8-13, 2006 https://doi.org/10.1055/s-2006-921404
  21. Shad A, Leach JC, Teddy PJ, Cadoux-Hudson TA : Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion : early technical experience. J Neurosurg Spine 2 : 116-122, 2005 https://doi.org/10.3171/spi.2005.2.2.0116
  22. Smith GW, Robinson RA : The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A : 607-624, 1958
  23. van Jonbergen HP, Spruit M, Anderson PG, Pavlov PW : Anterior cervical interbody fusion with a titanium box cage : early radiological assessment of fusion and subsidence. Spine J 5 : 645-649; discussion 649, 2005 https://doi.org/10.1016/j.spinee.2005.07.007
  24. Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A : A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine : a clinical and radiologic study. Spine (Phila Pa 1976) 27 : 1694-1701, 2002 https://doi.org/10.1097/00007632-200208150-00003
  25. Yang JJ, Yu CH, Chang BS, Yeom JS, Lee JH, Lee CK : Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage. Clin Orthop Surg 3 : 16-23, 2011 https://doi.org/10.4055/cios.2011.3.1.16

Cited by

  1. Risk factors for subsidence in anterior cervical fusion with stand-alone polyetheretherketone (PEEK) cages: a review of 82 cases and 182 levels vol.134, pp.10, 2013, https://doi.org/10.1007/s00402-014-2047-z
  2. Two-level anterior cervical discectomy and fusion using self-locking stand-alone polyetheretherketone cages with two anchoring clips placed in the upper and lower vertebrae, respectively vol.25, pp.suppl1, 2013, https://doi.org/10.1007/s00590-015-1613-6
  3. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population vol.2016, pp.None, 2016, https://doi.org/10.1155/2016/4654109
  4. Four-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy vol.24, pp.3, 2013, https://doi.org/10.1177/1602400313
  5. Anterior Cervical Discectomy and Fusion with Stand-Alone Trabecular Metal Cages as a Surgical Treatment for Cervical Radiculopathy: Mid-Term Outcomes vol.10, pp.2, 2013, https://doi.org/10.4184/asj.2016.10.2.245
  6. Clinical Outcomes of a Zero Profile Implant for Single-Level Anterior Cervical Discectomy and Fusion vol.23, pp.2, 2013, https://doi.org/10.4184/jkss.2016.23.2.71
  7. Autologous bone graft versus PEKK cage for vertebral replacement after 1- or 2-level anterior median corpectomy vol.24, pp.2, 2013, https://doi.org/10.3171/2015.5.spine14887
  8. Usefulness of Anterior Cervical Interbody Fusion Using Locally Harvested Bone: Minimum 5-Year Follow-Up vol.51, pp.3, 2013, https://doi.org/10.4055/jkoa.2016.51.3.191
  9. Vascularized Fibular Strut Autografts in Spinal Reconstruction after Resection of Vertebral Chordoma or Chondrosarcoma: A Retrospective Series vol.81, pp.1, 2013, https://doi.org/10.1093/neuros/nyw057
  10. Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter “PI vol.11, pp.1, 2013, https://doi.org/10.1186/s13037-017-0128-y
  11. Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: a systematic review vol.160, pp.4, 2018, https://doi.org/10.1007/s00701-018-3490-3
  12. Risk Factors of Cage Subsidence in Patients with Ossification of Posterior Longitudinal Ligament (OPLL) After Anterior Cervical Discectomy and Fusion vol.24, pp.None, 2013, https://doi.org/10.12659/msm.910964
  13. Risk Factors of Cage Subsidence in Patients with Ossification of Posterior Longitudinal Ligament (OPLL) After Anterior Cervical Discectomy and Fusion vol.24, pp.None, 2013, https://doi.org/10.12659/msm.910964
  14. Retrospective Analysis of Arthrodesis from Various Options after Anterior Cervical Discectomy vol.9, pp.1, 2018, https://doi.org/10.4103/jnrp.jnrp_366_17
  15. Four Levels Anterior Cervical Discectomy and Fusion by Stand Alone PEEK Cages vol.8, pp.2, 2018, https://doi.org/10.4236/ojmn.2018.82014
  16. Clinical and Radiological Outcomes of Anterior Approach Microscopic Surgery for the Pincer Mechanism in Cervical Spondylotic Myelopathy vol.2019, pp.None, 2013, https://doi.org/10.1155/2019/9175234
  17. Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review vol.28, pp.2, 2013, https://doi.org/10.1007/s00586-018-5820-9
  18. Feasibility of local bone dust as a graft material in anterior cervical discectomy and fusion vol.31, pp.4, 2019, https://doi.org/10.3171/2019.3.spine181416
  19. Feasibility of local bone dust as a graft material in anterior cervical discectomy and fusion vol.31, pp.4, 2019, https://doi.org/10.3171/2019.3.spine181416
  20. A Randomized Control Trial Comparing Local Autografts and Allografts in Single Level Anterior Cervical Discectomy and Fusion Using a StandAlone Cage vol.15, pp.6, 2021, https://doi.org/10.31616/asj.2020.0182