Comparison According to Fusion Level in ACDF Using PEEK Cage Alone for Degenerative Cervical Disease

Kyung-Jin Song; Kwang-Bok Lee; Ki-Bum Kim

doi:10.4055/jkoa.2011.46.5.364

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Song, Lee, and Kim: Comparison According to Fusion Level in ACDF Using PEEK Cage Alone for Degenerative Cervical Disease

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(5): 364-371.

Published online: 31 October 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.5.364

Comparison According to Fusion Level in ACDF Using PEEK Cage Alone for Degenerative Cervical Disease

Kyung-Jin Song, M.D., Kwang-Bok Lee, M.D., Ki-Bum Kim, M.D.

Department of Orthopedic Surgery, Chonbuk National University Medical School, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Jeonju, Korea.

Correspondence to: Kwang-Bok Lee, M.D. Department of Orthopedic Surgery, Chonbuk National University Medical School and Hospital, 634-18, Keumam-dong, Dukjin-gu, Jeonju 561-712, Korea. TEL: +82-63-250-2586, FAX: +82-63-271-6538, osdr2815@naver.com

Received 9 November 2010 Accepted 3 March 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study examined the clinical efficacy of an anterior cervical discectomy and fusion (ACDF) with PEEK (polyetheretherketone) cage alone with regard to the clinical and radiological outcomes, as well as the risk factors for the cage subsidence.

Materials and Methods

A total of 128 patients who underwent group A (1-level, n=48), group B (2-levels, n=57), group C (3-levels, n=23) ACDF using a PEEK cage alone were enrolled in this study. The fusion rate, segmental kyphosis were assessed by radiographs. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and Neck Disability Index (NDI). The risk factors for cage subsidence were analyzed according to the difference in incidence between the subsidence group and non-subsidence group.

Results

Solid fusion was achieved in 93.8% (45/48), 71.9% (41/57) and 69.6% (15/23) of subjects in group A, B and C, respectively. Segmental kyphosis was observed in 22.9% (11/48), 43.9% (25/57) and 47.8% (11/23) of subjects in group A, B and C, respectively. The VAS scores changed from 7.79±1.01 in group A, 7.74±1.09 in group B, 7.91±0.79 in group C preoperatively to 4.23±1.29 in group A, 5.25±1.34 in group B and 5.35±1.07 in group C at the last follow up. In addition, the NDI was also improved at the last follow up. The VAS score and NDI at the last follow up were similar in the subsidence and non-subsidence group. The 3-level ACDF (p=0.05), osteoporosis (p=0.01), and old age (p=0.01) were the risk factors for cage subsidence.

Conclusion

Only 1 level ACDF with PEEK cage alone was similar in clinical and radiologic (solid fusion rate, local kyphosis) outcomes compared to ACDF with published other modalities. Old age, 3 fusion level, osteoporosis, and C6-7 fusion were risk factors for the cage subsidence with higher complication rates.

Keywords: anterior cervical discectomy and fusion, cage alone, cage subsidence

Figures and Tables

Figure 1

A 52-year-old male status post ACDF with PEEK (Solis) cage alone at C6-C7, (A) postoperative plain lateral radiograph; (B) plain lateral radiograph 1.5 months postsurgery showing bone bridging; (C) plain lateral radiograph 2 years postsurgery showing normal alignment, no collapse and good consolidation of bone graft in the cage; (D) coronal CT image at 2 years postsurgery showing bony bridging (connection) and definite consolidation of graft-bone in the cage; (E) sagittal CT image at 2 years postsurgery.

Figure 2

Mean lordotic angle of fusion segment.

Figure 3

A 47-year-old male status post ACDF with PEEK (Solis) cage alone at C4-C5, 5-6, 6-7, (A) postoperative plain lateral radiograph; (B) plain lateral radiograph 2 years postsurgery showing cage subsidence and no bony consolidation of bone graft in the cage; (C) coronal CT image at 2 years postsurgery and (D) sagittal CT image at 2 years postsurgery showing no bony bridging (connection) in the graft-bone, and a vacant space in the cage (no bony tissue).

Figure 4

The trend of VAS score at the different follow up period.

Figure 5

The trend of NDI at the different follow up period.

Table 1

Demographic Data

^*Mean±SD.

Table 2

Fusion Rate and Time to Fusion

^*Post-hoc test (Tukey's multiple comparison test); Group A vs Group B, Group A vs Group C: significant; Group B vs Group C: not significant.

Table 3

Local Kyphotic Deformity and Cage Subsidence

Table 4

Risk Factors of Cage Subsidence

^*Levels of the subsidence/levels of the non-subsidence; ^†Numbers of subsidence/Numbers of non-subsidence; ^‡Post-operative disc height-pre-operative disc height; ^§Cobb angle of preoperative disc; ^∥Distance between anterior margin of vertebra and indicator of cage at the cervical lateral radiograph.

Table 5

Clinical Results vs. Cage Subsidence

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