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Acta Neurochirurgica

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01-02-2016 | Clinical Article - Spine

Clinical and radiological outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages

Authors: Ehab Shiban, Karina Gapon, Maria Wostrack, Bernhard Meyer, Jens Lehmberg

Published in: Acta Neurochirurgica | Issue 2/2016

Abstract

Objective

To evaluate long-term results after one-, two-, and three-level anterior cervical discectomy and fusion (ACDF) with stand-alone empty polyetheretherketone (PEEK) cages.

Methods

We performed a retrospective review of a consecutive patient cohort that underwent ACDF with stand-alone empty PEEK cages between 2007 and 2010 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 to 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). Analysis of associations between fusion, subsidence, cervical alignment, and clinical outcome parameters were performed.

Results

Of 407 consecutive cases, 318 met all inclusion criteria. Follow-up data were obtained from 265 (83 %) cases. The mean age at presentation was 55 years and 139 patients were male (52 %). In the sample, 127, 125, and 13 patients had one-, two-, and three-level surgeries, respectively; 132 (49 %) presented with spondylotic cervical myelopathy and 133 (50 %) with cervical radiculopathy. Fusion was achieved in 85, 95, and 94 % of segments in one-, two-, and three-level surgeries, respectively. Non-fusion was associated with higher VAS pain levels. Radiographic adjacent segment disease (ASD) was observed in 20, 29, and 15 % in one-, two-, and three-level surgeries, respectively. ASD was associated with lower HRQL. Subsidence was observed in 25, 27, and 15 % of segments in one-, two-, and three-level surgeries, respectively. However, this had no influence on clinical outcome. Follow-up operations for symptomatic adjacent disc disease and implant failure at index level were needed in 16 (6 %) and four (1.5 %) cases, respectively. Younger age was associated with better clinical outcome. Multilevel surgery favored better myelopathy outcomes and fusion reduced overall pain. ASD worsened EuroQOL-Index values. Worsening of the cervical alignment induced arm pain.

Conclusions

One- and two-level ACDF with stand-alone empty PEEK cages achieved very high fusion rates and a low rate of follow-up operations. The rate of good clinical outcome is highly satisfactory. Younger age was the single most influential factor associated with better clinical outcome.

Anderson PA, Subach BR, Riew KD (2009) Predictors of outcome after anterior cervical discectomy and fusion: a multivariate analysis. Spine (Phila Pa 1976) 34:161–166CrossRef

Barsa P, Suchomel P (2007) Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 16:1395–1400PubMedPubMedCentralCrossRef

Bydon M, Xu R, De la Garza-Ramos R, Macki M, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A (2014) Adjacent segment disease after anterior cervical discectomy and fusion: incidence and clinical outcomes of patients requiring anterior versus posterior repeat cervical fusion. Surg Neurol Int 5:74–78CrossRef

Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S (2012) Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 13:172PubMedPubMedCentralCrossRef

Chagas H, Domingues F, Aversa A, Vidal Fonseca AL, de Souza JM (2005) Cervical spondylotic myelopathy: 10 years of prospective outcome analysis of anterior decompression and fusion. Surg Neurol 64:30–35CrossRef

Chen Y, Wang X, Lu X, Yang L, Yang H, Yuan W, Chen D (2013) Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J 22:1539–1546PubMedPubMedCentralCrossRef

Chou YC, Chen DC, Hsieh WA, Chen WF, Yen PS, Harnod T, Chiou TL, Chang YL, Su CF, Lin SZ, Chen SY (2008) Efficacy of anterior cervical fusion: comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci 15:1240–1245PubMedCrossRef

Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617PubMedCrossRef

Demircan MN, Kutlay AM, Colak A, Kaya S, Tekin T, Kibici K, Ungoren K (2007) Multilevel cervical fusion without plates, screws or autogenous iliac crest bone graft. J Clin Neurosci 14:723–728PubMedCrossRef

10.

Dufour T, Huppert J, Louis C, Beaurain J, Stecken J, Aubourg L, Vila T (2010) Radiological analysis of 37 segments in cervical spine implanted with a peek stand-alone device, with at least one-year follow-up. Br J Neurosurg 24:633–640PubMedCrossRef

11.

Ebersold MJ, Pare MC, Quast LM (1995) Surgical treatment for cervical spondylotic myelopathy. J Neurosurg 82:745–751PubMedCrossRef

12.

Ferch RD, Shad A, Cadoux-Hudson TA, Teddy PJ (2004) Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg 100:13–19PubMed

13.

Fujiwara K, Yonenobu K, Ebara S, Yamashita K, Ono K (1989) The prognosis of surgery for cervical compression myelopathy. An analysis of the factors involved. J Bone Joint Surg Br 71:393–398PubMed

14.

Gercek E, Arlet V, Delisle J, Marchesi D (2003) Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 12:513–516PubMedPubMedCentralCrossRef

15.

Gore DR, Sepic SB, Gardner GM (1986) Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976) 11:521–524CrossRef

16.

Handa Y, Kubota T, Ishii H, Sato K, Tsuchida A, Arai Y (2002) Evaluation of prognostic factors and clinical outcome in elderly patients in whom expansive laminoplasty is performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. A retrospective comparison with younger patients. J Neurosurg 96:173–179PubMed

17.

Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Haas JW, Holland B (2004) Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine 29:2485–2492PubMedCrossRef

18.

Hermansen A, Hedlund R, Vavruch L, Peolsson A (2013) Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10- to 13-year follow-up of a prospective randomized study: clinical article. J Neurosurg Spine 19:403–411PubMedCrossRef

19.

Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528PubMed

20.

Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4:190S–194SPubMedCrossRef

21.

Hwang SL, Lee KS, Su YF, Kuo TH, Lieu AS, Lin CL, Howng SL, Hwang YF (2007) Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease. J Spinal Disord Tech 20:565–570PubMedCrossRef

22.

Jacobs W, Willems PC, Kruyt M, van Limbeek J, Anderson PG, Pavlov P, Bartels R, Oner C (2011) Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine (Phila Pa 1976) 36:E950–960CrossRef

23.

Kaiser MG, Mummaneni PV, Matz PG, Anderson PA, Groff MW, Heary RF, Holly LT, Ryken TC, Choudhri TF, Vresilovic EJ, Resnick DK (2009) Joint section on disorders of the spine and peripheral nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Radiographic assessment of cervical subaxial fusion. J Neurosurg Spine 11:221–227PubMedCrossRef

24.

Karikari IO, Jain D, Owens TR, Gottfried O, Hodges TR, Nimjee SM, Bagley CA (2014) Impact of subsidence on clinical outcomes and radiographic fusion rates in anterior cervical discectomy and fusion: a systematic review. J Spinal Disord Tech 27:1–10PubMedCrossRef

25.

Katsuura A, Hukuda S, Saruhashi Y, Mori K (2001) Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324PubMedPubMedCentralCrossRef

26.

Kim CH, Chung CK, Hahn S (2013) Autologous iliac bone graft with anterior plating is advantageous over the stand-alone cage for segmental lordosis in single-level cervical disc disease. Neurosurgery 72:257–265PubMedCrossRef

27.

Kulkarni AG, Hee HT, Wong HK (2007) Solis cage (PEEK) for anterior cervical fusion: preliminary radiological results with emphasis on fusion and subsidence. Spine J 7:205–209PubMedCrossRef

28.

Laing RJ, Ng I, Seeley HM, Hutchinson PJ (2001) Prospective study of clinical and radiological outcome after anterior cervical discectomy. Br J Neurosurg 15:319–323PubMedCrossRef

29.

Maldonado CV, Paz RD, Martin CB (2011) Adjacent-level degeneration after cervical disc arthroplasty versus fusion. Eur Spine J 20:403–407PubMedPubMedCentralCrossRef

30.

Matsumoto M, Okada E, Ichihara D, Watanabe K, Chiba K, Toyama Y, Fujiwara H, Momoshima S, Nishiwaki Y, Iwanami A, Ikegami T, Takahata T, Hashimoto T (2010) Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study. Spine (Phila Pa 1976) 35:36–43CrossRef

31.

Mummaneni PV, Burkus JK, Haid RW, Traynelis VC, Zdeblick TA (2007) Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6:198–209PubMedCrossRef

32.

Naderi S, Ozgen S, Pamir MN, Ozek MM, Erzen C (1998) Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery 43:43–49PubMedCrossRef

33.

Niu CC, Liao JC, Chen WJ, Chen LH (2010) Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages. J Spinal Disord Tech 23:310–316PubMedCrossRef

34.

Nunley PD, Jawahar A, Kerr EJ 3rd, Gordon CJ, Cavanaugh DA, Birdsong EM, Stocks M, Danielson G (2012) Factors affecting the incidence of symptomatic adjacent-level disease in cervical spine after total disc arthroplasty: 2- to 4-year follow-up of 3 prospective randomized trials. Spine (Phila Pa 1976) 37:445–451CrossRef

35.

Park MS, Kelly MP, Lee DH, Min WK, Rahman RK, Riew KD (2013) Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J 14:1228–1234PubMedPubMedCentralCrossRef

36.

Payer M, May D, Reverdin A, Tessitore E (2003) 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):143–148PubMed

37.

Prasarn ML, Baria D, Milne E, Latta L, Sukovich W (2012) Adjacent-level biomechanics after single versus multilevel cervical spine fusion. J Neurosurg Spine 16:172–177PubMedCrossRef

38.

Peolsson A, Almkvist C, Dahlberg C, Lindqvist S, Pettersson S (2007) Age- and sex-specific reference values of a test of neck muscle endurance. J Manip Physiol Ther 30:171–177CrossRef

39.

Peolsson A, Peolsson M (2008) Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis. Eur Spine J 17:406–414PubMedPubMedCentralCrossRef

40.

Schils F, Rilliet B, Payer M (2006) Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study. J Neurosurg Spine 4:292–299PubMedCrossRef

41.

Thomé C, Krauss JK, Zevgaridis D (2004) A prospective clinical comparison of rectangular titanium cages and iliac crest autografts in anterior cervical discectomy and fusion. Neurosurg Rev 27:34–41PubMedCrossRef

42.

Topuz K, Colak A, Kaya S, Simşek H, Kutlay M, Demircan MN, Velioğlu M (2009) Two-level contiguous cervical disc disease treated with peek cages packed with demineralized bone matrix: results of 3-year follow-up. Eur Spine J 18:238–243PubMedPubMedCentralCrossRef

43.

Villavicencio AT, Babuska JM, Ashton A, Busch E, Roeca C, Nelson EL, Mason A, Burneikiene S (2009) Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery 68:1309–1316

44.

Wright IP, Eisenstein SM (2007) Anterior cervical discectomy and fusion without instrumentation. Spine (Phila Pa 1976) 32:772–774CrossRef

45.

Wu WJ, Jiang LS, Liang Y, Dai LY (2012) Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study. Eur Spine J 21:1374–1382PubMedPubMedCentralCrossRef

46.

Yamazaki T, Yanaka K, Sato H, Uemura K, Tsukada A, Nose T (2003) Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences. Neurosurgery 52:122–126PubMed

47.

Yu S, Li F, Yan N, Yuan C, He S, Hou T (2011) Anterior fusion technique for multilevel cervical spondylotic myelopathy: a retrospective analysis of surgical outcome of patients with different number of levels fused. PLoS ONE 9, e91329CrossRef

Title: Clinical and radiological outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages
Authors: Ehab Shiban
Karina Gapon
Maria Wostrack
Bernhard Meyer
Jens Lehmberg
Publication date: 01-02-2016
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 2/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-015-2630-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical and radiological outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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