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Published in: European Spine Journal 12/2012

01-12-2012 | Original Article

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

Published in: European Spine Journal | Issue 12/2012

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Abstract

Introduction

Three- or four-level anterior cervical discectomy and fusion with autograft and plate fixation have demonstrated relatively good fusion rates and outcomes, but donor site morbidity and the limitations of autograft harvest remain problematic. The purpose of this study is to assess the radiographic and clinical outcomes of three- or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct.

Methods

This retrospective review included 43 consecutive patients who underwent three- or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct (three level: 39 cases, four level: 4 cases). The fusion rate, time to fusion, Cobb angle and disc height were assessed radiographically. Clinical outcomes were evaluated with the VAS, NDI, and SF36 scores. Complications were also recorded.

Results

Solid fusion was achieved in all the patients, and mean time to fusion was 13.7 ± 5.1 weeks. The postoperative Cobb angle, lordotic angle, and disc height (5.6°, 10.5° and 3.15 mm, respectively) increased significantly compared to preoperative values (p = 0.038, p = 0.032, and p = 0.0004, respectively), and these improvements were maintained through final follow-up. The postoperative NDI (17.2), VAS (2.8), and SF36 (13.1) scores increased significantly compared to the preoperative scores (p = 0.026, p = 0.0007 and p = 0.041, respectively). Complications included three cases of respiratory difficulty, four cases of dysphagia and one case of hoarseness. There were no cases of donor site morbidity.

Conclusions

Three- or four-level anterior cervical discectomy and fusion with a PEEK cage, and plate construct provide good clinical and radiographic outcomes including high fusion rates, low complication rates, low donor site morbidity, and good maintenance of the lordotic angle and disc height in the treatment of multilevel cervical spondylosis.
Literature
1.
go back to reference Lowery GL, McDonough RF (1998) The significance of hardware failure in anterior cervical plate fixation. Patients with 2- to 7-year follow-up. Spine (Phila Pa 1976) 23:181–186CrossRef Lowery GL, McDonough RF (1998) The significance of hardware failure in anterior cervical plate fixation. Patients with 2- to 7-year follow-up. Spine (Phila Pa 1976) 23:181–186CrossRef
2.
go back to reference Malloy KM, Hilibrand AS (2002) Autograft versus allograft in degenerative cervical disease. Clin Orthop Relat Res 394:27–38PubMedCrossRef Malloy KM, Hilibrand AS (2002) Autograft versus allograft in degenerative cervical disease. Clin Orthop Relat Res 394:27–38PubMedCrossRef
3.
go back to reference Bolesta MJ, Rechtine GR, Chrin AM (2000) Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine (Phila Pa 1976) 25:2040–2044CrossRef Bolesta MJ, Rechtine GR, Chrin AM (2000) Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine (Phila Pa 1976) 25:2040–2044CrossRef
4.
go back to reference Emery SE, Fisher JR, Bohlman HHN (1997) Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine (Phila Pa 1976) 22:2622–2624CrossRef Emery SE, Fisher JR, Bohlman HHN (1997) Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine (Phila Pa 1976) 22:2622–2624CrossRef
5.
go back to reference Song KJ, Lee KB (2006) A preliminary study of the use of cage and plating for single-segment fusion in degenerative cervical spine disease. J Clin Neurosci 13(2):181–187PubMedCrossRef Song KJ, Lee KB (2006) A preliminary study of the use of cage and plating for single-segment fusion in degenerative cervical spine disease. J Clin Neurosci 13(2):181–187PubMedCrossRef
6.
go back to reference Cho DY, Liau WR, Lee WY, Liu JT, Chiu CL, Sheu PC (2003) Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery 51(6):1343–1349 (discussion 1349–1350; Erratum in. Neurosurgery 52(3):693) Cho DY, Liau WR, Lee WY, Liu JT, Chiu CL, Sheu PC (2003) Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery 51(6):1343–1349 (discussion 1349–1350; Erratum in. Neurosurgery 52(3):693)
7.
go back to reference 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(2):205–209PubMedCrossRef 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(2):205–209PubMedCrossRef
8.
go back to reference Kawakami M, Tamaki T, Iwasaki H, Yoshida M, Ando M, Yamada H (2000) A comparative study of surgical approaches for cervical compressive myelopathy. Clin Orthop Relat Res 381:129–136PubMedCrossRef Kawakami M, Tamaki T, Iwasaki H, Yoshida M, Ando M, Yamada H (2000) A comparative study of surgical approaches for cervical compressive myelopathy. Clin Orthop Relat Res 381:129–136PubMedCrossRef
9.
go back to reference Guo Q, Bi X, Ni B et al (2011) Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis. Eur Spine J 20:1539–1544PubMedCrossRef Guo Q, Bi X, Ni B et al (2011) Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis. Eur Spine J 20:1539–1544PubMedCrossRef
10.
go back to reference Lin Q, Zhou X, Wang X, Cao P, Tsai N, Yuan W (2012) A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J 21:474–481PubMedCrossRef Lin Q, Zhou X, Wang X, Cao P, Tsai N, Yuan W (2012) A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J 21:474–481PubMedCrossRef
11.
go back to reference Uribe JS, Sangala JR, Duckworth EA, Vale FL (2009) Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up. Eur Spine J 18:654–662PubMedCrossRef Uribe JS, Sangala JR, Duckworth EA, Vale FL (2009) Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up. Eur Spine J 18:654–662PubMedCrossRef
12.
go back to reference Song KJ, Taghavi CE, Hsu MS, Lee KB, Kim GH, Song JH (2010) Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders. Eur Spine J 19:1677–1683PubMedCrossRef Song KJ, Taghavi CE, Hsu MS, Lee KB, Kim GH, Song JH (2010) Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders. Eur Spine J 19:1677–1683PubMedCrossRef
13.
go back to reference Gercek E, Arlet V, Delisle J, Marchesi D (2003) Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 12(5):513–516PubMedCrossRef Gercek E, Arlet V, Delisle J, Marchesi D (2003) Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 12(5):513–516PubMedCrossRef
14.
go back to reference Barsa P, Suchomel P (2007) Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 16(9):1395–1400PubMedCrossRef Barsa P, Suchomel P (2007) Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 16(9):1395–1400PubMedCrossRef
15.
go back to reference Schmieder K, Wolzik-Grossmann M, Pechlivanis I, Engelhardt M, Scholz M, Harders A (2006) Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine. 4(6):447–453PubMedCrossRef Schmieder K, Wolzik-Grossmann M, Pechlivanis I, Engelhardt M, Scholz M, Harders A (2006) Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine. 4(6):447–453PubMedCrossRef
16.
go back to reference Emery SE, Bohlman HH, Bolesta MJ, Jones PK (1998) Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up. J Bone Joint Surg Am 80(7):941–951PubMed Emery SE, Bohlman HH, Bolesta MJ, Jones PK (1998) Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up. J Bone Joint Surg Am 80(7):941–951PubMed
17.
go back to reference 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(8):723–728PubMedCrossRef 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(8):723–728PubMedCrossRef
18.
go back to reference Brantigan JW (1994) Pseudarthrosis rate after allograft posterior lumbar interbody fusion with pedicle screw and plate fixation. Spine (Phila Pa 1976) 19(11):1271–1279 Brantigan JW (1994) Pseudarthrosis rate after allograft posterior lumbar interbody fusion with pedicle screw and plate fixation. Spine (Phila Pa 1976) 19(11):1271–1279
19.
go back to reference Vernon H, Mior S (1991) The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 14(7):409–415PubMed Vernon H, Mior S (1991) The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 14(7):409–415PubMed
20.
go back to reference Song KJ, Choi BW, Choi BR, Seo GB (2010) Cross-Cultural Adaptation and Validation of the Korean Version of the Neck Disability Index. Spine (Phila Pa 1976) 35(20):E1045–E1049CrossRef Song KJ, Choi BW, Choi BR, Seo GB (2010) Cross-Cultural Adaptation and Validation of the Korean Version of the Neck Disability Index. Spine (Phila Pa 1976) 35(20):E1045–E1049CrossRef
21.
go back to reference Hains F, Waalen J, Mior S (1998) Psychometric properties of the neck disability index. J Manipulative Physiol Ther 21(2):75–80PubMed Hains F, Waalen J, Mior S (1998) Psychometric properties of the neck disability index. J Manipulative Physiol Ther 21(2):75–80PubMed
22.
go back to reference Bazaz R, Lee MJ, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery. Spine 27:2453–2458PubMedCrossRef Bazaz R, Lee MJ, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery. Spine 27:2453–2458PubMedCrossRef
23.
go back to reference Topuz K, Colak A, Kaya S et al (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 18:238–243PubMedCrossRef Topuz K, Colak A, Kaya S et al (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 18:238–243PubMedCrossRef
24.
go back to reference Kim SW, Limson MA, Kim SB et al (2009) Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J 18:218–231PubMedCrossRef Kim SW, Limson MA, Kim SB et al (2009) Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J 18:218–231PubMedCrossRef
25.
go back to reference Brooke NS, Rorke AW, King AT et al (1997) Preliminary experience of carbon fiber cage prostheses for treatment of cervical spine disorders. Br J Neurosurg 11:221–227PubMedCrossRef Brooke NS, Rorke AW, King AT et al (1997) Preliminary experience of carbon fiber cage prostheses for treatment of cervical spine disorders. Br J Neurosurg 11:221–227PubMedCrossRef
26.
go back to reference Munoz FL, de las Heras BG, Lopez VC et al (1998) Comparison of three techniques of anterior fusion in single-level cervical disc herniation. Eur Spine J 7:512–516CrossRef Munoz FL, de las Heras BG, Lopez VC et al (1998) Comparison of three techniques of anterior fusion in single-level cervical disc herniation. Eur Spine J 7:512–516CrossRef
27.
go back to reference Das K, Couldwell WT, Sava G (2001) Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. J Neurosurg Spine 94:174–178CrossRef Das K, Couldwell WT, Sava G (2001) Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. J Neurosurg Spine 94:174–178CrossRef
28.
go back to reference Kast E, Derakhshani S, Bothmann M et al (2009) Subsidence after anterior cervical interbody fusion. A randomized prospective clinical trial. Neurosurg Rev 32:207–214PubMedCrossRef Kast E, Derakhshani S, Bothmann M et al (2009) Subsidence after anterior cervical interbody fusion. A randomized prospective clinical trial. Neurosurg Rev 32:207–214PubMedCrossRef
29.
go back to reference Geisler FH, Caspar W, Pitzen T, Johnson TA (1998) Reoperation in patients after anterior cervical plate stabilization in degenerative disease. Spine 23(8):911–920PubMedCrossRef Geisler FH, Caspar W, Pitzen T, Johnson TA (1998) Reoperation in patients after anterior cervical plate stabilization in degenerative disease. Spine 23(8):911–920PubMedCrossRef
30.
go back to reference Wang JC, McDonough PW, Kanim LEA, Endow KK, Delamarter RB (2001) Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine 26:643–647PubMedCrossRef Wang JC, McDonough PW, Kanim LEA, Endow KK, Delamarter RB (2001) Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine 26:643–647PubMedCrossRef
31.
go back to reference Papadopoulos EC, Huang RC, Girardi FP, Synnott K, Cammisa FP (2006) Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine 8:897–902CrossRef Papadopoulos EC, Huang RC, Girardi FP, Synnott K, Cammisa FP (2006) Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine 8:897–902CrossRef
32.
go back to reference Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity: a statistical evaluation. Spine 20:1055–1060PubMedCrossRef Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity: a statistical evaluation. Spine 20:1055–1060PubMedCrossRef
33.
go back to reference Keller EE, Triplett WW (1987) Iliac bone graft: review of 60 consecutive cases. J Oral Maxillofac Surg 45:11–14PubMedCrossRef Keller EE, Triplett WW (1987) Iliac bone graft: review of 60 consecutive cases. J Oral Maxillofac Surg 45:11–14PubMedCrossRef
34.
go back to reference Pitzen T, Kiefer R, Munchen D, Barbier D, Reith W, Steudel WI (2006) Filling a cervical spine cage with local autograft: change of bone density and assessment of bony fusion. Zentralbl Neurochir 67:8–13PubMedCrossRef Pitzen T, Kiefer R, Munchen D, Barbier D, Reith W, Steudel WI (2006) Filling a cervical spine cage with local autograft: change of bone density and assessment of bony fusion. Zentralbl Neurochir 67:8–13PubMedCrossRef
Metadata
Title
Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct
Publication date
01-12-2012
Published in
European Spine Journal / Issue 12/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-012-2447-0

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