Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cages
Titanium (TTN) cages have a higher modulus of elasticity when compared with polyetheretherketone (PEEK) cages. This suggests that TTN-cages could show more frequent cage subsidence after anterior cervical discectomy and fusion (ACDF) and therefore might lead to a higher loss of correction. We compared the long term results of stand-alone PEEK- and TTN-cages in a comparable patient collective that was operated under identical operative settings.
From 2002 to 2007 154 patients underwent single-level ACDF for degenerative disc disease (DDD). Clinical and radiological outcome were assessed in 86 eligible patients after a mean of 28.4 months. 44 patients received a TTN- and 42 patients a PEEK-cage.
Solid arthrodesis was found in 93.2% of the TTN-group and 88.1% of the PEEK-group. Cage subsidence was observed in 20.5% of the TTN- and 14.3% of the PEEK-group. A significant segmental lordotic correction was achieved by both cage-types. Even though a loss of correction was found at the last follow-up in both groups, it did not reach the level of statistical significance. Statistical analysis of these results revealed no differences between the TTN- and PEEK-group.
When assessed with the neck disability index (NDI), the visual analogue scale (VAS) of neck and arm pain and Odom’s criteria the clinical data showed no significant differences between the groups.
Clinical and radiological outcomes of ACDF with TTN- or PEEK-cages do not appear to be influenced by the chosen synthetic graft. The modulus of elasticity represents only one of many physical properties of a cage. Design, shape, size, surface architecture of a cage as well as bone density, endplate preparation and applied distraction during surgery need to be considered as further important factors.
- Dorai Z, Morgan H, Coimbra C: Titanium cage reconstruction after cervical corpectomy. J Neurosurg 2003,99(1 Suppl):3–7.
- Hacker RJ: A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results. J Neurosurg 2000,93(2 Suppl):222–226.
- Mastronardi L, Ducati A, Ferrante L: Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir (Wien) 2006,148(3):307–312. discussion 312 CrossRef
- Vadapalli S, Sairyo K, Goel VK, Robon M, Biyani A, Khandha A, Ebraheim NA: Biomechanical rationale for using polyetheretherketone (PEEK) spacers for lumbar interbody fusion-A finite element study. Spine (Phila Pa 1976) 2006,31(26):E992-E998. CrossRef
- Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine (Phila Pa 1976) 2000,25(20):2646–2654. discussion 2655 CrossRef
- Profeta G, de Falco R, Ianniciello G, Profeta L, Cigliano A, Raja AI: Preliminary experience with anterior cervical microdiscectomy and interbody titanium cage fusion (Novus CT-Ti) in patients with cervical disc disease. Surg Neurol 2000,53(5):417–426. CrossRef
- Cabraja M, Kroppenstedt S: Bone grafting and substitutes in spine surgery. J Neurosurg Sci 2012,56(2):87–95.
- McKenna PJ, Freeman BJ, Mulholland RC, Grevitt MP, Webb JK, Mehdian SH: A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results. Eur Spine J 2005,14(8):727–737. CrossRef
- Johansson CB, Roser K, Bolind P, Donath K, Albrektsson T: Bone-tissue formation and integration of titanium implants: an evaluation with newly developed enzyme and immunohistochemical techniques. Clin Implant Dent Relat Res 1999,1(1):33–40. CrossRef
- Schmieder K, Wolzik-Grossmann M, Pechlivanis I, Engelhardt M, Scholz M, Harders A: Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine 2006,4(6):447–453. CrossRef
- Cabraja M, Abbushi A, Kroppenstedt S, Woiciechowsky C: Cages with fixation wings versus cages plus plating for cervical reconstruction after corpectomy - is there any difference? Cen Eur Neurosurg 2011,71(2):59–63. CrossRef
- Cabraja M, Abbushi A, Koeppen D, Kroppenstedt S, Woiciechowsky C: Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome. Neurosurg Focus 2010,28(3):E15. CrossRef
- Thome C, Krauss JK, Zevgaridis D: A prospective clinical comparison of rectangular titanium cages and iliac crest autografts in anterior cervical discectomy and fusion. Neurosurg Rev 2004,27(1):34–41. CrossRef
- Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM: Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine (Phila Pa 1976) 2000,25(11):1437–1446. CrossRef
- Cutler AR, Siddiqui S, Mohan AL, Hillard VH, Cerabona F, Das K: Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg Spine 2006,5(6):534–539. CrossRef
- Chou YC, Chen DC, Hsieh WA, Chen WF, Yen PS, Harnod T, Chiou TL, Chang YL, Su CF, Lin SZ, et al.: Efficacy of anterior cervical fusion: comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci 2008,15(11):1240–1245. CrossRef
- Meier U, Kemmesies D: [Experiences with six different intervertebral disc spacers for spondylodesis of the cervical spine]. Orthopade 2004,33(11):1290–1299. CrossRef
- Niu CC, Liao JC, Chen WJ, Chen LH: 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 2012,23(5):310–316. CrossRef
- Matge G: Cervical cage fusion with 5 different implants: 250 cases. Acta Neurochir (Wien) 2002,144(6):539–549. discussion 550 CrossRef
- Barsa P, Suchomel P: Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 2007,16(9):1395–1400. CrossRef
- Chiang CJ, Kuo YJ, Chiang YF, Rau G, Tsuang YH: Anterior cervical fusion using a polyetheretherketone cage containing a bovine xenograftp: three to five-year follow-up. Spine (Phila Pa 1976) 2008,33(23):2524–2428. CrossRef
- Francke EI, Demetropoulos CK, Agabegi SS, Truumees E, Herkowitz HN: Distractive force relative to initial graft compression in an in vivo anterior cervical discectomy and fusion model. Spine (Phila Pa 1976) 2010,35(5):526–530. CrossRef
- 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 2011,3(1):16–23. CrossRef
- Lemcke J, Al-Zain F, Meier U, Suess O: Polyetheretherketone (PEEK) Spacers for Anterior Cervical Fusion: A Retrospective Comparative Effectiveness Clinical Trial. Open Orthop J 2011, 5:348–353. CrossRef
- Cabraja M, Klein M, Lehmann TN: Long-term results following titanium cranioplasty of large skull defects. Neurosurg Focus 2009,26(6):E10. CrossRef
- Verran J, Whitehead K: Factors affecting microbial adhesion to stainless steel and other materials used in medical devices. Int J Artif Organs 2005,28(11):1138–1145.
- Diedrich O, Perlick L, Schmitt O, Kraft CN: Radiographic characteristics on conventional radiographs after posterior lumbar interbody fusion: comparative study between radiotranslucent and radiopaque cages. J Spinal Disord 2001,14(6):522–532. CrossRef
- Disch AC, Schaser KD, Melcher I, Feraboli F, Schmoelz W, Druschel C, Luzzati A: Oncosurgical results of multilevel thoracolumbar en-bloc spondylectomy and reconstruction with a carbon composite vertebral body replacement system. Spine (Phila Pa 1976) 2011,36(10)):E647-E655. CrossRef
- Teo EC, Yang K, Fuss FK, Lee KK, Qiu TX, Ng HW: Effects of cervical cages on load distribution of cancellous core: a finite element analysis. J Spinal Disord Tech 2004,17(3):226–231. CrossRef
- Wilke HJ, Kettler A, Goetz C, Claes L: Subsidence resulting from simulated postoperative neck movements: an in vitro investigation with a new cervical fusion cage. Spine (Phila Pa 1976) 2000,25(21):2762–2770. CrossRef
- Pechlivanis I, Thuring T, Brenke C, Seiz M, Thome C, Barth M, Harders A, Schmieder K: Non-fusion rates in anterior cervical discectomy and implantation of empty polyetheretherketone cages. Spine (Phila Pa 1976) 2011,36(1):15–20.
- Tureyen K: Disc height loss after anterior cervical microdiscectomy with titanium intervertebral cage fusion. Acta Neurochir (Wien) 2003,145(7):565–569. discussion 569–570 CrossRef
- Cabraja M, Koeppen D, Lanksch WR, Maier-Hauff K, Kroppenstedt S: Polymethylmethacrylate-assisted ventral discectomy: rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years. BMC Musculoskelet Disord 2011, 12:140. CrossRef
- Andaluz N, Zuccarello M, Kuntz C: Long-term follow-up of cervical radiographic sagittal spinal alignment after 1- and 2-level cervical corpectomy for the treatment of spondylosis of the subaxial cervical spine causing radiculomyelopathy or myelopathy: a retrospective study. J Neurosurg Spine 2012,16(1):2–7. CrossRef
- Harrison DD, Janik TJ, Troyanovich SJ, Holland B: Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine (Phila Pa 1976) 1996,21(6):667–675. CrossRef
- Kulkarni AG, Hee HT, Wong HK: Solis cage (PEEK) for anterior cervical fusion: preliminary radiological results with emphasis on fusion and subsidence. Spine J 2007,7(2):205–209. CrossRef
- Boker DK, Schultheiss R, Probst EM: Radiologic long-term results after cervical vertebral interbody fusion with polymethyl methacrylat (PMMA). Neurosurg Rev 1989,12(3):217–221. CrossRef
- Barlocher CB, Barth A, Krauss JK, Binggeli R, Seiler RW: Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 2002,12(1):E4. CrossRef
- van den Bent MJ, Oosting J, Wouda EJ, van Acker RE, Ansink BJ, Braakman R: Anterior cervical discectomy with or without fusion with acrylate. A randomized trial. Spine (Phila Pa 1976) 1996,21(7):834–839. discussion 840 CrossRef
- Brown JA, Havel P, Ebraheim N, Greenblatt SH, Jackson WT: Cervical stabilization by plate and bone fusion. Spine (Phila Pa 1976) 1988,13(3):236–240. CrossRef
- Gassman J, Seligson D: The anterior cervical plate. Spine (Phila Pa 1976) 1983,8(7):700–707. CrossRef
- Kaiser MG, Haid RW, Subach BR, Barnes B, Rodts GE: Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 2002,50(2):229–236. discussion 236–228
- Wang JC, McDonough PW, Endow KK, Delamarter RB: Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 2000,25(1):41–45. CrossRef
- Samartzis D, Shen FH, Lyon C, Phillips M, Goldberg EJ, An HS: Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion? Spine J 2004,4(6):636–643. CrossRef
- Jagannathan J, Shaffrey CI, Oskouian RJ, Dumont AS, Herrold C, Sansur CA, Jane JA: Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar. J Neurosurg Spine 2008,8(5):420–428. CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/13/172/prepub
- Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cages
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Musculoskeletal Disorders
- Online Date
- September 2012
- Online ISSN
- BioMed Central
- Additional Links