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Two-level contiguous cervical disc disease treated with peek cages packed with demineralized bone matrix: results of 3-year follow-up

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Abstract

Interbody cages are widely used instruments for cervical fusion operations. Long-term follow-up studies are needed to clarify if these devices are dependable. In this prospective study, 79 patients (42 women and 37 men) with a mean age of 51 years operated between January 2000 and December 2005 for treatment of degenerative cervical disc disease and spondylosis associated with radiculopathy or myelopathy were evaluated. Patients underwent two-level contiguous anterior cervical discectomy and fusion operations with standard anterior Smith–Robinson approach. To achieve fusion PEEK cages packed with demineralized bone matrix mixed with autologous blood were used. Clinical outcome was evaluated with Odom’s criteria and results were evaluated as ‘excellent’, ‘good’, ‘fair’ and ‘poor’. Spinal curves, mobility and fusion status were assessed with anterior–posterior and lateral (neutral, flexion and extension) radiographs obtained before surgery and at 3, 12, 24 and 36 months postoperatively. The Ishihara curvature index (ICI) was used for spinal curve evaluation. Lateral dynamic (flexion and extension) radiographs at postoperative 12th month revealed the fusion status classified as 1A, 1B, 2A and 2B. The radiological outcomes were classified as ‘non-fusion’ when 2B healing was observed, and as ‘fusion’ when 1A, 1B or 2A healing was observed at the levels subjected to surgery. According to Odom’s criteria, clinical outcomes were classified as ‘excellent’ or ‘good’ in 69 patients (success rate: 87.3%). Eight patients were graded as ‘fair’ and two as ‘poor’. Preoperative mean ICI was 10.4 ± 3.72 and postoperative mean ICI was 10.1 ± 3.14. The difference was statistically insignificant (P > 0.05); therefore, preoperative lordosis was said to be preserved at final follow-up. Final fusion rate (Types 1A, 1B, and 2A) was 91.7% (145/158 levels). Radiological imaging showed no cage failure or dislodgement and reoperation due to non-fusion was not needed.

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References

  1. Arringon ED, Smith VJ, Chambers HG et al (1996) Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res 329:300–309. doi:10.1097/00003086-199608000-00037

    Article  Google Scholar 

  2. Bartels RH, Donk R, van Azn RD (2001) Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage. J Neurosurg 95:40–42

    PubMed  CAS  Google Scholar 

  3. Bohlman HH, Emery SE, Goodfellow DB et al (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy: long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg 75:1298–1307

    PubMed  CAS  Google Scholar 

  4. Castro FP, Holt RT, Majd M et al (2000) A cost analysis of two anterior cervical fusion procedures. J Spinal Disord 13:511–514. doi:10.1097/00002517-200012000-00008

    Article  PubMed  Google Scholar 

  5. Cho DY, Lee WY, Sheu PC (2004) Treatment of multilevel cervical fusion with cages. Surg Neurol 62:378–385. doi:10.1016/j.surneu.2004.01.021

    Article  PubMed  Google Scholar 

  6. Cho DY, Liau WR, Lee WY, Liu JT, Chiu CL, Sheu PC (2002) Priliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery 51:1343–1350. doi:10.1097/00006123-200212000-00003

    Article  PubMed  Google Scholar 

  7. Cook SD, Dalton JE, Tan EH, Tejeiro WV, Young MJ, Whitecloud TS 3rd (1994) In vivo evaluation of anterior cervical fusions with hydroxyapatite graft material. Spine 19:1856–1866

    Article  PubMed  CAS  Google Scholar 

  8. Dang AB, Hu SS, Tay BK (2008) Biomechanics of the anterior longitudinal ligament during 8 g whiplash simulation following single- and contiguous two-level fusion: a finite element study. Spine 33(6):607–611

    PubMed  Google Scholar 

  9. Das K, Couldwell WT, Sava G et al (2001) Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. J Neurosurg 94(1 suppl):174–178

    PubMed  CAS  Google Scholar 

  10. 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 14:723–728. doi:10.1016/j.jocn.2006.02.026

    Article  PubMed  Google Scholar 

  11. Eck KR, Lenke LG, Bridwell KH et al (2000) Radiographic assessment of anterior titanium mesh cages. J Spinal Disord 13:501–510. doi:10.1097/00002517-200012000-00006

    Article  PubMed  CAS  Google Scholar 

  12. Emery SS, Fisher RS, Bohlman HH (1997) Three-level anterior cervical discectomy and fusion. Spine 22:2622–2625. doi:10.1097/00007632-199711150-00008

    Article  PubMed  CAS  Google Scholar 

  13. Giovanni P, Raffaele F, Giuseppina I (2000) Preliminary experience with anterior cervical microdiscectomy and interbody titanium cage fusion in patients with cervical disc disease. Surg Neurol 53:417–426. doi:10.1016/S0090-3019(00)00207-X

    Article  Google Scholar 

  14. Gu YT, Jia LS, Chen TY (2007) Biomechanical study of a hat type cervical intervertebral fusion cage. Int Orthop 31(1):101–105. doi:10.1007/s00264-006-0141-8

    Article  PubMed  Google Scholar 

  15. Hacker RJ (2002) Threaded cages for degenerative cervical disease. Clin Orthop Relat Res 394:39–46. doi:10.1097/00003086-200201000-00005

    Article  PubMed  Google Scholar 

  16. Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL (2000) A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:2646–2655. doi:10.1097/00007632-200010150-00017

    Article  PubMed  CAS  Google Scholar 

  17. Ishihara A (1968) Roentgenographic studies on the normal pattern of cervical curvature. Nippon Seikeigeka Gakkai Zasshi 42:1033–1044

    PubMed  CAS  Google Scholar 

  18. Katsuura A, Hukuda S, Imanaka T et al (1996) Anterior cervical plate used in degenerative disease can maintain lordosis. J Spinal Disord 9:470–476. doi:10.1097/00002517-199612000-00003

    Article  PubMed  CAS  Google Scholar 

  19. Katzer A, Marquardt H, Westendorf J, Wening JV, von Foerster G (2002) Polyetheretherketone-cytotoxicity and mutagenicity in vitro. Biomaterials 23(8):1749–1759. doi:10.1016/S0142-9612(01)00300-3

    Article  PubMed  CAS  Google Scholar 

  20. 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 7:205–209. doi:10.1016/j.spinee.2006.03.002

    Article  PubMed  Google Scholar 

  21. Liao JC, Niu CC, Chen WJ, Chen LH (2008) Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop 32(5):643–648

    Google Scholar 

  22. Ludek V, Rude H, Davood J, Waclaw L, Adel S (2002) A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine. Spine 27:1694–1701. doi:10.1097/00007632-200208150-00003

    Article  Google Scholar 

  23. Matge G (1998) Anterior interbody fusion with the BAK-cage in cervical spondylosis. Acta Neurochir (Wien) 140:1–8. doi:10.1007/s007010050049

    Article  CAS  Google Scholar 

  24. Peolsson A, Vavruch L, Hedlund R (2007) Long-term randomised comparison between a carbon fibre cage and Cloward procedure in the cervical spine. Eur Spine J 16(2):173–178

    Article  PubMed  Google Scholar 

  25. Rawlinson JN (1994) Morbidity after anterior cervical decompression and fusion: the influence of the donor site on recovery, and the results of a trial of Surgibone compared to autologous bone. Acta Neurochir (Wien) 131:106–118. doi:10.1007/BF01401460

    Article  CAS  Google Scholar 

  26. Sampath P, Bendebba M, Davis JD et al (2000) Outcome of patients treated for cervical myelopathy: a prospective, multicenter study with independent clinical review. Spine 25:670–676. doi:10.1097/00007632-200003150-00004

    Article  PubMed  CAS  Google Scholar 

  27. Sampath P, Bendebba M, Davis JD et al (1999) Outcome in patients with cervical radiculopathy: prospective, multicenter study with independent clinical review. Spine 24:591–597. doi:10.1097/00007632-199903150-00021

    Article  PubMed  CAS  Google Scholar 

  28. Savolainen S, Rinne J, Hernesniemi J (1998) A prospective randomized study of anterior single-level disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery 43:51–55. doi:10.1097/00006123-199807000-00032

    Article  PubMed  CAS  Google Scholar 

  29. Shapiro S, Connolly P, Donnaldson J et al (2004) Cadaveric fibula, locking plate, and allogenic bone matrix for anterior cervical fusion after cervical discectomy for radiculopathy or myelopathy. J Neurosurg Spine 1:160–167

    Article  Google Scholar 

  30. Shapiro S, Connolly P, Donnaldson J et al (2001) Cadaveric fibula, locking plate, and allogenic bone matrix for anterior cervical fusion after cervical discectomy for radiculopathy or myelopathy. J Neurosurg 95(Supp 1):43–50

    PubMed  CAS  Google Scholar 

  31. Shono Y, McAfee PC, Cunningham BW, Brantigan JW (1993) A biomechanical analysis of decompression and reconstruction methods in the cervical spine. Emphasis on a carbon-fiber-composite cage. J Bone Joint Surg Am 75(11):1674–1684

    PubMed  CAS  Google Scholar 

  32. Silber JS, Anderson DG, Daffner SD (2003) Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 28:134–139. doi:10.1097/00007632-200301150-00008

    Article  PubMed  Google Scholar 

  33. 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 13:181–187. doi:10.1016/j.jocn.2005.02.018

    Article  PubMed  Google Scholar 

  34. Steffen T, Tsantrizos A, Fruth I, Aebi M (2000) Cages: designs and concepts. Eur Spine J 9(suppl 1):89–94

    Article  Google Scholar 

  35. Summers BN, Eisenstein SM (1989) Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Joint Surg Br 71(4):677–680

    PubMed  CAS  Google Scholar 

  36. Tullberg T (1993) Failure of a carbon fiber implant: a case report. Spine 23:1804–1806. doi:10.1097/00007632-199808150-00016

    Article  Google Scholar 

  37. Vaidya R, Carp J, Sethi A, Bartol S, Craig J, Les CM (2007) Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein-2. Eur Spine J 16(8):1257–1265

    Article  PubMed  Google Scholar 

  38. Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A (2002) A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine. Spine 27(16):1694–1701. doi:10.1097/00007632-200208150-00003

    Article  PubMed  Google Scholar 

  39. Wenz LM, Merritt K, Brown SA, Moet A, Steffee AD (1990) In vitro biocompatibility of polyetheretherketone and polysulfone composites. J Biomed Mater Res 24:207–215. doi:10.1002/jbm.820240207

    Article  PubMed  CAS  Google Scholar 

  40. Zdeblick TA, Ducker TB (1991) The use of freeze-dried allograft bone for anterior cervical fusions. Spine 16:726–729. doi:10.1097/00007632-199107000-00006

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. GATA Haydarpaşa Egitim Hastanesi, Norosirurji Servisi, 34668, Istanbul, Turkey

    Kıvanç Topuz, Ahmet Çolak, Serdar Kaya, Hakan Şimşek, Murat Kutlay, Mehmet Nusret Demircan & Murat Velioğlu

  2. Department of Radiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey

    Murat Velioğlu

Authors
  1. Kıvanç Topuz
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  2. Ahmet Çolak
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  3. Serdar Kaya
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  7. Murat Velioğlu
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Correspondence to Serdar Kaya.

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Topuz, K., Çolak, A., Kaya, S. et al. 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, 238–243 (2009). https://doi.org/10.1007/s00586-008-0869-5

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  • DOI: https://doi.org/10.1007/s00586-008-0869-5

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