Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

  • Kim, Soo-Han (Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences) ;
  • Lee, Jung-Kil (Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences) ;
  • Jang, Jae-Won (Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences) ;
  • Park, Hyun-Woong (Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences) ;
  • Hur, Hyuk (Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences)
  • Received : 2016.03.06
  • Accepted : 2016.12.15
  • Published : 2017.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : This study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM). Methods : From January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2-7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade. Results : The mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups. Conclusion : This study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

Keywords

References

  1. Aebi M : Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J 19 Suppl 1 : S33-S39, 2009
  2. Bishop RC, Moore KA, Hadley MN : Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate : a prospective comparative analysis. J Neurosurg 85 : 206-210, 1996 https://doi.org/10.3171/jns.1996.85.2.0206
  3. Bohlman HH : Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg Am 61 : 1119-1142, 1979 https://doi.org/10.2106/00004623-197961080-00001
  4. Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, et al. : A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the second national acute spinal cord injury study. N Engl J Med 322 : 1405-1411, 1990 https://doi.org/10.1056/NEJM199005173222001
  5. Cauthen JC, Kinard RE, Vogler JB, Jackson DE, DePaz OB, Hunter OL, et al. : Outcome analysis of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients. Spine (Phila Pa 1976) 23 : 188-192, 1998 https://doi.org/10.1097/00007632-199801150-00008
  6. Cho DY, Liau WR, Lee WY, Liu JT, Chiu CL, Sheu PC : Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery 51 : 1343-1349; discussion 1349-1350, 2002 https://doi.org/10.1227/01.NEU.0000309109.71345.19
  7. Du W, Wang C, Tan J, Shen B, Ni S, Zheng Y : Management of subaxial cervical facet dislocation through anterior approach monitored by spinal cord evoked potential. Spine (Phila Pa 1976) 39 : 48-52, 2014 https://doi.org/10.1097/BRS.0000000000000046
  8. Fazl M, Pirouzmand F : Intraoperative reduction of locked facets in the cervical spine by use of a modified interlaminar spreader : technical note. Neurosurgery 48 : 444-445; discussion 445-446, 2001
  9. Feng G, Hong Y, Li L, Liu H, Pei F, Song Y, et al. : Anterior decompression and nonstructural bone grafting and posterior fixation for cervical facet dislocation with traumatic disc herniation. Spine (Phila Pa 1976) 37 : 2082-2088, 2012 https://doi.org/10.1097/BRS.0b013e31825ee846
  10. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, et al. : The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 7 : 179-192, 1969
  11. Garvey TA, Eismont FJ, Roberti LJ : Anterior decompression, structural bone grafting, and Caspar plate stabilization for unstable cervical spine fractures and/or dislocations. Spine (Phila Pa 1976) 17 : S431-S435, 1992 https://doi.org/10.1097/00007632-199210001-00015
  12. Hadley MN, Fitzpatrick BC, Sonntag VK, Browner CM : Facet fracturedislocation injuries of the cervical spine. Neurosurgery 30 : 661-666, 1992
  13. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH : Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81 : 519-528, 1999 https://doi.org/10.2106/00004623-199904000-00009
  14. Kim KH CD, Sung JK : The management of bilateral interfacetal dislocation with anterior fixation in cervical spine : comparision with combined antero-posterior fixation. J Korean Neurosurg Soc 42 : 305-310, 2007 https://doi.org/10.3340/jkns.2007.42.4.305
  15. Kulkarni AG, Hee HT, Wong HK : Solis cage (PEEK) for anterior cervical fusion : preliminary radiological results with emphasis on fusion and subsidence. Spine J 7 : 205-209, 2007 https://doi.org/10.1016/j.spinee.2006.03.002
  16. Ning X, Wen Y, Xiao-Jian Y, Bin N, De-Yu C, Jian-Ru X, et al. : Anterior cervical locking plate-related complications; prevention and treatment recommendations. Int Orthop 32 : 649-655, 2008 https://doi.org/10.1007/s00264-007-0369-y
  17. Oh HS, Shim CS, Kim JS, Lee SH : Clinical and radiological comparison of femur and fibular allografts for the treatment of cervical degenerative disc diseases. J Korean Neurosurg Soc 92 : 18-23, 2013
  18. Park MS, Kelly MP, Lee DH, Min WK, Rahman RK, Riew KD : Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J 14 : 1228-1234, 2013
  19. Paxinos O, Ghanayem AJ, Zindrick MR, Voronov LI, Havey RM, Carandang G, et al. : Anterior cervical discectomy and fusion with a locked plate and wedged graft effectively stabilizes flexion-distraction stage-3 injury in the lower cervical spine : a biomechanical study. Spine (Phila Pa 1976) 34 : E9-E15, 2009 https://doi.org/10.1097/BRS.0b013e318188386a
  20. Rawlinson JN : 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, 1994 https://doi.org/10.1007/BF01401460
  21. Reindl R, Ouellet J, Harvey EJ, Berry G, Arlet V : Anterior reduction for cervical spine dislocation. Spine (Phila Pa 1976) 31 : 648-652, 2006 https://doi.org/10.1097/01.brs.0000202811.03476.a0
  22. Riew KD, Rhee JM : The use of titanium mesh cages in the cervical spine. Clin Orthop Relat Res : 47-54, 2002
  23. Rizzolo SJ, Piazza MR, Cotler JM, Balderston RA, Schaefer D, Flanders A : Intervertebral disc injury complicating cervical spine trauma. Spine (Phila Pa 1976) 16 : S187-S189, 1991 https://doi.org/10.1097/00007632-199106001-00002
  24. Robertson PA, Ryan MD : Neurological deterioration after reduction of cervical subluxation. Mechanical compression by disc tissue. J Bone Joint Surg Br 74 : 224-227, 1992
  25. Shapiro S, Snyder W, Kaufman K, Abel T : Outcome of 51 cases of unilateral locked cervical facets : interspinous braided cable for lateral mass plate fusion compared with interspinous wire and facet wiring with iliac crest. J Neurosurg 91 : 19-24, 1999
  26. Song KJ, Choi BW, Kim GH, Song JH : Usefulness of polyetheretherketone (PEEK) cage with plate augmentation for anterior arthrodesis in traumatic cervical spine injury. Spine J 10 : 50-57, 2010 https://doi.org/10.1016/j.spinee.2009.08.458
  27. 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 27 : 34-41, 2004 https://doi.org/10.1007/s10143-003-0297-2
  28. Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A : A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine : a clinical and radiologic study. Spine 27 : 1694-1701, 2002 https://doi.org/10.1097/00007632-200208150-00003
  29. Vital JM, Gille O, Senegas J, Pointillart V : Reduction technique for uniand biarticular dislocations of the lower cervical spine. Spine 23 : 949-954; discussion 955, 1998 https://doi.org/10.1097/00007632-199804150-00021
  30. Yamagata T, Takami T, Uda T, Ikeda H, Nagata T, Sakamoto S, et al. : Outcomes of contemporary use of rectangular titanium stand-alone cages in anterior cervical discectomy and fusion : cage subsidence and cervical alignment. J Clin Neurosci 19 : 1673-1678, 2012 https://doi.org/10.1016/j.jocn.2011.11.043

Cited by

  1. Outcomes of Anterior Cervical Fusion Using Polyetheretherketone Cage with Demineralized Bone Matrix and Plate for Management of Subaxial Cervical Spine Injuries vol.14, pp.2, 2017, https://doi.org/10.13004/kjnt.2018.14.2.123
  2. Clinical Efficacy of Cages in Anterior Cervical Fusion for Degenerative Cervical Disease vol.26, pp.4, 2019, https://doi.org/10.4184/jkss.2019.26.4.172
  3. Cages in ACDF are Associated With a Higher Nonunion Rate Than Allograft : A Stratified Comparative Analysis of 6130 Patients vol.44, pp.6, 2019, https://doi.org/10.1097/brs.0000000000002854
  4. Cage Subsidence after Surgery on the Anterior Part of the Subaxial Cervical Spine: a Monocentric Prospective Clinical Study with a 3-Year Follow-Up vol.26, pp.2, 2017, https://doi.org/10.21823/2311-2905-2020-26-2-139-147
  5. Structural Allograft Versus PEEK Implants in Anterior Cervical Discectomy and Fusion: A Systematic Review vol.10, pp.6, 2017, https://doi.org/10.1177/2192568219883256
  6. Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient vol.17, pp.4, 2017, https://doi.org/10.14245/ns.2040216.108
  7. Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review vol.11, pp.2, 2017, https://doi.org/10.1177/2192568220907574