J Korean Neurosurg Soc.  2017 Feb;60(2):211-219. 10.3340/jkns.2015.0203.014.

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

Affiliations
  • 1Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea. genius60@hanmail.net
  • 2Department of Neurosurgery, Happy-view Samsung Hospital, Gwangju, Korea.

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.

Keyword

ACDF; DBM; Iliac autograft; PEEK cage; Subaxial cervical spine injury

MeSH Terms

Autografts*
Bone Matrix*
Diskectomy*
Follow-Up Studies
Humans
Retrospective Studies
Spinal Injuries
Spine*
Tissue Donors
Transplants
Visual Analog Scale

Figure

  • Fig. 1 Imaging studies of a 54-year-old man who underwent a C5–6 anterior cervical fusion using autologous iliac bone graft after subaxial injury. A: Simple cervical lateral radiograph shows C5–6 subluxation and disc space widening with spinous process fracture. B: Postoperative radiograph shows satisfactory reduction of the injured segment after C5–6 fusion with anterior plating. C: Last follow-up radiograph at 24 months after surgery shows satisfactory fusion at the C5–6 level; however, some degrees of subsidence and development of adjacent segment degeneration (yellow arrow) were observed with impingement of the plate to C4–5 disc level.

  • Fig. 2 Imaging studies of a 47-year-old man who underwent C6–7 fusion using a synthetic cage filled with demineralized bone matrix and local osteophytes. A: Simple cervical lateral radiograph shows C6–7 subluxation and disc space widening. B: Postoperative radiograph shows satisfactory reduction of the injured segment after C6–7 fusion. C: Last follow-up radiograph at 24 months after surgery shows satisfactory fusion at the C6–7 level, without the development of subsidence and junctional problems. D: Computed tomography image shows successful filling of bony tissue within the synthetic cage.


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Outcomes of Anterior Cervical Fusion Using Polyetheretherketone Cage with Demineralized Bone Matrix and Plate for Management of Subaxial Cervical Spine Injuries
Moon-Soo Han, Gwang-Jun Lee, Ju-Hwi Kim, Seul-Kee Lee, Bong Ju Moon, Jung-Kil Lee
Korean J Neurotrauma. 2018;14(2):123-128.    doi: 10.13004/kjnt.2018.14.2.123.

Clinical Efficacy of Cages in Anterior Cervical Fusion for Degenerative Cervical Disease
Moon Soo Park, Woo-Kie Min, Sang-Bong Ko, Young-Yul Kim, Byung-Wan Choi, Jong Hyun Ko
J Korean Soc Spine Surg. 2019;26(4):172-177.    doi: 10.4184/jkss.2019.26.4.172.

Risk Factors for Prevertebral Soft Tissue Swelling Following Single-Level Anterior Cervical Spine Surgery
Junsang Park, Sang Mook Kang, Yu Deok Won, Myung-Hoon Han, Jin Hwan Cheong, Byeong-Jin Ha, Je Il Ryu
J Korean Neurosurg Soc. 2023;66(6):716-725.    doi: 10.3340/jkns.2023.0123.


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