Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages.
METHODS
A prospective study was performed in case with cervical spondylosis who underwent anterior cervical discectomy and fusion (ACDF) with titanium or polyetheretherketone (PEEK) cages.


OBJECTIVE
To find out which fusion cage yielded better clinical and radiographic results.


BACKGROUND
Although use of autogenous iliac-bone grafts in ACDF for cervical disc diseases remain standard surgical procedure, donor site morbidity and graft collapse or breakage are concerns. Cage technology was developed to prevent these complications. However, there is no comparison regarding the efficacy between titanium and PEEK cage.


METHODS
January 2005 to January 2006, 53 patients who had 1 and 2-levels ACDF with titanium or PEEK cages were evaluated. We measured the rate and amount of interspace collapse, segmental sagittal angulations, and the radiographic fusion success rate. Odom criteria were used to assess the clinical results.


RESULTS
The fusion rate was higher in the PEEK group (100% vs. 86.5%, P=0.0335). There was no significant difference between both groups in loss of cervical lordosis (3.2 + or - 2.4 vs. 2.8 + or - 3.4, P=0.166). The mean anterior interspace collapse (1.6 + or - 1.0 mm) in the titanium group was significantly higher than the collapse of the PEEK group (0.5 + or - 0.6 mm) (P<0.0001). The mean posterior interspace collapse was also higher in the titanium group (1.6 + or - 0.9 mm vs. 0.5 + or - 0.5 mm, P<0.0001). An interspace collapse of 3 mm or greater was observed in 16.2% of the patients in the titanium group, compared with zero patients in the PEEK group (P<0.0001). The PEEK group achieved an 80% rate of successful clinical outcomes, compared with 75% in the titanium group (P=0.6642).


CONCLUSIONS
The PEEK cage is superior to the titanium cage in maintaining cervical interspace height and radiographic fusion after 1 and 2-levels anterior cervical decompression procedures.
Niu
Chi-Chien
CC
Department of Orthopedics Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Liao
Jen-Chung
JC
Chen
Wen-Jer
WJ
Chen
Lih-Huei
LH
D000328:Adult; D000368:Aged; D001577:Benzophenones; D001672:Biocompatible Materials / Q000592:standards / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery*; D007659:Ketones / Q000592:standards / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011092:Polyethylene Glycols / Q000592:standards / Q000627:therapeutic use*; D011108:Polymers; D011446:Prospective Studies; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000601:surgery; D014025:Titanium / Q000592:standards / Q000627:therapeutic use*; D016896:Treatment Outcome
D001577:Benzophenones; D001672:Biocompatible Materials; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols; D014025:Titanium