title: A comparison of local bone graft with PEEK cage versus iliac bone graft used in anterior cervical discectomy and fusion.
abstract: OBJECTIVE
  Anterior cervical discectomy and fusion (ACDF) is a popular procedure for patients with cervical spondylotic myelopathy, but few studies reported the clinical outcomes of cervical local bone graft with a PEEK cage used in it. This retrospective study was performed to compare the clinical and radiological outcomes of using local bone graft with a PEEK cage versus iliac bone graft in ACDF.
  
  
  METHODS
  A total of 60 consecutive patients who underwent ACDF were evaluated from January 2010 to January 2013. Twenty-nine patients received ACDF with a PEEK cage combined with cervical local bone graft (local bone group) and 31 patients received ACDF with autologous tricortical iliac bone graft (iliac bone group). The intraoperative and perioperative complications of both groups were recorded. Preoperative and postoperative radiographs were taken to calculate the ratio of interbody height to the disc height and the interbody bony fusion rate. The Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) were used to estimate postoperative clinical outcomes.
  
  
  RESULTS
  The mean follow-up duration was 25.0±3.8months in the local bone group and 24.4±3.4months in the iliac bone group (P=0.56). Although there was no significant difference between the two groups in terms of blood loss (P=0.17), the length of surgery was significantly less in the local bone group comparing with that of iliac bone group (P=0.01). Postoperatively, VAS scores were significantly decreased, and JOA scores were improved in both groups. However, no statistically significant differences were found between the two groups at final follow up (P=0.45 and P=0.93). The disc space height and segmental interbody angle at the surgical segment were greater in local bone group than those in the iliac bone group (P<0.001 and P<0.001). The fusion rates were 93.1% in local bone group and 90.3% in the iliac bone group at last follow up (P=0.70). Perioperative complication rates in local bone group and iliac bone groups were 6.8% and 29%, respectively (P=0.04).
  
  
  CONCLUSIONS
  Based on this study, patients receiving ACDF with local bone graft combined with a PEEK cage had significant shorter operation time, lower perioperative complications rate, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.
authors.affiliation: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China.
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Liu
authors.affiliation: Department of Orthopedic Surgery, The 94th Hospital of Chinese People's Liberation Army, Nanchang 330002, PR China.
authors.forename: Xu
authors.initials: X
authors.lastname: Xiong
authors.affiliation: School of Humanities, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, PR China.
authors.forename: Ai-Fen
authors.initials: AF
authors.lastname: Peng
authors.affiliation: Department of Orthopedic Surgery, The 94th Hospital of Chinese People's Liberation Army, Nanchang 330002, PR China.
authors.forename: Min
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China.
authors.forename: Xuan-Yin
authors.initials: XY
authors.lastname: Chen
authors.affiliation: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China.
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Long
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA. Electronic address: rxu4@jhmi.edu.
authors.forename: Risheng
authors.initials: R
authors.lastname: Xu
authors.affiliation: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China. Electronic address: liuzhiliyfy@163.com.
authors.forename: Zhi-Li
authors.initials: ZL
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D001577:Benzophenones; D016025:Bone Transplantation / Q000379:methods; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007659:Ketones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011108:Polymers; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001577:Benzophenones; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols
keywords: Anterior cervical discectomy and fusion; Cervical spine; Iliac bone graft; Local bone graft