The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion

Background Data: Anterior cervical discectomy and fusion (ACF) is currently the gold standard for surgical treatment of cervical degenerated disease (CDD). For many years, patients were treated with ACF using tricortical autogenous bone graft augmented with anterior cervical locking plate. Later, Ca...

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Autores principales:	Khaled Hassan, Mohamed El-Meshtawy
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2013
Materias:	multiple level CDD cervical locking plate cervical PEEK cage Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/d4e45036f6734612a7be004e168a20a3
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spelling	oai:doaj.org-article:d4e45036f6734612a7be004e168a20a32021-12-02T00:23:40ZThe Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and FusionDOI:10.21608/ESJ.2013.38212314-89502314-8969https://doaj.org/article/d4e45036f6734612a7be004e168a20a32013-07-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_3821.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Anterior cervical discectomy and fusion (ACF) is currently the gold standard for surgical treatment of cervical degenerated disease (CDD). For many years, patients were treated with ACF using tricortical autogenous bone graft augmented with anterior cervical locking plate. Later, Cages packed with calcium triphosphate bone substitute were the treatment of choice. Study Design: A comparative clinical case study. Purpose: Compare the outcomes of ACF using stand-alone PEEK cages packed with calcium triphosphate bone substitute compared with tricortical iliac autograft augmented with anterior locking plate in treatment of three or more-level CDD in 47 patients. Patients and Methods: We evaluated 47 patients (22 patients in the locking plate group and 25 patients in the cage group) at our institution from January 2007 to September 2010. They were followed up for minimum 2 years. The clinical outcomes (Nurick grade and JOA score), radiographic changes (local kyphotic angle (LKA), fusion, subsidence, and adjacent disc degeneration), and complications were compared between the 2 groups. Results: The blood loss was significantly less in cage group (388 cc) than plate group (529.6cc).Both groups showed significant improvement in LKA postoperatively and at latest follow up with no significant difference. Fusion was 94.1% and 94.4% in cage and plate groups in order. There was insignificant more subsidence in cage (21.4%) than plate group (11.3 %). There was significant improvement in Nurick grading of both cage and plate groups as it improved from 3.32 and 3.68 preoperatively to 0.84 and 1.05 at latest follow up in order with no significant difference between the two groups. Final outcome was comparable in both groups: In cage group: excellent in 7 patients, good in 16, and fair in 2. In plate group, excellent in 8 patients, good in 11, and fair in 3. Conclusion: In multiple levels (three or more) ACF, the use of stand-alone PEEK cages results in less blood loss, less adjacent disc degeneration, less complications than the use of autograft augmented with locking plate but unfortunately, more incidence of subsidence. However, there is no significant difference in the postoperative and latest follow up LKA, fusion rate, clinical, and functional outcomes between the cage and plate groups. (2013ESJ049)Khaled Hassan Mohamed El-MeshtawyEgyptian Spine Associationarticlemultiple level CDDcervical locking platecervical PEEK cageNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 7, Iss 1, Pp 13-22 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	multiple level CDD cervical locking plate cervical PEEK cage Neurology. Diseases of the nervous system RC346-429
spellingShingle	multiple level CDD cervical locking plate cervical PEEK cage Neurology. Diseases of the nervous system RC346-429 Khaled Hassan Mohamed El-Meshtawy The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion
description	Background Data: Anterior cervical discectomy and fusion (ACF) is currently the gold standard for surgical treatment of cervical degenerated disease (CDD). For many years, patients were treated with ACF using tricortical autogenous bone graft augmented with anterior cervical locking plate. Later, Cages packed with calcium triphosphate bone substitute were the treatment of choice. Study Design: A comparative clinical case study. Purpose: Compare the outcomes of ACF using stand-alone PEEK cages packed with calcium triphosphate bone substitute compared with tricortical iliac autograft augmented with anterior locking plate in treatment of three or more-level CDD in 47 patients. Patients and Methods: We evaluated 47 patients (22 patients in the locking plate group and 25 patients in the cage group) at our institution from January 2007 to September 2010. They were followed up for minimum 2 years. The clinical outcomes (Nurick grade and JOA score), radiographic changes (local kyphotic angle (LKA), fusion, subsidence, and adjacent disc degeneration), and complications were compared between the 2 groups. Results: The blood loss was significantly less in cage group (388 cc) than plate group (529.6cc).Both groups showed significant improvement in LKA postoperatively and at latest follow up with no significant difference. Fusion was 94.1% and 94.4% in cage and plate groups in order. There was insignificant more subsidence in cage (21.4%) than plate group (11.3 %). There was significant improvement in Nurick grading of both cage and plate groups as it improved from 3.32 and 3.68 preoperatively to 0.84 and 1.05 at latest follow up in order with no significant difference between the two groups. Final outcome was comparable in both groups: In cage group: excellent in 7 patients, good in 16, and fair in 2. In plate group, excellent in 8 patients, good in 11, and fair in 3. Conclusion: In multiple levels (three or more) ACF, the use of stand-alone PEEK cages results in less blood loss, less adjacent disc degeneration, less complications than the use of autograft augmented with locking plate but unfortunately, more incidence of subsidence. However, there is no significant difference in the postoperative and latest follow up LKA, fusion rate, clinical, and functional outcomes between the cage and plate groups. (2013ESJ049)
format	article
author	Khaled Hassan Mohamed El-Meshtawy
author_facet	Khaled Hassan Mohamed El-Meshtawy
author_sort	Khaled Hassan
title	The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion
title_short	The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion
title_full	The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion
title_fullStr	The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion
title_full_unstemmed	The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion
title_sort	efficacy of stand-alone peek cages versus locking plate in three or more-level anterior cervical discectomy and fusion
publisher	Egyptian Spine Association
publishDate	2013
url	https://doaj.org/article/d4e45036f6734612a7be004e168a20a3
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The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion

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