Cho Der-Yang, Liau Wen-Rei, Lee Wen-Yen, Liu Jung-Tung, Chiu Chung-Lian, Sheu Pon-Chun
Department of Neurosurgery, China Medical College Hospital, Taichung, Taiwan, Republic of China.
Neurosurgery. 2002 Dec;51(6):1343-49; discussion 1349-50.
We investigated the effectiveness of a new material, polyetheretherketone (PEEK), in a spinal cage used in performing cervical spinal fusion for the correction of cervical kyphosis.
A total of 80 patients with various cervical diseases were divided into two groups. Patients in Group A (40 patients) underwent microdiscectomy and PEEK cage fusion, and patients in Group B (40 patients) were treated with microdisectomy and autogenous iliac crest graft (AICG) fusion. We evaluated the patients for cervical lordosis, the height of the foramina, the cross sectional area of the foramina, and fusion status on the basis of x-rays. The patients' neurological and functional outcomes were assessed on the basis of the Prolo scale. Magnetic resonance imaging was also performed for spinal cord evaluation.
The use of the PEEK cage in patients who undergo spinal fusion may increase cervical lordosis (mean, 2.33 +/- 3.00 mm; P = 0.03), whereas AICG fusion may not (mean, -0.84 +/- 6.69 mm; P = 0.49). The use of the PEEK cage was found to increase the height of the foramina (mean, 2.54 +/- 1.40 mm; P = 0.00) and increase its cross sectional area (mean, 40.36 +/- 23.53 mm2; P = 0.00). The height of the foramina increased only in the PEEK group postoperatively. The cross sectional area of the foramina increased in both groups postoperatively. The complication rate in patients who underwent fusion procedures with the PEEK cage was less than that in patients who underwent fusion with AICG fusion (2.50 versus 17.50%; P = 0.03). Both groups had a satisfactory fusion rate (100 versus 93.1%). The patients' postoperative Prolo scale scores were statistically better in the PEEK group (8.50 +/- 1.49 versus 7.17 +/- 2.13; P = 0.00), and more patients in the PEEK group than in the AICG group achieved excellent outcomes (66.63 versus 28.57%; P = 0.00). Because PEEK is radiotransparent on x-rays and few artifacts are seen on magnetic resonance imaging scans, it is better suited than autogenous iliac crest donor material for postoperative radiographic evaluation.
The PEEK cage provides solid fusion, increased cervical lordosis, and increased height and cross sectional area of the foramina. There are few complications associated with the use of this cage, and the functional and neurological outcomes are satisfactory. It also facilitates postoperative x-ray and magnetic resonance imaging evaluation. The PEEK cage is therefore a good substitute for AICG fusion in patients with cervical disc disease.
我们研究了一种新型材料聚醚醚酮（PEEK）在用于颈椎融合以矫正颈椎后凸的椎间融合器中的有效性。
总共80例患有各种颈椎疾病的患者被分为两组。A组（40例患者）接受了显微椎间盘切除术和PEEK椎间融合器融合术，B组（40例患者）接受了显微椎间盘切除术和自体髂嵴植骨（AICG）融合术。我们根据X线评估患者的颈椎前凸、椎间孔高度、椎间孔横截面积以及融合状态。根据普罗洛量表评估患者的神经和功能结果。还进行了磁共振成像以评估脊髓情况。
接受脊柱融合术的患者使用PEEK椎间融合器可能会增加颈椎前凸（平均值为2.33±3.00 mm；P = 0.03），而AICG融合术则不会（平均值为-0.84±6.69 mm；P = 0.49）。发现使用PEEK椎间融合器可增加椎间孔高度（平均值为2.54±1.40 mm；P = 0.00）并增加其横截面积（平均值为40.36±23.53 mm²；P = 0.00）。椎间孔高度仅在术后的PEEK组中增加。两组术后椎间孔横截面积均增加。接受PEEK椎间融合器融合手术的患者的并发症发生率低于接受AICG融合术的患者（2.50%对17.50%；P = 0.03）。两组的融合率均令人满意（100%对93.1%）。PEEK组患者术后的普罗洛量表评分在统计学上更好（8.50±1.49对7.17±2.13；P = 0.00），并且PEEK组中达到优秀结果的患者比AICG组更多（66.63%对28.57%；P = 0.00）。由于PEEK在X射线下是射线可透过的，并且在磁共振成像扫描中几乎看不到伪影，因此它比自体髂嵴供体材料更适合术后影像学评估。
PEEK椎间融合器可提供牢固的融合，增加颈椎前凸，增加椎间孔高度和横截面积。使用这种椎间融合器相关的并发症很少，并且功能和神经学结果令人满意。它还便于术后X线和磁共振成像评估。因此，对于颈椎间盘疾病患者，PEEK椎间融合器是AICG融合术的良好替代品。
