Department of Orthopedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Changi General Hospital, 2 Simei Street 3, Bukit Merah, 529889, Singapore.
BMC Musculoskelet Disord. 2020 May 28;21(1):331. doi: 10.1186/s12891-020-03325-y.
Allografts and polyetheretherketone (PEEK) cages are the two most commonly used materials in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in two-level ACDF remains controversial. The primary aim of this retrospective study was to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage.
From 2010 to 2015, 88 consecutive patients underwent two-level ACDF, of whom 53 received an allograft and 35 patients received a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected before and six months and two years after surgery. Clinical efficacy was evaluated using a visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, the Neck Disability Index, the Neurogenic Symptom Score, and the Japanese Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up.
A preoperative comparison revealed no difference between the two patient groups in terms of age, sex, body mass index, smoking status, preoperative symptoms, operation level, or follow-up (mean = 42.8 months). No differences in the improvements in clinical outcomes were observed between the two groups. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rate for the PEEK cage was 100% at both levels, while the fusion rate for the allograft group was 98.1% at the cephalad level and 94.2% at the caudad level (p > 0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) of segments in the PEEK group and 7.7% (4/52) of segments in the allograft group (p = 0.057). At the caudal level, a higher incidence of cage subsidence was noted in the PEEK group than in the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p = 0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p < 0.05).
The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF than the use of allografts. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.
同种异体移植物和聚醚醚酮（PEEK） cage 是颈椎前路椎间盘切除融合术（ACDF）中最常使用的两种材料。然而，它们在两节段 ACDF 中的有效性仍存在争议。本回顾性研究的主要目的是比较使用板固定的两节段 ACDF 中使用结构性同种异体移植物或 PEEK cage 的临床和影像学结果。
2010 年至 2015 年，88 例连续患者接受了两节段 ACDF，其中 53 例接受了同种异体移植物，35 例患者接受了 PEEK cage。所有 PEEK cage 均填充有局部自体移植物。所有临床结果均在术前和术后 6 个月和 2 年进行前瞻性收集。使用颈部疼痛和肢体疼痛的视觉模拟评分、颈部疼痛和残疾评分、颈部残疾指数、神经症状评分和日本矫形协会评分评估临床疗效。在术前、术后即刻和最后一次随访时评估影像学结果。
术前比较显示两组患者在年龄、性别、体重指数、吸烟状况、术前症状、手术水平或随访方面无差异（平均 42.8 个月）。两组之间的临床结果改善无差异。两组术后均表现出椎间盘高度、节段高度和节段前凸的显著改善。PEEK cage 在两个水平的融合率均为 100%，而同种异体移植物组在头侧水平的融合率为 98.1%，在尾侧水平的融合率为 94.2%（p>0.05）。PEEK 组的 22.9%（35 个中的 8 个）和同种异体移植物组的 7.7%（52 个中的 4 个）的头侧水平发生了沉降（p=0.057）。在尾侧水平，PEEK 组的 cage 沉降发生率高于同种异体移植物组[37.1%（35 个中的 13 个）比 15.4%（52 个中的 8 个）]（p=0.02）。总体而言，PEEK 组中有 30%（70 个中的 21 个）发生沉降，同种异体移植物组中有 11%（104 个中的 12 个）发生沉降（p<0.05）。
在两节段 ACDF 中使用 PEEK cage 比使用同种异体移植物导致更高的沉降率。使用同种异体移植物或 PEEK cage 进行两节段 ACDF 可获得相似的临床结果，在对线和融合率方面有影像学改善。
