Epstein Nancy E, Agulnick Marc A
Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, and Editor-in-Chief Surgical Neurology International NY and ℅ Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA.
Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA. 1122 Franklin Avenue Suite 106 Garden City, NY 11530, USA.
Surg Neurol Int. 2022 Nov 25;13:556. doi: 10.25259/SNI_992_2022. eCollection 2022.
Multiple anterior cervical diskectomy/fusion (ACDF) techniques now use a variety of Polyehteretherketone (PEEK) cages; stand-alone (SA) and zero-profile (ZP) with/without screws, cages filled with demineralized bone matrix/autograft, and cages coated with hydroxyapatite or titanium. We compared the safety/ efficacy between different PEEK ACDF cage constructs in 17 studies, and in some cases, additionally contrasted results with "routine" ACDF (i.e. series/historical data performed with combinations of iliac autograft/allograft and plates).
We focused on the clinical outcomes, fusion rates, postoperative radiographic changes/lordosis/ subsidence, and/or reoperation rates for various PEEK ACDF constructs vs. "routine" ACDF.
One to 3 and 4-level PEEK ACDF cages demonstrated high fusion rates, few cage failures, and low reoperation rates. Subsidence for PEEK ACDF cages did not reduce fusion rates or diminish the quality of postoperative outcomes. Further, titanium-coated (T-C) PEEK cages lowered fusion rates in one study (i.e. 44.1% fusions vs. 88.2% for routine PEEK ACDF) while ACDF PEEK cages coated with hydroxyapatite (HA) showed only a "trend" toward enhanced arthrodesis.
One to 3-4 multilevel ACDF PEEK cage constructs demonstrated comparable safety/efficacy when compared with each other, or in select cases, with "routine" ACDF (i.e. using autograft/allograft and plates).
目前，多种颈椎前路椎间盘切除融合术（ACDF）技术使用了各种聚醚醚酮（PEEK）椎间融合器；独立式（SA）和零切迹（ZP），带或不带螺钉，填充有脱矿骨基质/自体移植物的椎间融合器，以及涂有羟基磷灰石或钛的椎间融合器。我们在17项研究中比较了不同PEEK ACDF椎间融合器结构之间的安全性/有效性，在某些情况下，还将结果与“常规”ACDF（即使用髂骨自体移植物/同种异体移植物和钢板组合进行的系列研究/历史数据）进行了对比。
我们重点关注各种PEEK ACDF结构与“常规”ACDF的临床结果、融合率、术后影像学变化/前凸/沉降和/或再次手术率。
单节段至三节段以及四节段的PEEK ACDF椎间融合器显示出高融合率、较少的椎间融合器失败和低再次手术率。PEEK ACDF椎间融合器的沉降并未降低融合率或影响术后结果的质量。此外，一项研究中，钛涂层（T-C）PEEK椎间融合器降低了融合率（即融合率为44.1%，而常规PEEK ACDF为88.2%），而涂有羟基磷灰石（HA）的ACDF PEEK椎间融合器仅显示出融合增强的“趋势”。
单节段至三到四节段的多节段ACDF PEEK椎间融合器结构在相互比较时，或在某些情况下与“常规”ACDF（即使用自体移植物/同种异体移植物和钢板）相比，显示出相当的安全性/有效性。
