Comparison between Polyetheretherketone (PEEK) Cages Versus an Iliac-Crest Autograft Used in Treatment of Single or Double Level Anterior Cervical Discectomy
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- Category: Vol. 81, March 2013
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Comparison between Polyetheretherketone (PEEK) Cages Versus an Iliac-Crest Autograft Used in Treatment of Single or Double Level Anterior Cervical Discectomy,AYMAN E.A. GALHOM
Abstract
Background: Anterior cervical discectomy with fusion (ACDF) is challenging with respect to both patient selection and choice of surgical procedure.
Objective: The aim of this study was to evaluate the clinical outcome of ACDF, with respect to both patient selection and choice of surgical procedure: Fusion with an autologous iliac crest graft (ICG) versus fusion with an artificial cage made of polyetheretherketone (PEEK) filled with hydroxya-patite (HA).
Patients and Methods: From January 2007 to January 2011, 40 consecutive patients referred to the Department of Neurosurgery, Suez Canal university hospital were recruited for the study and randomized into two treatment groups. Clinical assessment of pre-operative clinical data and post-operative status using Nurick scale for myelopathy, Odom's criteria for functional outcome, and Visual Analogue Scale (VAS) for both neck and arm pain. Radiological fusion was assessed by X-ray. Operative complications were reported.
Results: Eighteen patients were operated for one level discectomy and fusion with either ICG or PEEK cages with HA and 22 patients for two levels. There were 24 (60%) males and 16 (40%) females. The age of the patients ranged from 30-72 years, a mean ± SD 45±8.34. At the 2 years clinical follow-up, there were significant post operative improvements of Nurick scale, and VAS comparative to preoperative record. According to Odom criteria, 18/20 patients (90%) were graded excellent-good in the cage group compared to 16/ 20 patients (85%) in the group with bone graft. The relation was note statistically significant between the two groups p<0.35. A significant difference was found in VAS for arm pain between the two groups at 24 months with less pain in the cage group (p<0.02). Fusion occurred in 17/20 patients (85%) and 29/34 (85.2%) segments of the PEEK group, while it was 18/20 (90%) of the ICG group and 25/28 (89.2%) segments.
Conclusion: Iliac bone graft is still effective with favorable outcome as PEEK cage with HA in treatment of cervical disc. However, the former had higher fusion rate but the latter lack of donor site morbidity.