Anterior cervical discectomy and fusion performed using structural allograft or polyetheretherketone: pseudarthrosis and revision surgery rates with minimum 2-year follow-up

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OBJECTIVE

Both structural allograft and PEEK have been used for anterior cervical discectomy and fusion (ACDF). There are reports that PEEK has a higher pseudarthrosis rate than structural allograft. The authors compared pseudarthrosis, revision, subsidence, and loss of lordosis rates in patients with PEEK and structural allograft.

METHODS

The authors performed a retrospective review of patients who were treated with ACDF at their hospital between 2005 and 2017. Inclusion criteria were adult patients with either PEEK or structural allograft, anterior plate fixation, and a minimum 2-year follow-up. Exclusion criteria were hybrid PEEK and allograft cases, additional posterior surgery, adjacent corpectomies, infection, tumor, stand-alone or integrated screw and cage devices, bone morphogenetic protein use, or lack of a minimum 2-year follow-up. Demographic variables, number of treated levels, interbody type (PEEK cage vs structural allograft), graft packing material, pseudarthrosis rates, revision surgery rates, subsidence, and cervical lordosis changes were collected. These data were analyzed by Pearson’s chi-square test (or Fisher’s exact test, according to the sample size and expected value) and Student t-test.

RESULTS

A total of 168 patients (264 levels total, mean follow-up time 39.5 ± 24.0 months) were analyzed. Sixty-one patients had PEEK, and 107 patients had structural allograft. Pseudarthrosis rates for 1-level fusions were 5.4% (PEEK) and 3.4% (allograft) (p > 0.05); 2-level fusions were 7.1% (PEEK) and 8.1% (allograft) (p > 0.05); and ≥ 3-level fusions were 10% (PEEK) and 11.1% (allograft) (p > 0.05). There was no statistical difference in the subsidence magnitude between PEEK and allograft in 1-, 2-, and ≥ 3-level ACDF (p > 0.05). Postoperative lordosis loss was not different between cohorts for 1- and 2-level surgeries.

CONCLUSIONS

In 1- and 2-level ACDF with plating involving the same number of fusion levels, there was no statistically significant difference in the pseudarthrosis rate, revision surgery rate, subsidence, and lordosis loss between PEEK cages and structural allograft.

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; BMP = bone morphogenetic protein; DBM = demineralized bone matrix.
Article Information

Contributor Notes

Correspondence Minghao Wang: University of California, San Francisco, CA. wisewangmh@hotmail.com.INCLUDE WHEN CITING Published online December 13, 2019; DOI: 10.3171/2019.9.SPINE19879.Disclosures Dr. Chan received support of a non–study-related clinical or research effort that he oversaw from Orthofix. Dr. Chou is a consultant for Medtronic and Globus, and he receives royalties from Globus. Dr. Mummaneni is a consultant for DePuy Synthes, Globus, and Stryker, and has direct stock ownership in Spinicity/ISD. He receives support for a non–study-related clinical or research effort that he oversees from NREF and ISSG. He receives royalties from Thieme Publishing, Springer Publishing, and DePuy Synthes. He receives honoraria from Spineart.
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References
  • 1

    Armaghani SJEven JLZern EKBraly BAKang JDDevin CJ: The evaluation of donor site pain after harvest of tricortical anterior iliac crest bone graft for spinal surgery: a prospective study. Spine (Phila Pa 1976) 41:E191E1962016

    • Search Google Scholar
    • Export Citation
  • 2

    Cabraja MOezdemir SKoeppen DKroppenstedt S: Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 13:1722012

    • Search Google Scholar
    • Export Citation
  • 3

    Faldini CLeonetti DNanni MDi Martino ADenaro LDenaro V: Cervical disc herniation and cervical spondylosis surgically treated by Cloward procedure: a 10-year-minimum follow-up study. J Orthop Traumatol 11:991032010

    • Search Google Scholar
    • Export Citation
  • 4

    Gu YTJia LSChen TY: Biomechanical study of a hat type cervical intervertebral fusion cage. Int Orthop 31:1011052007

  • 5

    Kao FCNiu CCChen LHLai PLChen WJ: Maintenance of interbody space in one- and two-level anterior cervical interbody fusion: comparison of the effectiveness of autograft, allograft, and cage. Clin Orthop Relat Res (430):1081162005

    • Search Google Scholar
    • Export Citation
  • 6

    Kersten RFvan Gaalen SMde Gast AÖner FC: Polyetheretherketone (PEEK) cages in cervical applications: a systematic review. Spine J 15:144614602015

    • Search Google Scholar
    • Export Citation
  • 7

    Krause KLObayashi JTBridges KJRaslan AMThan KD: Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion. J Neurosurg Spine 30:46512018

    • Search Google Scholar
    • Export Citation
  • 8

    Lee JCJang HDAhn JChoi SWKang DShin BJ: Comparison of cortical ring allograft and plate fixation with autologous iliac bone graft for anterior cervical discectomy and fusion. Asian Spine J 13:2582642019

    • Search Google Scholar
    • Export Citation
  • 9

    Liao JCNiu CCChen WJChen LH: Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop 32:6436482008

    • Search Google Scholar
    • Export Citation
  • 10

    Miller LEBlock JE: Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery. Spine (Phila Pa 1976) 36:204520502011

    • Search Google Scholar
    • Export Citation
  • 11

    Niu CCLiao JCChen WJChen LH: Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages. J Spinal Disord Tech 23:3103162010

    • Search Google Scholar
    • Export Citation
  • 12

    Pirkle SKaskovich SCook DJHo AShi LLLee MJ: Cages in ACDF are associated with a higher nonunion rate than allograft: a stratified comparative analysis of 6130 patients. Spine (Phila Pa 1976) 44:3843882019

    • Search Google Scholar
    • Export Citation
  • 13

    Seaman SKerezoudis PBydon MTorner JCHitchon PW: Titanium vs. polyetheretherketone (PEEK) interbody fusion: meta-analysis and review of the literature. J Clin Neurosci 44:23292017

    • Search Google Scholar
    • Export Citation
  • 14

    Shimizu TFujibayashi SYamaguchi SOtsuki BOkuzu YMatsushita T: In vivo experimental study of anterior cervical fusion using bioactive polyetheretherketone in a canine model. PLoS One 12:e01844952017

    • Search Google Scholar
    • Export Citation
  • 15

    Silber JSAnderson DGDaffner SDBrislin BTLeland JMHilibrand AS: Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 28:1341392003

    • Search Google Scholar
    • Export Citation
  • 16

    Sugawara T: Anterior cervical spine surgery for degenerative disease: a review. Neurol Med Chir (Tokyo) 55:5405462015

  • 17

    Tomford WW: Bone allografts: past, present and future. Cell Tissue Bank 1:1051092000

  • 18

    Toth JMWang MEstes BTScifert JLSeim HB IIITurner AS: Polyetheretherketone as a biomaterial for spinal applications. Biomaterials 27:3243342006

    • Search Google Scholar
    • Export Citation
  • 19

    Vanek PBradac ODeLacy PSaur KBelsan TBenes V: Comparison of 3 fusion techniques in the treatment of the degenerative cervical spine disease. Is stand-alone autograft really the "gold standard?": prospective study with 2-year follow-up. Spine (Phila Pa 1976) 37:164516512012

    • Search Google Scholar
    • Export Citation
  • 20

    Wenz LMMerritt KBrown SAMoet ASteffee AD: In vitro biocompatibility of polyetheretherketone and polysulfone composites. J Biomed Mater Res 24:2072151990

    • Search Google Scholar
    • Export Citation
  • 21

    Yoon STKonopka JAWang JCYoussef JAMeisel HJBrodke DS: ACDF graft selection by surgeons: survey of AOSpine members. Global Spine J 7:4104162017

    • Search Google Scholar
    • Export Citation
  • 22

    Yson SCSembrano JNSantos ER: Comparison of allograft and polyetheretherketone (PEEK) cage subsidence rates in anterior cervical discectomy and fusion (ACDF). J Clin Neurosci 38:1181212017

    • Search Google Scholar
    • Export Citation
  • 23

    Zadegan SAAbedi AJazayeri SBVaccaro ARRahimi-Movaghar V: Demineralized bone matrix in anterior cervical discectomy and fusion: a systematic review. Eur Spine J 26:9589742017

    • Search Google Scholar
    • Export Citation
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