Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014:2014:398396.
doi: 10.1155/2014/398396. Epub 2014 Jul 2.

PEEK cages versus PMMA spacers in anterior cervical discectomy: comparison of fusion, subsidence, sagittal alignment, and clinical outcome with a minimum 1-year follow-up

Jan-Helge Klingler  1 , Marie T Krüger  1 , Ronen Sircar  1 , Evangelos Kogias  1 , Christoph Scholz  1 , Florian Volz  1 , Christian Scheiwe  1 , Ulrich Hubbe  1
Affiliations

PEEK cages versus PMMA spacers in anterior cervical discectomy: comparison of fusion, subsidence, sagittal alignment, and clinical outcome with a minimum 1-year follow-up

Jan-Helge Klingler et al. ScientificWorldJournal. 2014.

Abstract

Purpose: To compare radiographic and clinical outcomes after anterior cervical discectomy in patients with cervical degenerative disc disease using PEEK cages or PMMA spacers with a minimum 1-year follow-up.

Methods: Anterior cervical discectomy was performed in 107 patients in one or two levels using empty PEEK cages (51 levels), Sulcem PMMA spacers (49 levels) or Palacos PMMA spacers (41 levels) between January, 2005 and February, 2009. Bony fusion, subsidence, and sagittal alignment were retrospectively assessed in CT scans and radiographs at follow-up. Clinical outcome was measured using the VAS, NDI, and SF-36.

Results: Bony fusion was assessed in 65% (PEEK cage), 57% (Sulcem), and 46% (Palacos) after a mean follow-up of 2.5 years. Mean subsidence was 2.3-2.6 mm without significant differences between the groups. The most pronounced loss of lordosis was found in PEEK cages (-4.1°). VAS was 3.1 (PEEK cage), 3.6 (Sulcem), and 2.7 (Palacos) without significant differences. Functional outcome in the PEEK cage and Palacos group was superior to the Sulcem group.

Conclusions: The substitute groups showed differing fusion rates. Clinical outcome, however, appears to be generally not correlated with fusion status or subsidence. We could not specify a superior disc substitute for anterior cervical discectomy. This trial is registered with DRKS00003591.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient flow diagram. Out of 225 patients with ACD between January 2005 and February 2009, 107 patients were included in one PEEK cage group and two PMMA groups. ACD: anterior cervical discectomy, PEEK: polyetheretherketone, and PMMA: polymethylmethacrylate.
Figure 2
Figure 2
Fusion and nonfusion. Postoperative three-dimensional reconstructed CT scans after ACD with implantation of PEEK cages. (a) A continuous trabecular bone bridge through the cage (encircled) confirmed bony fusion; (b) no bony fusion was assessed due to the lack of continuous trabecular bone bridges.
Figure 3
Figure 3
Measurement techniques for subsidence and sagittal alignments. The interbody height ratio of C5/6 is the total segmental height (vertical dotted line with arrowheads) divided by the anterior-posterior diameter of C5 (horizontal dashed line with arrowheads). α is the angle indicating the cervical sagittal alignment (CSA); β is the angle indicating the segmental sagittal alignment (SSA).
Figure 4
Figure 4
Correlation between SSA and CSA after ACD with implantation of Sulcem PMMA spacers. The diagram shows the positive correlation between SSA and CSA in the Sulcem PMMA group indicating that a change in SSA was a significant predictor of a change in CSA. The mean change in SSA was −2.4° and in CSA was −5.2°. ACD: anterior cervical discectomy, CSA: cervical sagittal alignment, PMMA: polymethylmethacrylate, and SSA: segmental sagittal alignment.
See this image and copyright information in PMC

References

    1. Jacobs W, Willems PC, Kruyt M, et al. Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine. 2011;36(14):E950–E960. - PubMed
    1. Schroder J, Grosse-Dresselhaus F, Schul C, Wassmann H. PMMA versus titanium cage after anterior cervical discectomy—a prospective randomized trial. Zentralblatt für Neurochirurgie. 2007;68(1):2–7. - PubMed
    1. Cabraja M, Koeppen D, Lanksch WR, Maier-Hauff K, Kroppenstedt S. Polymethylmethacrylate-assisted ventral discectomy: rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years. BMC Musculoskeletal Disorders. 2011;12, article 140 - PMC - PubMed
    1. Korinth MC, Krüger A, Oertel MF, Gilsbach JM. Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease: results in 292 patients with monoradiculopathy. Spine. 2006;31(11):1207–1214. - PubMed
    1. Bärlocher CB, Barth A, Krauss JK, Binggeli R, Seiler RW. Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurgical Focus. 2002;12(1, article E4) - PubMed

MeSH terms

Associated data

LinkOut - more resources