[Artificial Disc Replacement] Outcomes of Interbody Fusion Cages Used in 1 & 2-levels Anterior Cervical Discectomy and Fusion: Titanium Cages vs. Polyetheretherketone (PEEK) Cages

[Justin]

Journal of Spinal Disorders & Techniques. Issue: Volume 23(5), July 2010, pp 310-316

Outcomes of Interbody Fusion Cages Used in 1 and 2-levels Anterior Cervical Discectomy and Fusion: Titanium Cages Versus Polyetheretherketone (PEEK) Cages

Niu, Chi-Chien MD; Liao, Jen-Chung MD; Chen, Wen-Jer MD; Chen, Lih-Huei MD. Author Information: Department of Orthopedics Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. © 2010 Lippincott Williams & Wilkins, Inc.

Study Design: A prospective study was performed in case with cervical spondylosis who underwent anterior cervical discectomy and fusion (ACDF) with titanium or polyetheretherketone (PEEK) cages.

Objective: To find out which fusion cage yielded better clinical and radiographic results.

Summary of Background Data: Although use of autogenous iliac-bone grafts in ACDF for cervical disc diseases remain standard surgical procedure, donor site morbidity and graft collapse or breakage are concerns. Cage technology was developed to prevent these complications. However, there is no comparison regarding the efficacy between titanium and PEEK cage.

Methods: January 2005 to January 2006, 53 patients who had 1 and 2-levels ACDF with titanium or PEEK cages were evaluated. We measured the rate and amount of interspace collapse, segmental sagittal angulations, and the radiographic fusion success rate. Odom criteria were used to assess the clinical results.

Results: The fusion rate was higher in the PEEK group (100% vs. 86.5%, P=0.0335). There was no significant difference between both groups in loss of cervical lordosis (3.2±2.4 vs. 2.8±3.4, P=0.166). The mean anterior interspace collapse (1.6±1.0 mm) in the titanium group was significantly higher than the collapse of the PEEK group (0.5±0.6 mm) (P<0.0001). The mean posterior interspace collapse was also higher in the titanium group (1.6±0.9 mm vs. 0.5±0.5 mm, P<0.0001). An interspace collapse of 3 mm or greater was observed in 16.2% of the patients in the titanium group, compared with zero patients in the PEEK group (P<0.0001). The PEEK group achieved an 80% rate of successful clinical outcomes, compared with 75% in the titanium group (P=0.6642).

Conclusions: The PEEK cage is superior to the titanium cage in maintaining cervical interspace height and radiographic fusion after 1 and 2-levels anterior cervical decompression procedures.

[Rob]

Interesting article. I know from my conversations with my surgeon that there are different style titanium cages. The article didn’t mention which titanium cages they were using for the study. He explained some of the differences and one was the contact surface area between the cage and the vertebrae.

He explained that some titanium cages collapse more than others, the greater the contact area the less collapse. For what it's worth he chose to use an ‘Infix’ cage manufactured by Zimmer for my ALIF noting that it has more contact area than others. Zimmer Spine - InFix Lumbar Interbody Spacer System

[Carmen]

Hi Rob,
I am glad you are doing so well. I am not on any pain meds because when i do, even if I take one, I have plumbing problems. The surgean is not thrilled with the news when I told him and he wants me to take another MRI. I wonder if everyone else has had this problem from back surgery. I was changing 4 to 5 times a day. When I don't take the pain meds I suffer from pain. ( but not uncontrollable) i can handle it but I am easier to be with when on the pain mads. My day goes so much better when on oxi-condin. i have been taking 20 Mg. I have a bottle of the 10Mg and i am wondering if I should try that? Well I have another appointment with the surgean after the MRI. i have had a number of x-rays and nothing has changed. I am 19 wks post op. Talk to you again soon. I still remember how much you helped me. Carmen

[KBear]

Hi Rob,
I am glad you are doing so well. I am not on any pain meds because when i do, even if I take one, I have plumbing problems. The surgean is not thrilled with the news when I told him and he wants me to take another MRI. I wonder if everyone else has had this problem from back surgery. I was changing 4 to 5 times a day. When I don't take the pain meds I suffer from pain. ( but not uncontrollable) i can handle it but I am easier to be with when on the pain mads. My day goes so much better when on oxi-condin. i have been taking 20 Mg. I have a bottle of the 10Mg and i am wondering if I should try that? Well I have another appointment with the surgean after the MRI. i have had a number of x-rays and nothing has changed. I am 19 wks post op. Talk to you again soon. I still remember how much you helped me. Carmen

Hey Carmen, You are still really early out from surgery, so I would expect you to still need pain medication. I had to up my medication for 6-8 months after surgery, before I was able to cut down and wean off. Best of Luck

[Carmen]

Hi,
I was surprised to hear from you, but glad. i am still in some pain but maybe it is better than the alternative. i always had trouble with plumbing problems. They were at the worst when I was in rehab. i will see if I can get a script for Opana ER and see if that will give me the same problems. There has got to be something out there that will work for me. I will keep you updcated. When I first thought I could drop the pain meds everything was fine, for awhile. i have had some stress lately so i have to clear my mind from anything that will bring it on. It is not so bad that I can't tolerate it. I could take maybe Eleve or something over the counter. My nurse said it may not be any better. We shall see. i hope you are doing good. It sounds like you are. I am so glad. Carmen

[Rob]

Hi Carmen,

It is REALLY good to hear from you. I’m soooooo glad you’re doing well. My plumbing problem was the opposite. I was constipated for 9 days!!! I don’t know if you’ve had the opportunity but I wrote a fairly wordy post about my experience in a blog that Justin posted for me on 7/20/10 under 'Surgical Outcomes' because it was too long for me to post. In the blog there is information on my surgeon, the hospital and BMP.

The link is http://www.spinepatientsociety.org/forum/attachments/surgical-outcomes/260d1279129514-robs-anterior-lumbar-interbody-fusion-alif-experience-before-during-after-hope-will-help-someone-1.pdf .

I'd REALLY like to talk more but I started a new job last Monday. They have me in training for the next few months. My wife and I will be relocating to California from Georgia the first part of next year so I can cover the Western states for this sales position I accepted.

You should know that I am REALLY glad to hear from you and that you’re doing well. I’ve thought about you many times over the pas several months. Hopefully I’ll be able to find more time to catch-up.

Take care.

Regards,

Rob