Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages

Mario Cabraja, Soner Oezdemir, Daniel Koeppen, Stefan Kroppenstedt, Mario Cabraja, Soner Oezdemir, Daniel Koeppen, Stefan Kroppenstedt

Abstract

Background: Titanium (TTN) cages have a higher modulus of elasticity when compared with polyetheretherketone (PEEK) cages. This suggests that TTN-cages could show more frequent cage subsidence after anterior cervical discectomy and fusion (ACDF) and therefore might lead to a higher loss of correction. We compared the long term results of stand-alone PEEK- and TTN-cages in a comparable patient collective that was operated under identical operative settings.

Methods: From 2002 to 2007 154 patients underwent single-level ACDF for degenerative disc disease (DDD). Clinical and radiological outcome were assessed in 86 eligible patients after a mean of 28.4 months. 44 patients received a TTN- and 42 patients a PEEK-cage.

Results: Solid arthrodesis was found in 93.2% of the TTN-group and 88.1% of the PEEK-group. Cage subsidence was observed in 20.5% of the TTN- and 14.3% of the PEEK-group. A significant segmental lordotic correction was achieved by both cage-types. Even though a loss of correction was found at the last follow-up in both groups, it did not reach the level of statistical significance. Statistical analysis of these results revealed no differences between the TTN- and PEEK-group.When assessed with the neck disability index (NDI), the visual analogue scale (VAS) of neck and arm pain and Odom's criteria the clinical data showed no significant differences between the groups.

Conclusions: Clinical and radiological outcomes of ACDF with TTN- or PEEK-cages do not appear to be influenced by the chosen synthetic graft. The modulus of elasticity represents only one of many physical properties of a cage. Design, shape, size, surface architecture of a cage as well as bone density, endplate preparation and applied distraction during surgery need to be considered as further important factors.

Figures

Figure 1
Figure 1
Patient flow.
Figure 2
Figure 2
CeSpace® TTN-cage with Plasmapore® coating and fixation ring (top) and CeSpace® PEEK-cage (bottom). Note that the Peek-Cage has a slight convex shape of the upper surface, while the TTN-cage is plane.
Figure 3
Figure 3
Bone formation could be seen in the TTN-group (A) and PEEK-group (B).
Figure 4
Figure 4
55-years old patient with a pseudarthrosis 3 years after surgery. The motion of the operated segment can be clearly seen by observing the movement of the spinous processes in the lateral functional x-rays.
Figure 5
Figure 5
Subsidence of a PEEK-cage into the posterior part of the inferior endplate (A) and subsidence of a TTN-cage into the anterior part of the inferior endplate (B). A radiolucent gap can be seen in both cases around the cage (arrows).

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Source: PubMed

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