Review of anterior cervical diskectomy/fusion (ACDF) using different polyetheretherketone (PEEK) cages
- Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, and Editor-in-Chief Surgical Neurology International NY and ℅ Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA,
- Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA. 1122 Franklin Avenue Suite 106 Garden City, NY 11530, USA
Nancy E. Epstein, M.D., F.A.C.S, Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, and Editor-in-Chief Surgical Neurology International NY and ℅ Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA.
DOI:10.25259/SNI_992_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nancy E. Epstein1, Marc A. Agulnick2. Review of anterior cervical diskectomy/fusion (ACDF) using different polyetheretherketone (PEEK) cages. 25-Nov-2022;13:556
How to cite this URL: Nancy E. Epstein1, Marc A. Agulnick2. Review of anterior cervical diskectomy/fusion (ACDF) using different polyetheretherketone (PEEK) cages. 25-Nov-2022;13:556. Available from: https://surgicalneurologyint.com/surgicalint-articles/12019/
Background: Multiple anterior cervical diskectomy/fusion (ACDF) techniques now use a variety of Polyehteretherketone (PEEK) cages; stand-alone (SA) and zero-profile (ZP) with/without screws, cages filled with demineralized bone matrix/autograft, and cages coated with hydroxyapatite or titanium. We compared the safety/ efficacy between different PEEK ACDF cage constructs in 17 studies, and in some cases, additionally contrasted results with “routine” ACDF (i.e. series/historical data performed with combinations of iliac autograft/allograft and plates).
Methods: We focused on the clinical outcomes, fusion rates, postoperative radiographic changes/lordosis/ subsidence, and/or reoperation rates for various PEEK ACDF constructs vs. “routine” ACDF.
Results: One to 3 and 4-level PEEK ACDF cages demonstrated high fusion rates, few cage failures, and low reoperation rates. Subsidence for PEEK ACDF cages did not reduce fusion rates or diminish the quality of postoperative outcomes. Further, titanium-coated (T-C) PEEK cages lowered fusion rates in one study (i.e. 44.1% fusions vs. 88.2% for routine PEEK ACDF) while ACDF PEEK cages coated with hydroxyapatite (HA) showed only a “trend” toward enhanced arthrodesis.
Conclusion: One to 3-4 multilevel ACDF PEEK cage constructs demonstrated comparable safety/efficacy when compared with each other, or in select cases, with “routine” ACDF (i.e. using autograft/allograft and plates).
Keywords: Anterior cervical diskectomy fusion (ACDF), Cages, Complications, Fusion rates, Hydroxyapatite Coated (HA), Outcomes, Polyetheretherketone (PEEK), Screws, Stand-Alone (SA), Subsidence, Titanium-Coated (T-C), Zero Profile (ZP)
Multiple anterior cervical diskectomy/fusion (ACDF) Polyetheretherketone (PEEK) cage constructs/techniques are now available. Their various designs include; Stand Alone (SA) or Zero Profile (ZP) cages with/without screws, cages filled with demineralized bone matrix (DBM) and/or autograft, and PEEK cages coated with hydroxyapatite or titanium [
Seventeen studies focused on the safety/efficacy between different ACDF PEEK cage constructs with occasional comparisons to “routine” ACDF controls [
Cho et al. Study from 2002 Fusion Rates and Complications for PEEK ACDF vs. Iliac Autograft ACDF
Cho et al. (2002) compared the complications, fusion rates, and outcomes for 40 patients undergoing ACDF with PEEK cages vs. 40 having ACDF utilizing iliac crest autograft (IA) [
Results of 1-Level PEEK ACDF
Several 1-level PEEK ACDF studies showed good/excellent postoperative results with high fusion rates [
Results of 1 to 2-Level PEEK ACDF
Multiple 1 to 2-level PEEK ACDF studies also demonstrated high fusion rates and improved outcomes [
Results of 2-Level PEEK ACDF
Several 2-level PEEK ACDF studies verified high fusion rates and better outcomes with these constructs [
Results of 3-4 Level PEEK ACDF
Several other series additionally documented the safety/ efficacy of 3 and 4-level PEEK ACDF [
Results of Zero Profile PEEK Cages vs. Stand Alone PEEK Cages for 3-4 Level ACDF
Zero Profile (ZP) PEEK ACDF, comprised of a radiolucent polyetheretherketone (PEEK) cage with an anterior titanium 4 hole plate for screw placement, were developed to avoid complications of anterior cervical plates, while maintaining stability (i.e. of interbody cages with plates). Two studies confirmed excellent results with ZP PEEK ACDF devices [
Lower Fusion Rates for Titanium-Coated (T-C) PEEK ACDF vs. PEEK ACDF Alone
In 2022, Godlewski et al. compared fusion rates for 85 PEEK ACDF cages vs. 59 T-C PEEK ACDF cages.[
Subsidence Rates Following Single or Multilevel PEEK ACDF Cage Constructs Varying from Stand-Alone Devices to Titanium-Coated (T-C) PEEK Cages
Several studies documented various postoperative subsidence rates (i.e. defined as a decrease in interbody height of >3 mm on X-rays at 1-year postoperatively) following single to multilevel PEEK ACDF cage procedures [
Double Lucency X-ray Sign of Titanium-Coated PEEK ACDF (Plus Autograft) Fusion
Hellbusch et al.(2012) described the double lucency sign for confirming fusion based on X-rays performed in 148 patients undergoing 1-level Titanium-Coated (T-C) PEEK ACDF cage fusions filled with autograft [
Comparison between multiple types of ACDF PEEK cage constructs and select instances of “routine” ACDF largely demonstrated comparable safety/efficacy for these procedures.
Declaration of patient consent
Patients’ consent not required as patients’ identities were not disclosed or compromised.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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