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Schröder J, Kampulz T, Bajaj SK, Hellwig AG, Winking M. PEEK Cages versus Titanium-Coated PEEK Cages in Single-Level Anterior Cervical Fusion: A Randomized Controlled Study. J Neurol Surg A Cent Eur Neurosurg 2024; 85:262-268. [PMID: 37506743 DOI: 10.1055/s-0043-1770694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
BACKGROUND The implantation of a spacer is a common practice after anterior diskectomy in cervical spine. Polyether ether ketone (PEEK) cages have replaced titanium implants due to their better radiologic visibility and appearance in postoperative magnetic resonance imaging (MRI) scans. However, PEEK showed apparently higher nonunion rates than titanium cages. The aim of the study was to evaluate the fusion behavior of plain PEEK cages in comparison to titanium-coated PEEK (TiPEEK) cages. METHOD We randomized 104 patients with single-level cervical radiculopathy or mild myelopathy. They were divided into two groups of 52 patients each, receiving either a PEEK cage or the titanium-coated variant of the same cage type. The 1- and 2-year follow-ups were completed by 43 patients in the PEEK group and by 50 patients in the TiPEEK group. Fusion was determined by plain X-ray and lateral functional X-ray. RESULTS Two years after surgery, a complete fusion was observed in 37 patients of the PEEK group (86%). Six cases were considered as nonunions. In the TiPEEK group, we found 41 fusions (82%) and 9 nonunions at this time. The difference was not considered significant (p = 0.59). The clinical evaluation of the two groups showed no difference in the neurologic examination as well in the pain scores over the time period. CONCLUSIONS Despite some assumptions about an advantage of TiPEEK over PEEK cages for fusion in cervical spine surgery, this prospective randomized controlled study did not find an accelerated or improved fusion using TiPEEK for anterior cervical diskectomy.
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Affiliation(s)
| | - Thomas Kampulz
- ZW-O Zentrum für - Wirbelsäulenchirurgie, Osnabrück, Germany
| | | | | | - Michael Winking
- ZW-O Zentrum für - Wirbelsäulenchirurgie, Osnabrück, Germany
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Kwon JW, Lee YH, Lee BH, Kim JH, Suk KS. Clinical and radiological outcomes of non-window-type bioactive glass-ceramic cage in single-level ACDF versus PEEK cage filled with autologous bone. Sci Rep 2024; 14:4035. [PMID: 38369553 PMCID: PMC10874951 DOI: 10.1038/s41598-024-54786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/16/2024] [Indexed: 02/20/2024] Open
Abstract
Bioactive glass-ceramic (BGC) cage is a substitute for polyether ether ketone (PEEK) cages in anterior cervical discectomy and fusion (ACDF). Only a few comparative studies exist using PEEK and non-window-type BGC cages (CaO-SiO2-P2O5-B2O3) in single-level ACDF. This study compared PEEK cages filled with autologous iliac bone grafts and BGC cages regarding clinical safety and effectiveness. A retrospective case series was performed on 40 patients who underwent single-level ACDF between October 2020 and July 2021 by a single orthopedic spine surgeon. The spacers used in each ACDF were a PEEK cage with a void filled with an autologous iliac bone graft and a non-window-type BGC cage in 20 cases. The grafts were compared pre-operatively and post-operatively at 6 weeks and 3, 6, and 12 months. Post-operative complications were investigated in each group. Clinical outcome was measured, including Visual Analog Scale (VAS) scores of neck and arm pains, Japanese Orthopedic Association score (JOA), and Neck Disability Index (NDI). Dynamic lateral radiographs were used to assess the inter-spinous motion (ISM) between the fusion segment and subsidence. The fusion status was evaluated using a computed tomography (CT) scan. Overall, 39 patients (19 and 20 patients in the PEEK and BGC groups, respectively) were recruited. Eighteen (94.7%) and 19 (95.0%) patients in the PEEK and BGC groups, respectively, were fused 12 months post-operatively, as assessed by ISM in dynamic lateral radiograph and bone bridging formation proven in CT scan. The PEEK and BGC groups showed substantial improvement in neck and arm VAS, JOA, and NDI scores. No substantial difference was found in clinical and radiological outcomes between the PEEK and BGC groups. However, the operation time was considerably shorter in the BGC group than in the PEEK group. In conclusion, a non-window-type BCG cage is a feasible substitute for a PEEK cage with an autologous iliac bone graft in single-level ACDF.
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Affiliation(s)
- Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Yong Ho Lee
- Department of Orthopedic Surgery, Yonsei Baro-Chuk Hospital, Seoul, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Jae Hong Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Kyung Soo Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea.
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Bębenek A, Dominiak M, Karpiński G, Pawełczyk T, Godlewski B. Impact of Implant Size and Position on Subsidence Degree after Anterior Cervical Discectomy and Fusion: Radiological and Clinical Analysis. J Clin Med 2024; 13:1151. [PMID: 38398464 PMCID: PMC10889498 DOI: 10.3390/jcm13041151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Implant subsidence is recognized as a complication of interbody stabilization, although its relevance remains ambiguous, particularly in terms of relating the effect of the position and depth of subsidence on the clinical outcome of the procedure. This study aimed to evaluate how implant positioning and size influence the incidence and degree of subsidence and to examine their implications for clinical outcomes. METHODS An observational study of 94 patients (157 levels) who underwent ACDF was conducted. Radiological parameters (implant position, implant height, vertebral body height, segmental height and intervertebral height) were assessed. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Subsidence was evaluated in groups according to its degree, and statistical analyses were performed. RESULTS The findings revealed that implant-to-endplate ratio and implant height were significant risk factors associated with the incidence and degree of subsidence. The incidence of subsidence varied as follows: 34 cases (41.5%) exhibited displacement of the implant into the adjacent endplate by 2-3 mm, 32 cases (39%) by 3-4 mm, 16 cases (19.5%) by ≥4 mm and 75 (47.8%) cases exhibited no subsidence. CONCLUSIONS The findings underscore that oversized or undersized implants relative to the disc space or endplate length elevate the risk and severity of subsidence.
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Affiliation(s)
- Adam Bębenek
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed—St. Raphael Hospital, 30693 Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed—St. Raphael Hospital, 30693 Cracow, Poland
| | - Grzegorz Karpiński
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed—St. Raphael Hospital, 30693 Cracow, Poland
| | - Tomasz Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92216 Lodz, Poland;
| | - Bartosz Godlewski
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed—St. Raphael Hospital, 30693 Cracow, Poland
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Bębenek A, Dominiak M, Godlewski B. Cervical Sagittal Balance: Impact on Clinical Outcomes and Subsidence in Anterior Cervical Discectomy and Fusion. Biomedicines 2023; 11:3310. [PMID: 38137531 PMCID: PMC10741008 DOI: 10.3390/biomedicines11123310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Degenerative disease of the cervical spine leads to sagittal imbalance, which may affect treatment results. The purpose of this study was to evaluate changes in selected cervical sagittal balance parameters and their effects on subsidence and clinical outcomes of the procedure. This study encompassed a total of 95 evaluated patients who underwent anterior cervical discectomy and fusion (ACDF). Selected cervical sagittal balance parameters were assessed using lateral projection X-rays: C2-C7 spinal vertical axis (C2-C7 SVA), spinocranial angle (SCA), C7 slope, C2-C7 lordosis, and the segmental Cobb angle. Measurements were collected the day before, the day after, and 12 months after surgery. Changes in clinical parameters was assessed using the VAS and NDI scales. Subsidence was defined as a loss of intervertebral height of more than 30% of the baseline value. Among all the assessed parameters, only the C2-C7 SVA demonstrated a statistically significant difference between the groups with and without subsidence: 26.03 vs. 21.79 [mm], with p = 0.0182, preoperatively and 27.80 vs. 24.94 [mm], with p = 0.0449, on the day after surgery, respectively. We conclude that higher preoperative and postoperative C2-C7 SVA values might contribute to an elevated risk of implant subsidence. Furthermore, both the SCA and C7 slope could conceivably influence the clinical outcome, respectively impacting pain, as assessed by the VAS and the disability, as evaluated through the NDI scale.
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Affiliation(s)
| | | | - Bartosz Godlewski
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed—St. Raphael Hospital, 30-693 Cracow, Poland; (A.B.); (M.D.)
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Wei Z, Zhang Z, Zhu W, Weng X. Polyetheretherketone development in bone tissue engineering and orthopedic surgery. Front Bioeng Biotechnol 2023; 11:1207277. [PMID: 37456732 PMCID: PMC10345210 DOI: 10.3389/fbioe.2023.1207277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.
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Affiliation(s)
- Zhanqi Wei
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Ze Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Wei Zhu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Godlewski B, Bebenek A, Dominiak M, Bochniak M, Cieslik P, Pawelczyk T. Adjacent segment mobility after ACDF considering fusion status at the implant insertion site. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1616-1623. [PMID: 36917300 DOI: 10.1007/s00586-023-07634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE This paper sets out to analyse mobility changes in segments adjacent to the operated segment. Additionally, it investigates the relationship between the degree of fusion in the operated disc space and mobility changes in the adjacent segments. METHODS In total, 170 disc spaces were operated on in 104 consecutive patients qualified for one- or two-level surgery. The degree of mobility of segments directly above and below the implant insertion site was calculated. Measurements were performed the day before the surgery and 12 months post-surgery. Functional (flexion and extension) radiographs of the cervical spine and CT scans obtained 12 months post-surgery were used to evaluate the fusion status. The results were subjected to statistical analysis. RESULTS Statistically significant increase in mobility was recorded for the segments situated immediately below the operative site, with a mean change in mobility of 1.7 mm. Complete fusion was demonstrated in 101 cases (71.1%), and partial fusion in 43 cases (29.9%). In the complete fusion subgroup, the ranges of both flexion and extension in the segments directly below the operative site were significantly greater than those in the partial fusion (pseudoarthrosis) subgroup. CONCLUSION The mobility of the adjacent segment below the implant insertion site was significantly increased at 12 months post-ACDF surgery. The range of this compensatory hypermobility was significantly greater in patients with complete fusion at the ACDF site than in cases of pseudoarthrosis. Implant subsidence was not associated with mobility changes in the segments directly above or directly below the site of ACDF surgery.
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Affiliation(s)
- Bartosz Godlewski
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed - St. Raphael Hospital in Cracow, ul. Adama Bochenka 12, 30-693, Cracow, Poland.
| | - Adam Bebenek
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed - St. Raphael Hospital in Cracow, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed - St. Raphael Hospital in Cracow, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Marcin Bochniak
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed - St. Raphael Hospital in Cracow, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Piotr Cieslik
- Department of Orthopaedics and Traumatology, Military Institute of Medicine, Warsaw, Poland
| | - Tomasz Pawelczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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Fedotkin AY, Akimchenko IO, Tran TH, Shugurov AR, Shesterikov EV, Kozelskaya AI, Rutkowski S, Tverdokhlebov SI. Improvement of the Surface Properties of Polyether Ether Ketone via Arc Evaporation for Biomedical Applications. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2990. [PMID: 37109826 PMCID: PMC10145034 DOI: 10.3390/ma16082990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 06/19/2023]
Abstract
Polyether ether ketone is a bioinert polymer, that is of high interest in research and medicine as an alternative material for the replacement of bone implants made of metal. The biggest deficit of this polymer is its hydrophobic surface, which is rather unfavorable for cell adhesion and thus leads to slow osseointegration. In order to address this drawback, 3D-printed and polymer extruded polyether ether ketone disc samples that were surface-modified with titanium thin films of four different thicknesses via arc evaporation were investigated and compared with non-modified disc samples. Depending on the modification time, the thickness of the coatings ranged from 40 nm to 450 nm. The 3D-printing process does not affect the surface or bulk properties of polyether ether ketone. It turned out that the chemical composition of the coatings obtained did not depend on the type of substrate. Titanium coatings contain titanium oxide and have an amorphous structure. Microdroplets formed on the sample surfaces during treatment with an arc evaporator contain a rutile phase in their composition. Surface modification of the samples via arc evaporation resulted in an increase in the arithmetic mean roughness from 20 nm to 40 nm for the extruded samples and from 40 nm to 100 nm for the 3D-printed samples, with the mean height difference increasing from 100 nm to 250 nm and from 140 nm to 450 nm. Despite the fact that the hardness and reduced elastic modulus of the unmodified 3D-printed samples (0.33 GPa and 5.80 GPa) are higher than those of the unmodified extruded samples (0.22 GPa and 3.40 GPa), the surface properties of the samples after modification are approximately the same. The water contact angles of the polyether ether ketone sample surfaces decrease from 70° to 10° for the extruded samples and from 80° to 6° for the 3D-printed samples as the thickness of the titanium coating increases, making this type of coating promising for biomedical applications.
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Affiliation(s)
- Alexander Y. Fedotkin
- Weinberg Research Center, School of Nuclear Science & Engineering, Tomsk Polytechnic University, 30, Lenin Avenue, 634050 Tomsk, Russia
| | - Igor O. Akimchenko
- Weinberg Research Center, School of Nuclear Science & Engineering, Tomsk Polytechnic University, 30, Lenin Avenue, 634050 Tomsk, Russia
| | - Tuan-Hoang Tran
- Weinberg Research Center, School of Nuclear Science & Engineering, Tomsk Polytechnic University, 30, Lenin Avenue, 634050 Tomsk, Russia
| | - Artur R. Shugurov
- Weinberg Research Center, School of Nuclear Science & Engineering, Tomsk Polytechnic University, 30, Lenin Avenue, 634050 Tomsk, Russia
- Institute of Strength Physics and Materials Science, Siberian Branch of the Russian Academy of Sciences, 2/4, pr. Akademicheskii, 634055 Tomsk, Russia
| | - Evgeniy V. Shesterikov
- Nanotechnology Research and Education Center, Tomsk State University of Control Systems and Radioelectronics, 40, Lenin Avenue, 634050 Tomsk, Russia
| | - Anna I. Kozelskaya
- Weinberg Research Center, School of Nuclear Science & Engineering, Tomsk Polytechnic University, 30, Lenin Avenue, 634050 Tomsk, Russia
| | - Sven Rutkowski
- Weinberg Research Center, School of Nuclear Science & Engineering, Tomsk Polytechnic University, 30, Lenin Avenue, 634050 Tomsk, Russia
| | - Sergei I. Tverdokhlebov
- Weinberg Research Center, School of Nuclear Science & Engineering, Tomsk Polytechnic University, 30, Lenin Avenue, 634050 Tomsk, Russia
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Epstein NE, Agulnick MA. Review of anterior cervical diskectomy/fusion (ACDF) using different polyetheretherketone (PEEK) cages. Surg Neurol Int 2022; 13:556. [PMID: 36600749 PMCID: PMC9805606 DOI: 10.25259/sni_992_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
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).
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Affiliation(s)
- Nancy E. Epstein
- 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,,Corresponding author: 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.
| | - Marc A. Agulnick
- Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA. 1122 Franklin Avenue Suite 106 Garden City, NY 11530, USA
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Godlewski B, Bebenek A, Dominiak M, Bochniak M, Cieslik P, Pawelczyk T. Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion. J Clin Med 2022; 11:jcm11206066. [PMID: 36294384 PMCID: PMC9605251 DOI: 10.3390/jcm11206066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022] Open
Abstract
Most surgical procedures performed on account of degenerative disease of the cervical spine involve a discectomy and interbody fixation. Bone fusion at the implant placement site is evaluated post-operatively. It is agreed that computed tomography is the best modality for assessing bone union. We evaluated the results obtained with various methods based solely on conventional radiographs in the same group of patients and compared them with results obtained using a method that is a combination of CT and conventional radiography, which we considered the most precise and a reference method. We operated on a total of 170 disc spaces in a group of 104 patients. Fusion was evaluated at 12 months after surgery with five different and popular classifications based on conventional radiographs and then compared with the reference method. Statistical analyses of test accuracy produced the following classification of fusion assessment methods with regard to the degree of consistency with the reference method, in descending order: (1) bone bridging is visible on the anterior and/or posterior edge of the operated disc space on a lateral radiograph; (2) change in the value of Cobb's angle for a motion segment on flexion vs. extension radiographs (threshold for fusion vs. pseudoarthrosis is 2°); (3) change in the interspinous distance between process tips on flexion vs. extension radiographs (threshold of 2 mm); (4) change in the value of Cobb's angle of a motion segment (threshold of 4°); (5) change in the interspinous distance between process bases on flexion vs. extension radiographs (threshold of 2 mm). When bone union is evaluated on the basis on radiographs, without CT evidence, we suggest using the "bone bridging" criterion as the most reliable commonly used approach to assessing bone union.
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Affiliation(s)
- Bartosz Godlewski
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
- Correspondence: ; Tel./Fax: +48-12-3855634
| | - Adam Bebenek
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Marcin Bochniak
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Piotr Cieslik
- Department of Orthopaedics and Traumatology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Tomasz Pawelczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-213 Lodz, Poland
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Godlewski B, Bebenek A, Dominiak M, Karpinski G, Cieslik P, Pawelczyk T. Subsidence following cervical discectomy and implant-to-bone ratio. BMC Musculoskelet Disord 2022; 23:750. [PMID: 35927645 PMCID: PMC9351094 DOI: 10.1186/s12891-022-05698-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Implant subsidence is an undesirable effect after anterior cervical discectomy and fusion (ACDF). We investigated the relation between the rate of implant subsidence and the ratio of the implant surface area to the surface area of the adjacent bone. Methods We operated 170 disc spaces in a group of 104 patients. Two types of implants were used: 1) PEEK (polyetheretherketone) cages and 2) titanium-coated (TC) PEEK cages. Patients were randomised to receive a specific implant using a randomisation table. All implants had a surface area of 1.61 cm2. Based on computed tomography images, bone surface areas were calculated for vertebral bodies immediately adjacent to the interbody implants. The implant-to-bone surface ratio was then calculated for each disc space. Implant subsidence was assessed over 12 months of follow-up, and associations between implant subsidence, the type of implant, and the implant-to-bone surface ratio were investigated. Results Twelve months after the surgery, computed tomography was performed on 86 patients (144 disc spaces). Furthermore, in 166 disc spaces and 102 patients, conventional radiographs were obtained. Subsidence was observed in 21% of the examined intervertebral spaces, and it was more frequently associated with higher values of bone surface area and lower values of the implant-to-bone surface ratio. The type of implant (PEEK vs TC-PEEK cages) did not significantly influence the rate of implant subsidence. Conclusions Implant subsidence was significantly related to the value of a coefficient representing the ratio of the implant's surface area to the bone surface area of the adjacent vertebral bodies, with subsidence occurring significantly more rarely for coefficient values ≥ 0.37.
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Affiliation(s)
- Bartosz Godlewski
- Department of Orthopaedics and Traumatology, With Spinal Surgery Ward. Scanmed St. Raphael Hospital, ul. Adama Bochenka 12, 30-693, Cracow, Poland.
| | - Adam Bebenek
- Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, With Spinal Surgery Ward. Scanmed St. Raphael Hospital, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Grzegorz Karpinski
- Department of Orthopaedics and Traumatology, With Spinal Surgery Ward. Scanmed St. Raphael Hospital, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Piotr Cieslik
- Department of Orthopaedics and Traumatology, Military Institute of Medicine, Warsaw, Poland
| | - Tomasz Pawelczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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