Correlation of Clinical and Radiological Outcome After Anterior Cervical Discectomy and Fusion With a Polyetheretherketone Cage

Overview

Journal J Clin Med Res

Specialty General Medicine

Date 2018 Feb 9

PMID 29416588

Citations 5

Authors

Savvas L Spanos

Ioannis D Siasios

Vassilios G Dimopoulos

Konstantinos N Paterakis

Dimos S Mastrogiannis

Theofanis P Giannis

Aggeliki A Fotiadou

John Pollina

Kostas N Fountas

Affiliations

Soon will be listed here.

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) with a polyetheretherketone (PEEK) cage is considered as the gold standard for patients with cervical disc disease. However, there are limited data on the impact of ACDF on the cervical kinematics and its association with patient-reported clinical outcomes. The purpose of this study was to investigate the impact of altered cervical sagittal alignment (cervical lordosis) and sagittal range of motion (ROM) on patients' self-reported pain and functional disability, after ACDF with a PEEK cage.

Methods: We prospectively studied 74 patients, who underwent single-, or consecutive two-level ACDF with a PEEK interbody cage. The clinical outcomes were assessed by using the pain numeric rating scale (NRS) and the neck disability index (NDI). Radiological outcomes included cervical lordosis and C2-C7 sagittal ROM. The outcome measures were collected preoperatively, at the day of patients' hospital discharge, and also at 6 and 12 months postoperatively.

Results: There was a statistically significant reduction of the NRS and NDI scores postoperatively at each time point (P < 0.005). Cervical lordosis and also ROM significantly reduced until the last follow-up (P < 0.005). There was significant positive correlation between NRS and NDI preoperatively, as well as at 6 and 12 months postoperatively (P < 0.005). In regard to the ROM and the NDI scores, there was no correlation preoperatively (P = 0.199) or postoperatively (6 months, P = 0.322; 12 months, P = 0.476). Additionally, there was no preoperative (P = 0.134) or postoperative (6 months, P = 0.772; 12 months, P = 0.335) correlation between the NDI scores and cervical lordosis.

Conclusions: In our study, reduction of cervical lordosis and sagittal ROM did not appear to significantly influence on patients' self-reported disability. Such findings further highlight the greater role of pain level over the mechanical limitations of ACDF with a PEEK cage on patients' own perceived recovery.

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References

Trouli M, Vernon H, Kakavelakis K, Antonopoulou M, Paganas A, Lionis C . Translation of the Neck Disability Index and validation of the Greek version in a sample of neck pain patients. BMC Musculoskelet Disord. 2008; 9:106. PMC: 2492862. DOI: 10.1186/1471-2474-9-106. View

Chen Y, Lu G, Wang B, Li L, Kuang L . A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study.... Eur Spine J. 2016; 25(7):2255-62. DOI: 10.1007/s00586-016-4391-x. View

McAviney J, Schulz D, Bock R, Harrison D, Holland B . Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther. 2005; 28(3):187-93. DOI: 10.1016/j.jmpt.2005.02.015. View

Hilibrand A, Balasubramanian K, Eichenbaum M, Thinnes J, Daffner S, Berta S . The effect of anterior cervical fusion on neck motion. Spine (Phila Pa 1976). 2006; 31(15):1688-92. DOI: 10.1097/01.brs.0000224165.66444.71. View

Nunley P, Jawahar A, Kerr 3rd E, Gordon C, Cavanaugh D, Birdsong E . Factors affecting the incidence of symptomatic adjacent-level disease in cervical spine after total disc arthroplasty: 2- to 4-year follow-up of 3 prospective randomized trials. Spine (Phila Pa 1976). 2011; 37(6):445-51. DOI: 10.1097/BRS.0b013e31822174b3. View

Landers M, Addis K, Longhurst J, Vom Steeg B, Puentedura E, Daubs M . Anterior cervical decompression and fusion on neck range of motion, pain, and function: a prospective analysis. Spine J. 2013; 13(11):1650-8. DOI: 10.1016/j.spinee.2013.06.020. View

Zhang L, Wang J, Tao Y, Feng X, Yang J, Zhang S . Outcome Evaluation of Zero-Profile Implant Compared with an Anterior Plate and Cage Used in Anterior Cervical Discectomy and Fusion: A Two-Year Follow-Up Study. Turk Neurosurg. 2016; 26(3):416-22. DOI: 10.5137/1019-5149.JTN.12017-14.1. View

Xie J, Hurlbert R . Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery. 2007; 61(1):107-16. DOI: 10.1227/01.neu.0000279730.44016.da. View

Guven M, Cosar M, Alkan B, Aras A, Akman T, Safak O . Comparison of Anterior Cervical Discectomy Fusion Techniques: Bladed and Non Bladed PEEK Cages. Turk Neurosurg. 2016; 26(3):404-10. DOI: 10.5137/1019-5149.JTN.12797-14.1. View

10.

Liu Y, Wang H, Li X, Chen J, Sun H, Wang G . Comparison of a zero-profile anchored spacer (ROI-C) and the polyetheretherketone (PEEK) cages with an anterior plate in anterior cervical discectomy and fusion for multilevel cervical spondylotic myelopathy. Eur Spine J. 2016; 25(6):1881-90. DOI: 10.1007/s00586-016-4500-x. View

11.

Chien A, Lai D, Wang S, Hsu W, Cheng C, Wang J . Comparison of Cervical Kinematics, Pain, and Functional Disability Between Single- and Two-level Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976). 2016; 41(15):E915-E922. DOI: 10.1097/BRS.0000000000001502. View

12.

Toth J, Wang M, Estes B, Scifert J, Seim 3rd H, Turner A . Polyetheretherketone as a biomaterial for spinal applications. Biomaterials. 2005; 27(3):324-34. DOI: 10.1016/j.biomaterials.2005.07.011. View

13.

Miyazaki M, Hymanson H, Morishita Y, He W, Zhang H, Wu G . Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976). 2008; 33(23):E870-6. DOI: 10.1097/BRS.0b013e3181839733. View

14.

Hwang S, Kayanja M, Milks R, Benzel E . Biomechanical comparison of adjacent segmental motion after ventral cervical fixation with varying angles of lordosis. Spine J. 2007; 7(2):216-21. DOI: 10.1016/j.spinee.2006.05.018. View

15.

Machino M, Yukawa Y, Imagama S, Ito K, Katayama Y, Matsumoto T . Age-Related and Degenerative Changes in the Osseous Anatomy, Alignment, and Range of Motion of the Cervical Spine: A Comparative Study of Radiographic Data From 1016 Patients With Cervical Spondylotic Myelopathy and 1230 Asymptomatic Subjects. Spine (Phila Pa 1976). 2015; 41(6):476-82. DOI: 10.1097/BRS.0000000000001237. View

16.

Jacobs W, Willems P, van Limbeek J, Bartels R, Pavlov P, Anderson P . Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. 2011; (1):CD004958. DOI: 10.1002/14651858.CD004958.pub2. View

17.

Park M, Kelly M, Lee D, Min W, Rahman R, Riew K . Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J. 2013; 14(7):1228-34. PMC: 4019713. DOI: 10.1016/j.spinee.2013.09.043. View

18.

Hessler C, Boysen K, Regelsberger J, Vettorazzi E, Winkler D, Westphal M . Patient satisfaction after anterior cervical discectomy and fusion is primarily driven by relieving pain. Clin J Pain. 2011; 28(5):398-403. DOI: 10.1097/AJP.0b013e318232cddc. View

19.

Park H, Lee J, Moon S, Seo S, Lee J, Kim S . The efficacy of the synthetic interbody cage and Grafton for anterior cervical fusion. Spine (Phila Pa 1976). 2009; 34(17):E591-5. DOI: 10.1097/BRS.0b013e3181ab8b9a. View

20.

Nordin M, Carragee E, Hogg-Johnson S, Weiner S, Hurwitz E, Peloso P . Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther. 2009; 32(2 Suppl):S117-40. DOI: 10.1016/j.jmpt.2008.11.016. View