Porous Cage Macro-Topography Improves Early Fusion Rates in Anterior Cervical Discectomy and Fusion

Overview

Journal Surg Res Pract

Publisher Wiley

Specialty General Surgery

Date 2024 Mar 25

PMID 38523843

Authors

Gregory M Malham

Dean T Biddau

Jordan P Laggoune

Charlie R Faulks

William R Walsh

Yi Yuen Wang

Affiliations

Soon will be listed here.

Abstract

Objectives: Anterior cervical discectomy and fusion (ACDF) aims to improve pain, relieve neural compression, achieve rapid solid bony arthrodesis, and restore cervical alignment. Bony fusion occurs as early as 3 months and up to 24 months after ACDF. The correlations between bony fusion and clinical outcomes after ACDF remain unclear. Macro-topographic and porous features have been introduced to interbody cage technology, aiming to improve the strength of the bone-implant interface to promote early fusion. In this study, we aimed to compare clinical outcomes and CT-evaluated fusion rates in patients undergoing ACDF using one of two different interbody cages: traditional NanoMetalene™ (NM) cages and NM cages with machined porous features (NMRT).

Methods: This was a prospective, observational, nonrandomised, cohort study of consecutive patients undergoing ACDF. The NM cage cohort was enrolled first, then the NMRT cohort second. The visual analogue scale, neck disability index, and 12-item Short Form Survey scores were evaluated preoperatively and at 6 weeks, 3 months, and 6 months. The minimum clinical follow-up period was 12 months. Plain radiographs were obtained on postoperative day 2 to assess instrumentation positioning, and computed tomography (CT) was performed at 3 and 6 months postoperatively to assess interbody fusion (Bridwell grade).

Results: Eighty-nine (52% male) patients with a mean age of 62 ± 10.5 years were included in this study. Forty-one patients received NM cages, and 48 received NMRT cages. All clinical outcomes improved significantly from baseline to 6 months. By 3 months, the NMRT group had significantly higher CT fusion rates than the NM group (79% vs 56%, =0.02). By 6 months, there were no significant differences in fusion rates between the NMRT and NM groups (83% vs 78%, =0.69). The mean Bridwell grade at 6 months was 1.4 ± 0.7 in the NMRT group and 1.8 ± 1.0 in the NM group (=0.08).

Conclusions: With both NM and NMRT cages, serial improvements in postoperative clinical outcomes were associated with fusion progression on CT. NMRT cages demonstrated significantly better fusion at 3 months and a trend toward higher quality of fusion at 6 months compared with NM cages, suggesting earlier cage integration with NMRT. An early 3-month postoperative CT is adequate for fusion assessment in almost 80% of patients undergoing ACDF with an NMRT cage, permitting an earlier return to activity.

References

Ouchida J, Yukawa Y, Ito K, Machino M, Inoue T, Tomita K . Functional computed tomography scanning for evaluating fusion status after anterior cervical decompression fusion. Eur Spine J. 2014; 24(12):2924-9. DOI: 10.1007/s00586-014-3722-z. View

Fogel G, Martin N, Lynch K, Pelletier M, Wills D, Wang T . Subsidence and fusion performance of a 3D-printed porous interbody cage with stress-optimized body lattice and microporous endplates - a comprehensive mechanical and biological analysis. Spine J. 2022; 22(6):1028-1037. DOI: 10.1016/j.spinee.2022.01.003. View

Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S . Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord. 2012; 13:172. PMC: 3493386. DOI: 10.1186/1471-2474-13-172. View

Zhao Y, Yang S, Huo Y, Li Z, Yang D, Ding W . Locking stand-alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review and meta-analysis based on randomized controlled trials. Eur Spine J. 2020; 29(11):2734-2744. DOI: 10.1007/s00586-020-06561-x. View

Buser Z, Brodke D, Youssef J, Meisel H, Myhre S, Hashimoto R . Synthetic bone graft versus autograft or allograft for spinal fusion: a systematic review. J Neurosurg Spine. 2016; 25(4):509-516. DOI: 10.3171/2016.1.SPINE151005. View

Overgaard Wichmann T, Bech-Azeddine R, Norling A, Einarsson H, Rasmussen M . Comparison of outcomes and complications between one- and two-level anterior cervical discectomy and fusion: a population-based study of 410 patients. Br J Neurosurg. 2021; 38(4):928-933. DOI: 10.1080/02688697.2021.2005778. View

Iunes E, Barletta E, Belsuzarri T, Onishi F, Aihara A, Cavalheiro S . Pseudarthrosis in anterior cervical discectomy and fusion with a self-locking, stand-alone cage filled with hydroxyapatite: a retrospective study with clinical and radiological outcomes of 98 levels with a minimum 2-year follow-up. J Neurosurg Spine. 2020; 33(6):717-726. DOI: 10.3171/2020.4.SPINE20357. View

Park D, Rhee J, Kim S, Enyo Y, Yoshiok K . Do CT scans overestimate the fusion rate after anterior cervical discectomy and fusion?. J Spinal Disord Tech. 2013; 28(2):41-6. DOI: 10.1097/BSD.0b013e31829a37ac. View

Park J, Cho D, Kim K, Sung J . Anterior cervical discectomy and fusion using a stand-alone polyetheretherketone cage packed with local autobone : assessment of bone fusion and subsidence. J Korean Neurosurg Soc. 2013; 54(3):189-93. PMC: 3836924. DOI: 10.3340/jkns.2013.54.3.189. View

10.

Walsh W, Pelletier M, Christou C, He J, Vizesi F, Boden S . The in vivo response to a novel Ti coating compared with polyether ether ketone: evaluation of the periphery and inner surfaces of an implant. Spine J. 2018; 18(7):1231-1240. DOI: 10.1016/j.spinee.2018.02.017. View

11.

Smith G, Robinson R . The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958; 40-A(3):607-24. View

12.

Tan G, Goss B, Thorpe P, Williams R . CT-based classification of long spinal allograft fusion. Eur Spine J. 2007; 16(11):1875-81. PMC: 2223338. DOI: 10.1007/s00586-007-0376-0. View

13.

Suess O, Schomaker M, Cabraja M, Danne M, Kombos T, Hanna M . Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter "PIERCE-PEEK" study. Patient Saf Surg. 2017; 11:12. PMC: 5410058. DOI: 10.1186/s13037-017-0128-y. View

14.

Oakley P, Harrison D . Radiophobia: 7 Reasons Why Radiography Used in Spine and Posture Rehabilitation Should Not Be Feared or Avoided. Dose Response. 2018; 16(2):1559325818781445. PMC: 6043928. DOI: 10.1177/1559325818781445. View

15.

Saifi C, Fein A, Cazzulino A, Lehman R, Phillips F, An H . Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013. Spine J. 2017; 18(6):1022-1029. DOI: 10.1016/j.spinee.2017.10.072. View

16.

Rhee J, Chapman J, Norvell D, Smith J, Sherry N, Riew K . Radiological Determination of Postoperative Cervical Fusion: A Systematic Review. Spine (Phila Pa 1976). 2015; 40(13):974-91. DOI: 10.1097/BRS.0000000000000940. View

17.

Seaman S, Kerezoudis P, Bydon M, Torner J, Hitchon P . Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature. J Clin Neurosci. 2017; 44:23-29. DOI: 10.1016/j.jocn.2017.06.062. View

18.

Simpson A, Whang P, Jonisch A, Haims A, Grauer J . The radiation exposure associated with cervical and lumbar spine radiographs. J Spinal Disord Tech. 2008; 21(6):409-12. DOI: 10.1097/BSD.0b013e3181568656. View

19.

Dimitriou R, Mataliotakis G, Angoules A, Kanakaris N, Giannoudis P . Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury. 2011; 42 Suppl 2:S3-15. DOI: 10.1016/j.injury.2011.06.015. View

20.

Nambiar M, Phan K, Cunningham J, Yang Y, Turner P, Mobbs R . Locking stand-alone cages versus anterior plate constructs in single-level fusion for degenerative cervical disease: a systematic review and meta-analysis. Eur Spine J. 2017; 26(9):2258-2266. DOI: 10.1007/s00586-017-5015-9. View