Comparison of Outcomes Between Cage Materials Used for Patients Undergoing Anterior Cervical Discectomy and Fusion with Standalone Cages: A Systematic Review and Meta-Analysis.

Chiduziem Onyedimma, Ousman Jallow, Yagiz U Yolcu, Mohammed Ali Alvi, Anshit Goyal, Abdul Karim Ghaith, Atiq Ur Rehman Bhatti, Kingsley Abode-Iyamah, Alfredo Quinones-Hinojosa, Brett A Freedman, Mohamad Bydon

Journal: World neurosurgery 2022;158():e38-e54

PMID: 34838765

Full Text on Elsevier Science View on PubMed

Abstract

INTRODUCTION

Interbody cages are currently being used to address diseases of the vertebra requiring surgical stabilization. Titanium cages were first introduced in 1988. Polyetheretherketone (PEEK) cages are used frequently as one of the alternatives to titanium cages in current practice. This study aimed to compare available cage materials by reviewing the surgical and radiographic outcomes following anterior cervical discectomy and fusion.

METHODS

A comprehensive search of several electronic databases was conducted following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Baseline characteristics, operative outcomes, arthrodesis rates, subsidence rates, and complications were collected from included studies. Collected outcomes were further stratified according to the procedure type, the number of levels operated, and graft used to compare cage materials.

RESULTS

Following the screening for inclusion criteria, a total of 37 studies with 2363 patients were included. The median age was 49.5 years and the median follow-up was 26 months. Overall, no significant differences were found between PEEK and titanium cages regarding fusion, neurologic deficit, subsidence rates, or "good and excellent" outcome according to Odom criteria. However, the standalone comparison between PEEK, titanium, and poly-methyl-methacrylate (PMMA) cages showed a significantly lower fusion rate for PMMA (PEEK: 94%, PMMA: 56%, titanium: 95%, P < 0.01).

CONCLUSIONS

In the present systematic review and meta-analysis, a comparison of the long-term patient-reported and the radiographic outcomes associated with the use of titanium and PEEK, intervertebral body cages showed similar findings. However, there were significantly lower fusion rates for PMMA cages when using a standalone cage without graft material.

Address: Meharry Medical College, Nashville, Tennessee, USA; Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.; Meharry Medical College, Nashville, Tennessee, USA.; Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.; Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.; Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: [email protected].

DOI: 10.1016/j.wneu.2021.10.084

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MeSH Terms: Cervical Vertebrae, Diskectomy, Humans, Ketones, Middle Aged, Polyethylene Glycols, Polymethyl Methacrylate, Spinal Fusion, Titanium, Treatment Outcome