Aim of this study was to evaluate the efficacy and safety of fusion solely with polyetheretherketone (PEEK) cages without plates and autogenous bone graft to provide fusion in multilevel cervical spondylosis in selected cases. 58 patients with cervical discogenic disorders in 3-4 levels (38 and 20 patients respectively) underwent multilevel anterior cervical discectomy and fusion (ACDF) operations with PEEK cages for a total of 194 levels. Minimum follow up was 24 months postoperatively. Outcome had been established in combination with the evaluation of cervical lordosis, fusion rates and neurological improvement that was assessed by Japanese Orthopedic Association (JOA) scoring system. They were assessed by radiographs, computerized tomography and magnetic resonance imaging studies. Clinical outcomes were based on the issues including length of hospital stay, blood loss, complication rates and functional outcomes. 38 patients underwent three-level, 20 patients underwent four-level operations. Fusion rate was 89.2%. Significant improvement in the JOA scores was recorded postoperatively, and Ishihara Curvature Index (ICI) was preserved. In the follow-up period, no cage migration was experienced and reoperation was not required except for one who later underwent corpectomy and anterior fusion. ACDF with the use of PEEK cages without plates proved to yield good clinical outcome and comfortable postoperative course for the patients with acceptable fusion rates
1. Aghayev K, Doulgeris J J, Gonzalez-Blohm S A, Eleraky M, Lee W E, 3rd, Vrionis F D. Biomechanical comparison of a two-level anterior discectomy and a one-level corpectomy, combined with fusion and anterior plate reconstruction in the cervical spine. Clin Biomech (Bristol, Avon). 2014;29(1):21-5.
2. Bolesta M J, Rechtine G R, 2nd, Chrin A M. One- and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine. J 2002;2(3):197-203.
3. Dong L, Tan M S, Yi P, Yang F, Tang X S. Segmental anterior cervical decompression with fusion for the treatment of multilevel cervical myelopathy. Zhongguo Gu Shang. 2014; 27(12): 995-9.
4. Fessler R G, Steck J C, Giovanini M A. Anterior cervical corpectomy for cervical spondylotic myelopathy. Neurosurgery. 1998;43(2):257-65; discussion 65-7.
5. Liu W, Hu L, Chou P H, Liu M, Kan W, Wang J. Comparison of anterior decompression and fusion versus laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis. Ther Clin Risk Manag. 2016;12:675-85.
6. Ashkenazi E, Smorgick Y, Rand N, Millgram M A, Mirovsky Y, Floman Y. Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosurg Spine. 2005;3(3):205-9.
7. Bartels R H, Donk R, van Azn R D. Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage. J Neurosurg. 2001;95(1 Suppl):40-2.
8. Liu Y, Qi M, Chen H, Yang L, Wang X, Shi G, Gao R, Wang C, Yuan W. Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy. Eur Spine J. 2012;21(12):2428-35.
9. Yang K C, Lu X S, Cai Q L, Ye L X, Lu W Q. Cervical spondylotic myelopathy treated by anterior multilevel decompression and fusion. Follow-up report of 214 cases. Clin Orthop Relat Res. 1987;221:161-4.
10. Demircan M N, Kutlay A M, Colak A, Kaya S, Tekin T, Kibici K, Ungoren K. Multilevel cervical fusion without plates, screws or autogenous iliac crest bone graft. J Clin Neurosci. 2007;14(8):723-8.
11. Zhou J, Li X, Dong J, Zhou X, Fang T, Lin H, Ma Y. Three-level anterior cervical discectomy and fusion with self-locking standalone polyetheretherketone cages. J Clin Neurosci. 2011;18(11):1505-9.
12. Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A. A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine (Phila Pa 1976). 2002;27(16):1694-701.
13. Ishihara A. Roentgenographic studies on the normal pattern of the cervical curvature. Nihon Seikeigeka Gakkai Zasshi. 1968;42(11):1033-44.
14. Montgomery D M, Brower R S. Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am. 1992;23(3):487-93.
15. Heller JG, Edwards CC, 2nd, Murakami H, Rodts GE. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976). 2001;26(12):1330-6.
16. Xu L, Kong P, Xu ZW. Anterior corpectomy decompression and titanium mesh bone iraft fusion combined with titanium nate fixation for the treatment of the multilevel cervical spondylotic myelopathy. Zhongguo Gu Shang. 2016;29(3):211-5.
17. Sun Y, Li L, Zhao J, Gu R. Comparison between anterior approaches and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy: A meta-analysis. Clin Neurol Neurosurg. 2015;134:28-36.
18. Hee H T, Majd M E, Holt R T, Whitecloud T S, 3rd, Pienkowski D. Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech. 2003;16(1):1-8;discussion -9.
19. Hanci M, Toprak M, Sarioglu A C, Kaynar M Y, Uzan M, Islak C. Oesophageal perforation subsequent to anterior cervical spine screw/plate fixation. Paraplegia. 1995;33(10):606-9.
20. Kostuik J P, Connolly P J, Esses S I, Suh P. Anterior cervical plate fixation with the titanium hollow screw plate system. Spine (Phila Pa 1976).1993;18(10):1273-8.
21. Bertalanffy H, Eggert H R. Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien). 1988;90(3-4):127-35.
22. Liu X, Wang H, Zhou Z, Jin A. Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy. Orthopedics. 2014;37(2): 117-22.
23. Hirabayashi K, Bohlman H H. Multilevel cervical spondylosis. Laminoplasty versus anterior decompression. Spine (Phila Pa 1976). 1995;20(15):1732-4.
24. Jiang L, Tan M, Dong L, Yang F, Yi P, Tang X, Hao Q. Comparison of Anterior Decompression and Fusion With Posterior Laminoplasty for Multilevel Cervical Compressive Myelopathy: A Systematic Review and Meta-Analysis. J Spinal Disord Tech. 2015;28(8):282-90.
25. Wei-bing X, Wun-Jer S, Gang L, Yue Z, Ming-xi J, Lian-shun J. Reconstructive techniques study after anterior decompression of multilevel cervical spondylotic myelopathy. J Spinal Disord Tech. 2009;22(7):511-5.
26. Morrison C, Macnair R, MacDonald C, Wykman A, Goldie I, Grant M H. In vitro biocompatibility testing of polymers for orthopaedic implants using cultured fibroblasts and osteoblasts. Biomaterials. 1995;16(13):987-92.
27. Bohlman H H, Emery S E, Goodfellow D B, Jones P K. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. 1993;75(9):1298-307.
28. Emery S E, Fisher J R, Bohlman H H. Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine (Phila Pa 1976). 1997;22(22):2622-4;discussion 5.
29. Das K, Couldwell W T, Sava G, Taddonio R F. Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. J Neurosurg. 2001;94(1 Suppl):174-8.