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A prospective randomized comparison of PEEK cage containing calcium sulphate or demineralized bone matrix with autograft in anterior cervical interbody fusion

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Abstract

Purpose

A variety of bone substitutes have been successfully used to fill PEEK cages in cervical interbody fusion in order to avoid the complications related to bone harvesting from the donor site. However, no controlled study has previously been conducted to compare the effectiveness of PEEK interbody cages containing calcium sulphate/ demineralized bone matrix (CS/DBM) with autogenous cancellous bone for the treatment of cervical spondylosis. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting PEEK cages containing CS/DBM for the treatment of cervical radiculopathy and/or myelopathy.

Methods

Sixty-eight patients with cervical radiculopathy and/or myelopathy were randomly assigned to receive one- or two-level discectomy and fusion with PEEK interbody cages containing CS/DBM or autogenous iliac cancellous bone (AIB). The patients were followed up for two years postoperatively. The radiological and clinical outcomes were assessed during a two-year follow-up.

Results

The mean blood loss was 75 ± 18.5 ml in the CS/DBM group and 100 ± 19.6 ml (P < 0.01) in the AIB group. The fusion rate was 94.3 % in the CS/DBM group and 100 % in the AIB group at 12-month follow-up. The fusion rate was 100 % at final follow-up in both groups. No significant difference (P > 0.05) was found regarding improvement of JOA score and segmental lordosis as well as neck and arm pain at all time intervals between the two groups. The total complication rate was significantly higher (P < 0.05) in the AIB group than in the CS/DBM group, but there was no significant difference between the two groups (P > 0.05) when comparing the complications in the neck.

Conclusions

In conclusion, the PEEK interbody fusion cage containing CS/DBM or AIB following one- or two-level discectomy had a similar outcome for cervical spondylotic radiculopathy and/or myelopathy. The rate of fusion and the recovery rate of JOA score between the two groups were the same. The filling of CS/DBM in the PEEK cage instead of AIB has the advantage of less operative blood loss and fewer complications at the donor site.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (81071453), the project administrated by Shanghai Science and Technology Committee (13DZ1940802 & 14441901700), the Program for Innovative Research Team of Shanghai Municipal Education Commission, and the Fund for Interdisciplinary Research on Medicine and Engineering of Shanghai Jiaotong University (YG2011MS24). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, People’s Republic of China

    Youzhuan Xie, Hua Li, Junjie Yuan, Lingjie Fu, Jianwei Yang & Pu Zhang

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  1. Youzhuan Xie
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  2. Hua Li
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  3. Junjie Yuan
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Correspondence to Pu Zhang.

Additional information

Youzhuan XIE and Hua LIcontributed equally to this work.

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Xie, Y., Li, H., Yuan, J. et al. A prospective randomized comparison of PEEK cage containing calcium sulphate or demineralized bone matrix with autograft in anterior cervical interbody fusion. International Orthopaedics (SICOT) 39, 1129–1136 (2015). https://doi.org/10.1007/s00264-014-2610-9

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