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PEEK-Cage-Fusion nach anteriorer zervikaler Korporektomie

Klinische und radiologische Ergebnisse bei spondylotischer Myelopathie

PEEK cage fusion after anterior cervical corpectomy

Clinical and radiological results in patients with spondylotic myelopathy

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Zusammenfassung

Hintergrund

Die anteriore zervikale Korporektomie und Fusion (ACCF) ist zur Dekompression der mehrsegmentalen Spinalkanalstenose mit spondylotischer Myelopathie etabliert. Neben auto- und heterologen Knochentransplantaten sowie Titanimplantaten kommen zur Fusion der dekomprimierten Segmente in den letzten Jahren zunehmend auch PEEK(Polyetheretherketon)-Cages zur Anwendung. Die Datenlage in der Literatur zur Anwendungssicherheit und den klinischen sowie radiologischen Ergebnissen ist jedoch noch dünn und widersprüchlich. Die vorliegende Studie stellt die größte bislang publizierte Serie von PEEK-Cage-Fusionen nach ACCF dar.

Material und Methoden

Retrospektive Aufarbeitung eines ACCF-Kollektivs mit plattenaugmentiertem PEEK-Cage bei 101 Patienten mit mehrsegmentaler zervikaler Spinalkanalstenose und zervikaler Myelopathie. Es wurden die Häufigkeiten postoperativer Implantatkomplikationen und implantatbedingter Revisionen innerhalb des 6‑Monats-Intervalls nach Operation bestimmt. Analysiert wurden zudem Sagittalparameter (Sinterung, segmentale und regionale Lordose) sowie die CT-Fusionsrate. Als klinische Ergebnisparameter wurden der Europäische Myelopathie Score (EMS) und der Neck Disability Index (NDI) herangezogen.

Ergebnisse

In 8/101 Fällen ist es zu Schraubenkomplikationen (Lockerung, Ausriss oder Bruch) gekommen. In 3/101 Fällen wurden implantatbedingte Revisionseingriffe nötig (allesamt wegen Dislokationen des Cages). Eine relevante Sinterung des Cages (Distraktionsverlust >3 mm) fand sich in 12 % der Fälle. Die Fusionsrate nach 6 Monaten lag bei 82 % der Fälle. Die segmentale und regionale (C2–C7) Lordose verbesserte sich signifikant durch den Eingriff. EMS und NDI verbesserten sich ebenfalls signifikant.

Diskussion

PEEK-Cages sind eine klinisch sowie radiologisch vergleichbar effektive und sichere Alternative zur ACCF gegenüber Titancages und Knochentransplantaten. Die kumulierten Komplikationsraten für PEEK-Cages unterscheiden sich kaum von den publizierten Daten für Knochen- oder Titan-Cage-Fusionen (Pseudarthroserate 13 % vs. 5–15 %; implantatbedingte Revisionen 4 % vs. 5–75 %).

Abstract

Background

Anterior cervical corpectomy and fusion (ACCF) has become a standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. In addition to the fusion technique using autogenous bone grafts and titanium implants, synthetic polyetheretherketone (PEEK) cages have been used increasingly during the last years. However, limited evidence on the clinical and radiological results of PEEK cages for ACCF exists in the literature. The study presented here is the largest series to date reporting clinical and radiological outcome as well as complication rates after one to three-level ACCF using PEEK cages augmented by an anterior plate-screw osteosynthesis.

Materials and methods

Retrospective study on 101 patients after stand-alone PEEK cage-ACCF with a minimum follow-up of 6 months. The number of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment were analysed. The neck disability index (NDI) and the European myelopathy score (EMS) were assessed.

Results

Screw complications were detected in 8/101 cases and 3 cases of cage dislocation occurred, resulting in an overall implant related revision rate of 2.9 % (all revision cases showed cage dislocation). The rate of cage subsidence >3 mm was 12 % and solid fusion was achieved in 82 % of the patients. NDI, EMS and lordotic alignment improved significantly.

Conclusions

PEEK cages are a safe and effective alternative to titanium cages or autogenous bone graft for ACCF. Further randomized evaluation of different fusion techniques in ACCF is still necessary.

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Authors and Affiliations

  1. Abt. Neurochirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    C. Schulz,  U. M. Mauer &  R. Mathieu

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Correspondence to C. Schulz.

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Interessenkonflikt

C. Schulz, U. M. Mauer und R. Mathieu geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Schulz, C., Mauer, U.M. & Mathieu, R. PEEK-Cage-Fusion nach anteriorer zervikaler Korporektomie. Orthopäde 46, 242–248 (2017). https://doi.org/10.1007/s00132-016-3345-7

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