PEEK cage를 이용한 다분절 경추 유합술의 유용성

Abstract

Background and Objectives : The operation for segmental multilevel cervical degenerated disc disease remains controversial. Data on safety and efficacy of stand-alone PEEK cages in multilevel postdiscectomy fusion are rarely available. We investigated the safety and effectiveness of interbody fusion cages without plate fixation. The purposes of the present study are to evaluate the clinical outcomes and radiological outcomes including bone fusion and subsidence that occurred after multilevel anterior cervical discectomy and fusion using a stand-alone cage packed with local autobone graft. To evaluate the utility of anterior cervical discectomy and fusion(ACDF) with polyetheretherketone (PEEK) cage and autograft through long term(average 36 months) follow-up.

Materials and Methods : Forty-eight selected patients(male:32 /female:16) who suffered from cervical radiculopathy, myelopathy or radiculomyelopathy underwent a multi-level ACDF with PEEK cage from March 2007 to May 2010 in single institute. We evaluated the patients for cervical lordosis, fusion status, and stability 24 months postoperatively on the basis of spine radiographs. We followed patients for an average 36.4±8.1 months(ranged from 23 to 49 months). The Japanese Orthopedic Association(JOA) score for evaluation of myelopathy and visual analogue scale(VAS) for radiating pain was used to estimate postoperative clinical outcome. Plain x-ray on true lateral standing flexion, extension and neutral position view and 3D CT scan were used every 6 months after surgery during follow-up period.

Results : The mean VAS and JOA scoring improved significantly after the surgery and radiological fusion rate was accomplished by 100% 36 months after the surgery (JOA score preoperatively 11.1±2.9, postoperatively 14.5±2.6). We had no complication related with the surgery except one case of osteomyelitis. There was one case of Grade I fusion, four cases of grade II, and 25 cases of grade III by radiologic evaluation.

Conclusion : This long term follow-up study for ACDF with PEEK cage in multilevels shows that this surgical method is comparable with other anterior cervical fusion methods in terms of clinical outcomes and radiologic fusion rate.