Functional and radiological outcome after cervical arthrodesis using polyetheretherketone or tricortical iliac bone graft for degenerative and traumatic spine pathologies: A single-center experience

Abstract

Introduction: Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure used for decompression and fusion of adjacent cervical vertebral bodies. Iliac bone graft was widely accepted for fusion during ACDF to the introduction of polyetheretherketone (PEEK) spacers. Even though PEEK spacers have the advantage of reducing donor-site complications, in cases with doubtful supporting ligament continuity, the long-term outcome of cervical spine stability is not confirmed. In this study, we are comparing the clinical and radiological outcomes of both substitutes. Materials and Methods: We did a retrospective analysis of 111 patients who underwent single-level ACDF using PEEK or tricortical iliac bone graft for various disc pathologies at our institution in the past 10 years along with clinical and radiological presentations and outcome of the procedure at 3 weeks, 6 months, and after 1 year. The study population was divided into two groups: Group “P” (PEEK spacer) and Group “G” (bone graft spacer). Distribution of clinical presentation in terms of radiculopathy, myelopathy, and myeloradiculopathy was evaluated and correlated with the demographic parameters. The standard deviation and P value of the radiological variables were calculated. “Mann–Whitney U-test” for the Japanese Orthopaedic Association score at 1-year follow-up and “Pearson's Chi-square” value for the Odom's score of both groups were used to analyze the correlation. Results: All the radiological parameters were analyzed by the Wilcoxon signed-rank test after checking for normality distribution. The improvements reported above in all domains were found to be statistically significant at P < 0.001. When analyzing the radiographic evidence of bony fusion at 1 year by Bridwell fusion grading, only two patients in Group P had poor fusion and all the patients in Group G had Grade 1 or 2 fusion. The clinical improvement analyzed by evaluating the ODOMS score after 1-year follow-up showed significant improvements in both groups. Conclusions: In our study, PEEK spacers have got definite advantage over iliac bone grafts in maintaining the disc segmental height, segmental angle, cervical lordosis, and fusion segment height without adding any donor-site morbidity.