Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion

假关节 医学 偷看 颈椎前路椎间盘切除融合术 外科 射线照相术 骨科手术 椎间盘切除术 牙科 颈椎 腰椎 化学 有机化学 聚合物
作者
Katie Krause,James T. Obayashi,Kelly J. Bridges,Ahmed M. Raslan,Khoi D. Than
出处
期刊:Journal of neurosurgery [Journal of Neurosurgery Publishing Group]
卷期号:30 (1): 46-51 被引量:41
标识
DOI:10.3171/2018.7.spine18531
摘要

OBJECTIVE Common interbody graft options for anterior cervical discectomy and fusion (ACDF) include structural allograft and polyetheretherketone (PEEK). PEEK has gained popularity due to its radiolucency and its elastic modulus, which is similar to that of bone. The authors sought to compare the rates of pseudarthrosis, a lack of solid bone growth across the disc space, and the need for revision surgery with the use of grafts made of allogenic bone versus PEEK. METHODS The authors retrospectively reviewed 127 cases in which patients had undergone a 1-level ACDF followed by at least 1 year of radiographic follow-up. Data on age, sex, body mass index, tobacco use, pseudarthrosis, and the reoperation rate for pseudarthrosis were collected. These data were analyzed by performing a Pearson’s chi-square test. RESULTS Of 127 patients, 56 had received PEEK implants and 71 had received allografts. Forty-six of the PEEK implants (82%) were stand-alone devices. There were no significant differences between the 2 treatment groups with respect to patient age, sex, or body mass index. Twenty-nine (52%) of 56 patients with PEEK implants demonstrated radiographic evidence of pseudarthrosis, compared to 7 (10%) of 71 patients with structural allografts (p < 0.001, OR 9.82; 95% CI 3.836–25.139). Seven patients with PEEK implants required reoperation for pseudarthrosis, compared to 1 patient with an allograft (p = 0.01, OR 10.00; 95% CI 1.192–83.884). There was no significant difference in tobacco use between the PEEK and allograft groups (p = 0.586). CONCLUSIONS The results of this study demonstrate that the use of PEEK devices in 1-level ACDF is associated with a significantly higher rate of radiographically demonstrated pseudarthrosis and need for revision surgery compared with the use of allografts. Surgeons should be aware of this when deciding on interbody graft options, and reimbursement policies should reflect these discrepancies.
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