[Interest of porous biomaterials in spinal surgery]

Speed and quality of interbody fusion in porous bioceramic Al2O3 and polyetheretherketone cages for anterior cervical discectomy and fusion: a comparative study

BACKGROUND

The objective of this prospective randomized monocentric study is to compare the speed and quality of interbody fusion of implanted porous Al₂O₃ (aluminium oxide) cages with PEEK (polyetheretherketone) cages in ACDF (anterior cervical discectomy and fusion).

MATERIALS AND METHODS

A total of 111 patients were enrolled in the study, which was carried out between 2015 and 2021. The 18-month follow-up (FU) was completed in 68 patients with an Al₂O₃ cage and 35 patients with a PEEK cage in one-level ACDF. Initially, the first evidence (initialization) of fusion was evaluated on computed tomography. Subsequently, interbody fusion was evaluated according to the fusion quality scale, fusion rate and incidence of subsidence.

RESULTS

Signs of incipient fusion at 3 months were detected in 22% of cases with the Al₂O₃ cage and 37.1% with the PEEK cage. At 12-month FU, the fusion rate was 88.2% for Al₂O₃ and 97.1% for PEEK cages, and at the final FU at 18 months, 92.6% and 100%, respectively. The incidence of subsidence was observed to be 11.8% and 22.9% of cases with Al₂O₃ and PEEK cages, respectively.

CONCLUSIONS

Porous Al₂O₃ cages demonstrated a lower speed and quality of fusion in comparison with PEEK cages. However, the fusion rate of Al₂O₃ cages was within the range of published results for various cages. The incidence of subsidence of Al₂O₃ cages was lower compared to published results. We consider the porous Al₂O₃ cage as safe for a stand-alone disc replacement in ACDF.

Preliminary results of anterior cervical arthroplasty by porous alumina ceramic cage for cervical disc herniation surgery

Objective

Anterior cervical arthroplasty (ACA) is the gold standard surgery in severe or unresponsive cases of cervical disc herniation, uncarthrosis, and foraminal stenosis. The aim of this study is to establish the impact and outcome evaluations of managing the patients operated for cervical arthroplasty by the intersomatic porous alumina ceramic cervical cages (PACC). The authors describe their experience in the area to allow the comparison of effectiveness of ceramic cages versus other interbody fusion cages.

Materials and Methods

Between April 2015 and September 2018, we operated 118 for ACA by using PACC. Among them, 52 were female and 66 were male, with an average age of 46.78 years.

Results

The mean symptoms duration was 14.1 months. The most frequent level of the disorder was C5-C6 followed by C6-C7 level. Mean follow-up was 3.3 years. The Neck Disability Index (NDI) and the visual analog scale (VAS) were used to evaluate the patients status. No significant differences were observed between our results and literature data regarding operative time, duration of hospitalization, and NDI; however, we observed a shorter period and higher rate of bony fusion.

Conclusion

The results from the present study corroborate that implementing of PACC is a good alternative treatment for the patient operated by ACA for cervical disc herniation or foraminal cervical stenosis.