General Session: Cervical Degenerative - Hall F

Presented by: K. Krause

Author(s):

K. Krause(1), K. Bridges(1), O. Obayashi(1), A. Raslan(1), K. Than(1)

(1) Oregon Health and Science University, Neurosurgery, Portland, OR, United States

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure used to treat radiculopathy or myelopathy. Common interbody graft options include: 1) structural allograft and 2) polyetheretherketone (PEEK) devices, which have gained popularity due to their radiolucent properties and elastic modulus similar to bone. The use of PEEK devices also results in higher billing for the surgeon than structural allograft, which may drive graft selection. In this study, we examined the occurrence of pseudarthrosis of PEEK devices vs. structural allograft in patients who underwent one-level ACDF.

Methods: 127 consecutive patients who underwent one-level ACDF, and had at least 1 year of radiographic follow-up at our tertiary care center, were retrospectively reviewed. Data on patient age, sex, body mass index (BMI), tobacco use, pseudarthrosis, and re-operation rate for pseudarthrosis were collected. Data was analyzed with a Pearson's chi square test.

Results: Of the 127 patients, 56 had PEEK implants, and 71 had structural allograft implants. There were no baseline differences between age, sex, or BMI in the two groups. There were 29/56 (51%) patients with PEEK who demonstrated radiographic evidence of pseudarthrosis, compared to 7/71 (10%) patients with structural allograft (p < 0.001, OR 9.82; CI: 3.836-25.139). Seven patients with PEEK implants required a revision operation for pseudarthrosis, compared to 1 patient with structural allograft (p = 0.01, OR 10.00; CI: 1.192-83.884). There was no statistical difference between the prevalence of tobacco use in patients with either a PEEK device or structural allograft (p = 0.586).

Conclusion: This study provides strong evidence that the use of PEEK interbody devices in one-level ACDF results in an alarmingly high rate of radiographic pseudarthrosis and need for revision surgery. Surgeons should be aware of this data when deciding on interbody graft options, and reimbursement policies should take into account these discrepancies in outcomes.