Implantation of an empty polyetheretherketone cage in anterior cervical discectomy and fusion: a prospective randomised controlled study with 2 years follow-up.

PURPOSE: To compare the clinical outcomes, radiographic results and fusion rate of ACDF between empty PEEK cages and PEEK cages packed with ß-tricalcium phosphate. METHODS: Forty-five patients were prospectively enrolled with cervical degenerative disc disease who requiring ACDF with a PEEK cage. 23 patients were randomised to the study group (empty cages) and 22 patients were in the control group (cages filled with ß-tricalcium phosphate). Both patient groups were fixed with a cervical locking plate. A CT scan was performed 12 months postoperatively and 24 months if not confirmed fused at 12 months to evaluate the status of fusion. Clinical status was evaluated using the Japanese Orthopaedic Association (JOA) score, the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS). RESULTS: 46 levels (97.88%) in the study group and 44 levels (97.77%) in the control group were confirmed as fused at 24 months. There was no significant difference between the fusion rates observed in the study and control groups (p = 0.82). There was no significant difference in JOA, ODI, or VAS scores at 24 months follow-up. The results showed that the members of the non-fusion group tended to be older than the individuals in the fusion group at 12 months, but was not significant in statistics. CONCLUSIONS: Similar fusion rates and clinical outcomes were achieved when using ACDF with PEEK cages and instrumentation, regardless of whether the cage was filled with bone substitute at 24 months follow-up. Fusion rates improved over time and are comparable between both groups. These slides can be retrieved under Electronic Supplementary material.

Biphasic calcium phosphate contained within a polyetheretherketone cage with and without plating for anterior cervical discectomy and fusion.

OBJECTIVE: To evaluate the properties of a combination bone graft consisting of biphasic calcium phosphate ceramic, polyetheretherketone (PEEK) cage in one- and two-level surgery. METHODS: Over a 12-month time period, a prospective single surgeon series of 75 patients were included in the study and 58 patients selected based on adequate data points. From these 58 patients, 32 were supplemented with anterior plate fixation and 26 patients without plating. Duration of clinical follow-up was a mean of 12.4 months (range, 6-26 months) in the Plated Group and 10.5 months (range, 6-21 months) in the Non-Plated Group. RESULTS: A 100% fusion rate with nil graft related complications was achieved in the Plated group compared with 96.2% fusion and 11.5% subsidence rates reported in the Non-Plated group. Patients in both groups experienced statistically significant improvement in pain and functional outcomes compared to their pre-operative status; however, there was no significant difference in outcome between the Plated and Non-Plated Groups. CONCLUSIONS: Biphasic calcium phosphate ceramic contained within a PEEK cage is an effective implant for use in anterior cervical surgery with high fusion rates and good clinical outcome.

Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases.

OBJECT: In this report the author presents surgery-related outcomes after application of a new technique. A posterior microendoscopic laminoforaminotomy was used for the surgical treatment of unilateral cervical radiculopathy secondary to intervertebral disc herniations and/or spondylotic foraminal stenosis. The results of this procedure are compared with those achieved using traditional laminoforaminotomy and anterior cervical discectomy with or without fusion. METHODS: One hundred consecutive patients who experienced unilateral cervical radicular syndromes, which were refractory to conservative therapy, and in whom imaging studies had confirmed lateral canal or foraminal compression, underwent surgical treatment. An endoscopy-assisted posterior laminoforaminotomy was performed using a microendoscopic visualization system for removal of herniated disc and foraminal decompression while the patient was in the sitting position. Excellent or good results were obtained in 97 patients. who returned to their preoperative employment and baseline level of physical activity. One patient returned to work but was unable to perform at baseline level; two patients returned to prior sedentary work but continued to have some activity-related pain and paresthesias. Two patients reported experiencing intermittent paresthesias or numbness, but this did not limit their activities. There were two cases of dural punctures, one case of superficial wound infection, and no deaths. CONCLUSIONS: The microendoscopic posterior laminoforaminotomy is an effective alternative for the treatment of unilateral cervical radiculopathy secondary to lateral or foraminal disc herniations or spondylosis. In this group of patients, it is preferable because it does not require the sacrifice of a cervical motion segment, has a low incidence of complications, and is associated with a much quicker return to unrestricted full activity than that obtained with other techniques.

Percutaneous lumbar discectomy. Technique and clinical result.

Lumbar disc herniation was treated by percutaneous discectomy using a new instrument for automatic aspiration and cutting of disc material. The inclusion criteria were limited to patients with pure disc herniation without stenosis or any other additional factors. Only contained hernias with a maximum size of 50% of the thecal sac were included. Three procedures out of 45 were technical failures. At 1-year follow-up 69% of the patients were satisfied. No complications were seen. The result was not influenced by the amount of disc material removed, age, duration of symptoms or the size of the disc hernia. Reduced size of disc hernia was found in 13 out of 14 satisfied patients followed by CT. All unsatisfied were conventionally operated on. The percutaneous treated patients had 1 day of hospitalisation and on average 11 weeks of sick-leave compared to an average of 6 days and 16 weeks following conventional discectomy.