Implantatassoziierte Komplikationen sowie klinischer und radiologischer Verlauf nach anteriorer zervikaler Korpektomie und Cage-Fusion – retrospektiver Vergleich von PEEK- gegen Titan-Cages

Zusammenfassung

Hintergrund Cages sind als anteriores Fusionsmaterial zur ACCF (Anterior Cervical Corpectomy and Fusion) etabliert, aber in klinischen Studien noch nicht ausreichend vergleichend hinsichtlich des bestgeeigneten Materials untersucht.

Patienten und Methoden Retrospektive Analyse von 126 Patienten nach Cage-ACCF (101 PEEK [Polyetheretherketon], 25 Titan) bei zervikaler spondylotischer Myelopathie. Es wurden implantatbedingte Komplikations- und Revisionsraten, radiologische (Sinterung, Fusion, segmentale und regionale Lordose) sowie klinische Parameter (NDI [Neck Disability Index] und EMS [Europäischer Myelopathie Score]) nach 6, 12 und 24 Wochen ausgewertet. Neben deskriptiven Datenanalysen wurden Unterschieds- sowie Zusammenhangshypothesen zwischen Cage-Material sowie den Komplikationen und den jeweiligen klinischen bzw. radiologischen Parametern geprüft.

Ergebnisse Signifikant häufiger Schrauben- und Cage-Komplikationen (36 vs. 7,9 % resp. 64 vs. 36,6 %) sowie tendenziell mehr implantatbedingte Revisionen in der Titan-Cage-Gruppe (16 vs. 2,97 %). Signifikant höhere Rate an Fusion Grad I und II in der PEEK-Gruppe nach 6 Monaten (82 vs. 52 %). Keine signifikanten Differenzen oder Korrelationen zwischen den segmentalen und regionalen Lordoseparametern, dem EMS und NDI sowie dem Cage-Material. Durch partielle Korrelationen mit Kontrolle inhomogen verteilter Parameter (Alter, Anteil von Mehrhöhenkorpektomien, mediane Länge der Fusionsstrecke und Überdistraktionsrate) konnten keine signifikanten Korrelationen von Komplikationen, Revisionen sowie klinischen und radiologischen Ergebnissen zum Cage-Material mehr aufgezeigt werden.

Schlussfolgerung Mit beiden Cage-Materialien lassen sich signifikante Verbesserungen der klinischen und radiologischen Befunde erreichen. Es lässt sich weder mit dieser Studie noch mit den publizierten Ergebnissen in der Literatur ein klinischer Vorteil eines bestimmten synthetischen Wirbelkörperersatzmaterials nach ACCF mit hoher Evidenz belegen.

Abstract

Background Anterior cervical corpectomy and fusion (ACCF) has become a standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. Beside the fusion technique using autogenous bone grafts, synthetic cages have been increasingly used in recent years. Published information on the clinical and radiological results of different cage materials for ACCF is still limited. The study presented here is the largest series to date reporting clinical and radiological outcomes and complication rates after one- to three-level ACCF using structural polyetheretherketone (PEEK) or titanium cages augmented by anterior plate-screw osteosynthesis.

Materials and Methods Retrospective comparative study on 126 patients after cage ACCF using modular PEEK (n = 101) or distractable titanium (n = 25) cages with a minimum follow-up of 6 months. The numbers of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment (segmental and regional Cobbʼs angles) were analysed. Neck Disability Index (NDI) and European Myelopathy Score (EMS) were assessed.

Results Significantly greater number of screw and cage complications were detected in the titanium cage group (36 vs. 7.9 % and 64 vs. 36.6 %, respectively). Non-significant trend to a higher rate of implant related revision rate in the titanium cage group (16 vs. 2.97 %). Significantly greater rate of grade I or II fusion in the PEEK cage group after 6 months (82 vs. 52 %). NDI, EMS and lordotic alignment improved significantly in both groups. There were neither significant differences between the two groups nor significant correlations between these clinico-radiological parameters and the cage material. Partial correlations performed with control of parameters showing inhomogenous distribution (patient age, fusion distance, rate of multilevel corpectomy and the rate of intraoperative segmental overdistraction) showed no significant correlations for any of the clinical or radiological outcome parameters and the complications or revisions to the cage material.

Conclusion Cages are a safe and effective alternative to autogenous bone graft for ACCF. A significant improvement in clinical and radiological parameters can be achieved with both titanium and PEEK implants. Significant differences between the two cage material groups or significant correlations of clinico-radiological outcome and cage material were not proven. Moreover there is no evidence in the literature for clinical advantages of one special cage material, to date. Therefore further prospective randomised evaluation of different fusion techniques in ACCF is still necessary.

Schlüsselwörter

Halswirbelsäule - zervikale Spinalkanalstenose - zervikale Myelopathie - anteriore zervikale Korpektomie - Zervikal-Cages

Key words

cervical spine - cervical spinal canal stenosis - cervical myelopathy - anterior cervical corpectomy - cage fusion

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