Clinical Outcome of ACDF Using PEEK Cage with Local Bone Graft in Single- and Double-Level Cervical Disc Disease with Radiculopathy and/or Myelopathy

Background: Anterior cervical discectomy and fusion (ACDF) with autogenous bone grafts has been reported to provide high fusion rates and good clinical outcomes. However, donor site morbidity from the iliac crest has remained a concern for prolonged postoperative pain, decreasing overall patient satisfaction with surgery. Alternate use of allograft or bone substitutes may not be readily available at all institutions. This study evaluates the clinical and radiographic outcomes of ACDF using polyether-ether-ketone (PEEK) cages with local bone grafts in patients with radiculopathy and/or myelopathy. Methods: This prospective clinical case study reports twenty-four consecutive patients treated with ACDF by a single surgeon using a PEEK cage filled with local bone graft at 30 levels were prospectively evaluated and followed up for at least 12 months. Eighteen patients underwent a single-level ACDF, while six patients underwent a two-level ACDF. Evaluation of the neurologic outcomes was done using the VAS score for neck and arm pain and the Japanese Orthopedic Association scoring system for myelopathy. The cervical lordosis, subsidence, and fusion status were assessed on radiographs at the same time points. Results: The mean follow-up of our patients was 18±4.4 (12–30) months. Preoperative neck and arm pain VAS improved from 8.1±1.1 and 7.5±0.9 to 2.2±1.1 and 1.8±0.8 at the final follow-up, respectively (P (grades I, II, and III new bone formation at 3, 20, and 7 levels, respectively) at the last follow-up with no implant-related complications. Conclusion: ACDF with PEEK cage and local bone graft in single- and double-level cervical disc disease is a safe and effective procedure, avoiding donor site morbidity and the cost of other bone substitutes.