Anterior Cervical Discectomy and Fusion (ACDF) using StandAlone Polyetheretherketone (PEEK) Cage Packed with Local Autologous Bone Graft

Earlier autologous the iliac crest bone was used to fill the disc space to maintain the interbody height and fusion with or without supplemented by cervical plating.There are several advantages of cervical plate system, but it has risk of hardware failure, high additional costs, adjacent level disc degeneration and questionable of necessity to use in absence of instability 5,6 .Moreover numerous complications results from autologous tricortical iliac crest bone graft including protrusion of bone block, breaking of bone graft, subsidence, collapsing, angular deformation, pseudo arthrosis 7 .To overcome these complications, it is replaced by standalone case packed with autologous iliac crest bone graft, however, it causes a number of donor site morbidities including infection, pain Abstract Introduction: It remains debatable that whether the cages should be filled with any type of bone or bone substitute in anterior cervical discectomy and fusion (ACDF) surgery.To fill the cage, the anterior and posterior osteophytes of the adjacent upper and lower vertebra could be used.The aims of the present study was to find out the clinical and radiological outcomes which includes bony fusion and subsidence after ACDF surgery with a stand-alone polyetheretherketone (PEEK) cage filled with local autologous bone from adjacent vertebral body.Methods: All of the thirty six consecutive patients underwent ACDF surgery with a stand-alone polyetheretherketone cage filled with local autologous bone graft from July 2015 to June 2017 were included in the present study.Subsidence (the interbody height decreased ≥2 mm) and Bone fusion were evaluated by cervical plain radiographs.Results: Subsidence (the inter body height decreased ≥2 mm) was found in 9 patients (25%).Among the nine patients of subsidence group, nonunion was found in five patients.Out of nine patients with subsidence, endplate was damaged in four patients during intraoperative preparation of endplate.Thirty one patients (86.11%) achieved solid bone fusion Conclusion: In selected patients with adequate and careful preparation of endplate, ACDF surgery using a stand-alone polyetheretherketone (PEEK) cage filled with local autologous bone could be a good alternative of anterior cervical discectomy and fusion (ACDF) with iliac crest bone graft or bone substitute with or without plating.