Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cagesReport as inadecuate

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BMC Musculoskeletal Disorders

, 13:172

Orthopedics and biomechanics


BackgroundTitanium TTN cages have a higher modulus of elasticity when compared with polyetheretherketone PEEK cages. This suggests that TTN-cages could show more frequent cage subsidence after anterior cervical discectomy and fusion ACDF and therefore might lead to a higher loss of correction. We compared the long term results of stand-alone PEEK- and TTN-cages in a comparable patient collective that was operated under identical operative settings.

MethodsFrom 2002 to 2007 154 patients underwent single-level ACDF for degenerative disc disease DDD. Clinical and radiological outcome were assessed in 86 eligible patients after a mean of 28.4 months. 44 patients received a TTN- and 42 patients a PEEK-cage.

ResultsSolid arthrodesis was found in 93.2% of the TTN-group and 88.1% of the PEEK-group. Cage subsidence was observed in 20.5% of the TTN- and 14.3% of the PEEK-group. A significant segmental lordotic correction was achieved by both cage-types. Even though a loss of correction was found at the last follow-up in both groups, it did not reach the level of statistical significance. Statistical analysis of these results revealed no differences between the TTN- and PEEK-group.

When assessed with the neck disability index NDI, the visual analogue scale VAS of neck and arm pain and Odom’s criteria the clinical data showed no significant differences between the groups.

ConclusionsClinical and radiological outcomes of ACDF with TTN- or PEEK-cages do not appear to be influenced by the chosen synthetic graft. The modulus of elasticity represents only one of many physical properties of a cage. Design, shape, size, surface architecture of a cage as well as bone density, endplate preparation and applied distraction during surgery need to be considered as further important factors.

AbbreviationsACDFanterior cervical discectomy and fusion

ASDadjacent segment disease

CTcomputer tomography

DDDdegenerative disc disease

MRImagnetic resonance imaging

NDIneck disability index


ROMrange of motion

SEMstandard error of the mean


VASvisual analogue scale.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-13-172 contains supplementary material, which is available to authorized users.

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Author: Mario Cabraja - Soner Oezdemir - Daniel Koeppen - Stefan Kroppenstedt


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