Junior Specialist UC Irvine Department of Neurosurgery Santa Clarita, California, United States
Introduction: Patients with prolonged cervical myelopathy and/or radiculopathy symptoms that are refractory to non-surgical treatments are candidates for anterior cervical discectomy and fusion (ACDF). Here, we evaluate the efficacy of hyperlordotic (HL) implants in restoring cervical anterior column realignment (ACR) in patients receiving ACDF surgery.
Methods: A consecutive series of patients who underwent ACDF with HL polyetheretherketone (PEEK) implants at one of two centers were retrospectively reviewed between 2014 and 2016. All patients included in this study underwent ACDF between C3-C7, with or without an Ames-International Spine Study Group Grade IV anterior osteotomy, inclusive of an HL PEEK cervical implant (10, 15, or 20 degrees), and had radiographic follow-up data greater than one year postoperatively. Lateral radiographs were analyzed to determine relevant cervical angles, and paired t-tests were used to determine significance with an alpha >0.05.
Results: A total of 46 patients were included in the study. The mean radiographic follow-up period was 14.4 months (range; 12 to 30 months). Mean patient age was 58.0 years (range; 31 to 77 years) and 16 patients (35%) were male. Mean body mass index (BMI) was 28.3 kg/m2. Overall, cervical lordosis increased from -7.8° at pre-op to -14.8° at post-op and to -15.7° at last follow up (p < 0.001). In addition, the mean segmental lordosis of ACR levels treated increased from -0.2° at pre-op to -4.8° at post-op (p < 0.001), but no significant change was observed at last follow up. Lastly, improvement in segmental lordosis was seen at both postoperative time points at the C3-4 (p=0.002 and p=0.005, respectively), C4-5 (p < 0.001 and p< 0.001, respectively), and C5-6 levels (p < 0.001 and p< 0.001, respectively).
Conclusion : The HL polyetheretherketone (PEEK) implant used for ACR was found to be effective in restoring cervical lordosis in patients with cervical pathology without requiring additional posterior surgery following an ACDF procedure.
