Medical Student Carle Illinois College of Medicine, Minnesota, United States
Introduction: Anterior Cervical Discectomy and Fusion is a common cervical surgery performed for cervical myelopathy. A cage is commonly used to facilitate fusion between vertebral bodies and can be constructed from different materials. We sought to compare PEEK and metal cages in their ability to facilitate fusion and improve patient-reported outcomes.
Methods: The cervical spine Quality Outcomes Database (QOD) was queried for all anterior cervical spine surgery patients who underwent ACDF for cervical myelopathy receiving PEEK and metal cages. Primary outcomes included surgical outcomes, and patient-reported outcomes and 3-, 12- and 24-month periods. Propensity scores were constructed from baseline pain and functionality, and symptoms at presentation. All analysis was conducted on R.
Results: 1039 and 2840 patients were initially identified in the imbalanced cohort with metal and PEEK cages respectively for ACDF. Imbalances were corrected for the race, insurance, and comorbidities. For 30-day surgical complications, PEEK cages had greater rates of surgical site infection (OR = 0.163, p = 0.005), whereas metal cages had greater rates of surgical site hematoma (OR = 3.92, p = 0.025). Minimal clinically important differences (MCID) for neck and arm pain at 3-months favored PEEK cages (OR = 1.325, 1.232, p < 0.05). Surgical length of stay was more prolonged in metal cage implantations in multi-level ACDF cases involving more than 3 levels.
Conclusion : From our propensity-matched analysis of the QOD, we observed that while PEEK cages have reduced rates of 30-day hematoma development, they have greater rates of surgical site infections. We also observed that PEEK cages were associated with lower pain at 3 months, though this effect was not observed in 12-month periods, suggesting an earlier stabilization of the cervical spine, which matches metal cages in long-term outcomes.
