Comparison between Acrylic Cage and Polyetheretherketone (PEEK) Cage in Single-Level Anterior Cervical Discectomy and Fusion: A Randomized Clinical Trial

Abstract

Background: ACDF is considered a standard neurosurgical treatment for degenerative diseases of cervical intervertebral discs. There are different materials used to restore physiologic disc height and enhance spinal fusion, but the ideal device has not been identified yet. To overcome this, we designed a new, inexpensive Acrylic cage. This study aims to compare polyetheretherketone (PEEK) cage with a novel Acrylic cage to find out which fusion cage yielded better clinical outcomes following anterior cervical discectomy and fusion (ACDF).

Materials and Methods: In a prospective clinical study, a total of 64 patients were randomly allocated to undergo ACDF either with Acrylic interbody fusion cage made of polymethylmethacrylate filled with bone graft (n=32) or PEEK cage (n=32). Nurick’s grading was used for quantifying the neurological deficit. Clinical and radiological outcome was assessed preoperatively, immediately after surgery, and subsequently at 2, 6, and 12 months follow up. Odom's criteria were used to evaluate the clinical outcomes of the patients.

Results: There was no significant difference in the age and sex distribution. There was no statistically significant difference in disc space height, intervertebral angel, and fusion status between the two groups, but there was a statistically significant improvement in the clinical outcomes of the Acrylic cage group compared with the PEEK cage group (mean difference: -0.438, 95% CI -0.807 to -0.068; p=0.016).

Conclusion: This study suggests that the use of Acrylic cage is associated with good clinical and radiological outcomes and it can be therefore a good substitute for bone graft and other cages in ACDF.

 Keywords: Anterior cervical discectomy and fusion, Acrylic cage, PEEK cage, Intervertebral angel, Disc space height