Structural Allograft Versus PEEK Implants in Anterior Cervical Discectomy and Fusion: A Systematic Review

• Type of Material: Article
• Authors: Amit Jain, Johns Hopkins University; Majd Marrache, Johns Hopkins University; Andrew Harris, Johns Hopkins University; Varun Puvanesarajah, Johns Hopkins University; Brian J. Neuman, Johns Hopkins University; Zorica Buser, University of Southern California; Jeffrey C. Wang, University of Southern California; Tim Yoon, Emory University; Hans Jörg Meisel, BG-Clinic Bergmannstrost
• Language: English
• Date: 2020-09-01
• Publisher: SAGE Publications (UK and US)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2019
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/2192568219883256
• Title of Journal or Parent Work: Global Spine Journal
• Volume: 10
• Issue: 6
• Start Page: 775
• End Page: 783
• Grant/Funding Information: The author(s) received no financial support for the research, authorship, and/or publication of this article.
• Keywords: structural allograft; usion rate; interbody device; polyetheretherketone interbody device; patient-reported outcome; systematic review; allograft; cervical spine degeneration; anterior cervical discectomy and fusion
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Neuroscience

Abstract

Study Design: Systematic literature review. Objective: Our primary objective was to compare reported fusion rates after anterior cervical discectomy and fusion (ACDF) using structural allograft versus polyetheretherketone (PEEK) interbody devices in patients with cervical spine degeneration. Our secondary objectives were to compare differences in rates of subsidence and reoperation and in patient-reported outcomes between the 2 groups. Methods: Through a systematic review of the English-language literature using various databases, we identified 4702 articles. After we applied inclusion and exclusion criteria, 14 articles (7 randomized controlled trials, 4 prospective studies, and 3 retrospective studies) reporting fusion rates of structural allograft or PEEK interbody devices were eligible for our analysis. No randomized controlled trials compared outcomes of structural allograft versus PEEK interbody devices. Extracted data included authors, study years, study designs, sample sizes, patient ages, duration of follow-up, types of interbody devices used, fusion rates, definition of fusion, reoperation rates, subsidence rates, and patient-reported outcomes. Results: Fusion rates were 82% to 100% for allograft and 88% to 98% for PEEK interbody devices. The reported data were insufficient to perform meta-analysis. Structural allograft had the highest reported rate of reoperation (14%), and PEEK interbody devices had the highest reported subsidence rate (18%). Patient-reported outcomes improved in both groups. There was insufficient high-quality evidence to compare the associations of various PEEK modifications with fusion rates. Conclusion: Fusion rates were similar between structural allograft and PEEK interbody devices when used for ACDF for cervical spine degeneration. Currently, there is insufficient high-quality evidence to assess associations of PEEK modifications with fusion rates. Level of Evidence: II.