The design evolution of interbody cages in anterior cervical discectomy and fusion: a systematic review

BMC Musculoskeletal Disorders

William R Walsh²  Ralph J Mobbs¹  Matthew H Pelletier²  Elizabeth Chong² 

[1] Department of Spine Surgery, Prince of Wales Hospital, Barker St, Sydney 2031, Australia;Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, Randwick 2031, UNSW NSW, Australia

关键词: Evolution;    Design;    Cage;    Interbody;    ACDF;    Review;    Anterior cervical discectomy fusion;   

Others  :  1177697
DOI  :  10.1186/s12891-015-0546-x

 received in 2014-10-01, accepted in 2015-03-30,  发布年份 2015

【 摘 要 】

Background

Anterior cervical discectomy with fusion is a common surgical procedure for patients experiencing pain and/or neurological deficits due to cervical spondylosis. Although iliac crest bone graft remains the gold standard today, the associated morbidity has inspired the search for alternatives, including allograft, synthetic and factor/cell-based grafts; and has further led to a focus on cage fusion technology. Compared to their graft counterparts, cage interbody implants have enhanced biomechanical properties, with designs constantly improving to maximise biocompatibility and osseointegration. We present a systematic review examining the historical progress of implant designs and performance, as well as an update on the currently available designs, and the potential future of cervical interbody implants.

Methods

We performed a systematic review using the keywords “cervical fusion implant design”, with no limits on year of publication. Databases used were PubMed, Medline, Embase and Cochrane. In addition, the search was extended to the reference lists of selected articles.

Results

180 articles were reviewed and 64 articles were eligible for inclusion. Exclusion criteria were based around study design, implant information and patient cohorts. The evolution of cage implant design has been shaped by improved understanding of ideal anatomy, progress in materials research and continuing experimentation of structural design. Originally, designs varied primarily in their choice of structure, however long-term studies have displayed the overall advantages of non-threaded, wedge shaped cages in complementing healthy anatomical profiles, and thus focus has shifted to refining material utilisation and streamlining anterior fixation.

Conclusions

Evolution of design has been dramatic over the past decades; however an ideal cage design has yet to be realised. Current research is focusing on the promotion of osseointegration through bioactiviation of surface materials, as well as streamlining anterior fixation with the introduction of integrated screws and zero profile designs. Future designs will benefit from a combination of these advances in order to achieve ideal disc heights, cervical alignments and fusions.

【 授权许可】

   
2015 Chong et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Irvine DH, Foster JB, Newell DJ, Klukvin BN: Prevalence of cervical spondylosis in general practice. Lancet 1965, 285(7395):1089-92.
• [2]Chau AMT, Mobbs RJ: Bone graft substitutes in anterior cervical discectomy and fusion. Eur Spine J 2009, 18(4):449-64.
• [3]Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al.: Anterior cervical discectomy and fusion associated complications. Spine 2007, 32(21)):2310-7.
• [4]Greg Anderson D, Albert TJ: Bone grafting, implants, and plating options for anterior cervical fusions. Orthop Clin N Am 2002, 33(2):317-28.
• [5]Cloward RB: The anterior approach for removal of ruptured cervical disks. J Neurosurg 1958, 15(6):602-17.
• [6]Smith GW, Robinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg 1958, 40(3):607-24.
• [7]Hacker RJ: A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results. J Neurosurg Spine 2000, 93(2):222-6.
• [8]Simmons EH, Bhalla S, Butt W: Anterior cervical discectomy and fusion: a clinical and biomechanical study with eight-year follow-up. J Bone Joint Surg 1969, 51(2):225-37.
• [9]Bailey R, Badgley C: Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg 1960, 42(4):565-624.
• [10]McConnell JR, Freeman BJ, Debnath UK, Grevitt MP, Prince HG, Webb JK: A prospective randomized comparison of coralline hydroxyapatite with autograft in cervical interbody fusion. Spine 2003, 28(4):317-23.
• [11]An HS, Simpson JM, Glover JM, Stephany J: Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion a prospective multicenter study. Spine 1995, 20(20):2211-6.
• [12]Bagby GW: Arthrodesis by the distraction-compression method using a stainless steel implant. Orthopedics 1988, 11(6):931-4.
• [13]Matge G: Anterior interbody fusion with the BAK-cage in cervical spondylosis. Acta Neurochir 1998, 140(1):1-8.
• [14]Matgé G: Cervical cage fusion with 5 different implants: 250 cases. Acta Neurochir 2002, 144(6):539-50.
• [15]Steffen T, Tsantrizos A, Fruth I, Aebi M: Cages: designs and concepts. Eur Spine J 2000, 9(1):S089-94.
• [16]Wilke HJ, Kettler A, Claes L: Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement. Eur Spine J 2000, 9(5):410-6.
• [17]Kandziora F, Schollmeier G, Scholz M, Schaefer J, Scholz A, Schmidmaier G, et al.: Influence of cage design on interbody fusion in a sheep cervical spine model. J Neurosurg Spine 2002, 96(3):321-32.
• [18]Kandziora F, Pflugmacher R, Schäfer J, Born C, Duda G, Haas NP, et al.: Biomechanical comparison of cervical spine interbody fusion cages. Spine 2001, 26(17):1850-7.
• [19]Kettler A, Wilke H-J, Claes L: Effects of neck movements on stability and subsidence in cervical interbody fusion: an in vitro study. J Neurosurg Spine 2001, 94(1):97-107.
• [20]Meriwether MW, Shockey RL. Box cage for intervertebral body fusion. In: Google Patents; 2000.
• [21]Steffen T, Tsantrizos A, Aebi M: Effect of implant design and endplate preparation on the compressive strength of interbody fusion constructs. Spine 2000, 25(9):1077-84.
• [22]Kast E, Derakhshani S, Bothmann M, Oberle J: Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial. Neurosurg Rev 2009, 32(2):207-14.
• [23]Wilke H, Kettler A, Goetz C, Claes L: Subsidence resulting from simulated postoperative neck movements: an in vitro investigation with a new cervical fusion cage. Spine 2000, 25(21):2762-70.
• [24]Gödde S, Fritsch E, Dienst M, Kohn D: Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion. Spine 2003, 28(15):1693-9.
• [25]Bartels RH, Donk R, van Dijk AR: Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage. J Neurosurg Spine 2001, 95(1):40-2.
• [26]Schmieder K, Wolzik-Grossmann M, Pechlivanis I, Engelhardt M, Scholz M, Harders A: Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine 2006, 4(6):447-53.
• [27]Emery SE, Fisher RJ, Bohlman HH: Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine 1997, 22(22):2622-4.
• [28]Wang JC, McDonough PW, Endow KK, Delamarter RB: Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine 2000, 25(1):41.
• [29]Mobbs RJ, Rao P, Chandran NK: Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating. J Clin Neurosci 2007, 14(7):639-42.
• [30]Schurman K, Busch G: Treatment of cervical luxation fractures with ventral fusion. CHIRURG 1970, 41(5):225-8.
• [31]Caspar W, Barbier DD, Klara PM: Anterior cervical fusion and Caspar plate stabilization for cervical trauma. Neurosurgery 1989, 25(4):491-502.
• [32]Bohler J, Gaudernak T: Anterior plate stabilization for fracture-dislocations of the lower cervical spine. J Trauma Inj Infect Crit Care 1980, 20(3):203-5.
• [33]Song K-J, Taghavi CE, Lee K-B, Song J-H, Eun J-P: The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine 2009, 34(26):2886-92.
• [34]Scholz M, Schnake K, Pingel A, Hoffmann R, Kandziora F: A new zero-profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res 2011, 469(3):666-73.
• [35]Bartels RH, Donk RD, Feuth T: Subsidence of stand-alone cervical carbon fiber cages. Neurosurgery 2006, 58(3):502-8.
• [36]Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A: A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine 2002, 27(16):1694-701.
• [37]Gercek E, Arlet V, Delisle J, Marchesi D: Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 2003, 12(5):513-6.
• [38]Mobbs RJ, Chau AM, Durmush D: Biphasic calcium phosphate contained within a polyetheretherketone cage with and without plating for anterior cervical discectomy and fusion. Orthop Surg 2012, 4(3):156-65.
• [39]Rao PJ, Walsh WR, Pellitier MH, Mobbs RJ: Spine interbody implants: material selection and modification, functionalization and bioactivation of surfaces to improve osseointegration. Orthop Surg 2014, 6(2):81-9.
• [40]Williams DF: There is no such thing as a biocompatible material. Biomaterials 2014, 35(38):10009-14.
• [41]Kurtz SM, Devine JN: PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 2007, 28(32):4845-69.
• [42]Chou Y-C, Chen D-C, Hsieh WA, Chen W-F, Yen P-S, Harnod T, et al.: Efficacy of anterior cervical fusion: Comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci 2008, 15(11):1240-5.
• [43]Niu CC, Liao JC, Chen WJ, Chen LH: Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages. J Spinal Disord Tech 2010, 23(5):310-6.
• [44]Liao JC, Niu CC, Chen WJ, Chen LH: Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop 2008, 32(5):643-8.
• [45]Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S: Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 2012, 13:172.
• [46]Chen Y, Wang X, Lu X, Yang L, Yang H, Yuan W, et al.: Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J 2013, 22(7):1539-46.
• [47]Frobin W, Leivseth G, Biggemann M, Brinckmann P: Vertebral height, disc height, posteroanterior displacement and dens–atlas gap in the cervical spine: precision measurement protocol and normal data. Clin Biomech 2002, 17(6):423-31.
• [48]Pait TG, Killefer JA, Arnautovic KI: Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures. Neurosurgery 1996, 39(4):769-76.
• [49]An HS, Evanich CJ, Nowicki BH, Haughton VM: Ideal thickness of Smith-Robinson graft for anterior cervical fusion: a cadaveric study with computed tomographic correlation. Spine 1993, 18(14):2043-7.
• [50]Wilkinson M: The morbid anatomy of cervical spondylosis and myelopathy. Brain 1960, 83(4):589-617.
• [51]Lu J, Ebraheim N, Yang H, Rollins J, Yeasting R: Anatomic bases for anterior spinal surgery: surgical anatomy of the cervical vertebral body and disc space. Surg Radiol Anat 1999, 21(4):235-9.
• [52]Lawrence J: Disc degeneration. Its frequency and relationship to symptoms. Ann Rheum Dis 1969, 28(2):121-38.
• [53]Friedenberg Z, Miller W: Degenerative disc disease of the cervical spine a comparative study of asymptomatic and symptomatic patients. J Bone Joint Surg 1963, 45(6):1171-8.
• [54]Tanaka N, Fujimoto Y, An HS, Ikuta Y, Yasuda M: The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine 2000, 25(3):286-91.
• [55]Kwon B, Kim DH, Marvin A, Jenis LG: Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. J Spinal Disord Tech 2005, 18(4):304-8.
• [56]Bayley JC, Yoo JU, Kruger DM, Schlegel J: The role of distraction in improving the space available for the cord in cervical spondylosis. Spine 1995, 20(7):771-5.
• [57]Truumees E, Demetropoulos CK, Yang KH, Herkowitz HN: Effects of disc height and distractive forces on graft compression in an anterior cervical discectomy model. Spine 2002, 27(22):2441-5.
• [58]Panjabi MM, Duranceau J, Goel V, Oxland T, Takata K: Cervical human vertebrae quantitative three-dimensional anatomy of the middle and lower regions. Spine 1991, 16(8):861-9.
• [59]Rosa AL, Beloti MM: Effect of cpTi surface roughness on human bone marrow cell attachment, proliferation, and differentiation. Braz Dent J 2003, 14(1):16-21.
• [60]Olivares-Navarrete R, Gittens RA, Schneider JM, Hyzy SL, Haithcock DA, Ullrich PF, et al.: Osteoblasts exhibit a more differentiated phenotype and increased bone morphogenetic protein production on titanium alloy substrates than on poly-ether-ether-ketone. Spine J 2012, 12(3):265-72.
• [61]Han C-M, Lee E-J, Kim H-E, Koh Y-H, Kim KN, Ha Y, et al.: The electron beam deposition of titanium on polyetheretherketone (PEEK) and the resulting enhanced biological properties. Biomaterials 2010, 31(13):3465-70.
• [62]Scholz M, Reyes PM, Schleicher P, Sawa AG, Baek S, Kandziora F, et al.: A new stand-alone cervical anterior interbody fusion device: biomechanical comparison with established anterior cervical fixation devices. Spine 2009, 34(2):156-60.
• [63]Qi M, Chen H, Liu Y, Zhang Y, Liang L, Yuan W: The use of a zero-profile device compared with an anterior plate and cage in the treatment of patients with symptomatic cervical spondylosis: a preliminary clinical investigation. Bone Joint J 2013, 95(4):543-7.
• [64]Miao J, Shen Y, Kuang Y, Yang L, Wang X, Chen Y, et al.: Early follow-up outcomes of a new zero-profile implant used in anterior cervical discectomy and fusion. J Spinal Disord Tech 2013, 26(5):E193-7.
• [65]Brenke C, Kindling S, Scharf J, Schmieder K, Barth M: Short-term experience with a new absorbable composite cage (beta-tricalcium phosphate-polylactic acid) in patients after stand-alone anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 2013, 38(11):E635-40.
• [66]Cauthen JC, Theis RP, Allen AT: Anterior cervical fusion: a comparison of cage, dowel and dowel-plate constructs. Spine J 2003, 3(2):106-17.
• [67]Bärlocher CB, Barth A, Krauss JK, Binggeli R, Seiler RW: Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 2002, 12(1):1-7.
• [68]van Jonbergen HP, Spruit M, Anderson PG, Pavlov PW: Anterior cervical interbody fusion with a titanium box cage: early radiological assessment of fusion and subsidence. Spine J 2005, 5(6):645-9.
• [69]Niu C-C, Chen L-H, Lai P-L, Fu T-S, Chen W-J: Trapezoidal titanium cage in anterior cervical interbody fusion: a clinical experience. Chang Gung Med J 2005, 28(4):212-21.
• [70]Salame K, Ouaknine GE, Razon N, Rochkind S: The use of carbon fiber cages in anterior cervical interbody fusion: report of 100 cases. Neurosurg Focus 2002, 12(1):E1.
• [71]van der Haven I, Van Loon P, Bartels R, Van Susante J: Anterior cervical interbody fusion with radiolucent carbon fiber cages: clinical and radiological results. Acta Orthop Belg 2005, 71(5):604-9.
• [72]Moreland DB, Asch HL, Clabeaux DE, Castiglia GJ, Czajka GA, Lewis PJ, et al.: Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft.[Erratum appears in Spine J. 2004 May-Jun;4(3):following table of contents]. Spine J 2004, 4(2):184-91.
• [73]Yang B, Li H, Zhang T, He X, Xu S: The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA): a meta analysis of randomized controlled trials. PLoS One 2012, 7(4):e35032.
• [74]Mastronardi L, Ducati A, Ferrante L: Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir 2006, 148(3):307-12.
• [75]Abuzayed B, Tutunculer B, Kucukyuruk B, Tuzgen S: Anatomic basis of anterior and posterior instrumentation of the spine: morphometric study. Surg Radiol Anat 2010, 32(1):75-85.
• [76]Moroney SP, Schultz AB, Miller JA: Analysis and measurement of neck loads. J Orthop Res 1988, 6(5):713-20.