Three-level anterior cervical discectomy and fusion with self-locking stand-alone polyetheretherketone cages

Anterior cervical plating is regarded as standard practice after multilevel anterior cervical discectomy and fusion. However, plate implantation in the anterior cervical spine poses a substantial risk of hardware-related complications. We retrospectively analyzed the efficacy and outcomes of 15 consecutive patients treated with a 3-level anterior cervical fusion using self-locking stand-alone polyetheretherketone (PEEK) cages. Patients were evaluated preoperatively and postoperatively using the Japanese Orthopedic Association (JOA) scale scores and radiographs. Clinical results were assessed using Odom's criteria. The mean JOA score (± standard deviation) improved significantly from 7.3 ± 1.5 points to 14.1 ± 1.3 points (p < 0.05) at the final follow-up. The outcomes were excellent for four patients (26.7%), good for nine patients (60%) and fair for two patients (13.3%). None of the patients experienced a poor clinical outcome. Thirteen patients achieved a solid fusion, after an average time of 5.7 months. The radiographic fusion rate of this procedure was 93.3%. Of 45 cages inserted in total, only four (8.89%) cages, in three patients, were found to have subsided. The degree of spinal curvature before surgery differed significantly from that immediately after surgery, and from that at the final follow-up examination (p < 0.05). Self-locking stand-alone PEEK cages packed with excised local osteophytes and calcium sulfate are safe and effective. This procedure can effectively restore cervical lordosis, obviate the complications related to graft harvest and screw-plate fixation, and lead to satisfactory outcomes.