Experience with a modular PEEK system for cervical vertebral body replacement

A retrospective case series.

The authors present their experience with the ATHLET vertebral body replacement (VBR) system in combination with the TOSCA plating system for the treatment of cervical spondylotic myelopathy.

Data obtained from 20 cases were reviewed. Corpectomy and VBR with the ATHLET system was performed in all cases. Patients underwent preoperative and postoperative assessment involving the Japanese Orthopedic Association score, Odom criteria, and radiographic studies to determine the position of the implant as well as cervical lordosis. The mean follow-up period was 20 months (16-28 mo).

Implantation of the ATHLET VBR itself was uncomplicated in all cases. The adjustment of the implants' height could be done in 2 mm steps. With increasing height of the implant, the angle of lordosis increases comparable with physiological conditions. The authors performed 13 one-level and 7 two-level corpectomies; from the latter group there were 2 revision cases (10%) with implant dislocation. Four cases (20%) of secondary subsidence of the implant were observed radiographs 12 months postoperatively; in all cases treatment remained conservative. Ten patients (50%) had excellent, 4 (30%) good, 2 (10%) satisfactory, and 2 (10%) poor outcome according to Odom criteria. The average improvement of the Japanese Orthopedic Association score was 1.6. All cases achieved osseous fusion without complications, 55% of them had an improvement, and 15% of them had no change of the sagittal contour.

The ATHLET VBR is easy to implant and avoids bone graft site morbidity. Due to a relatively high rate of secondary subsidence of the implant (20%) and secondary dislocation (10%) in combination to a poor to satisfactory outcome according to Odom criteria in 20%, the authors do not recommend the use of this PEEK implant for cervical VBR.