Comparison of the Operative Time and Post-Operative Pain with Peek Cage versus Autologous Iliac Crest Bone Graft in Anterior Cervical Discectomy and Fusion

  • Syed Ahmad Faizan Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore General Hospital (LGH), Lahore, Pakistan
  • Syed Ahmad Bilal
Keywords: cervical disc disease, cervical spondylo-myelopathy, cervical facet jump, Anterior Cervical Decompression and Fusion, Polyetheretherketone


Objective:  To compare the operative time and post-operative pain with PEEK cage method versus autologous iliac crest bone graft in anterior cervical discectomy and fusion in the cervical spine.

Material & Methods:  This randomized control trial study (RCT). 90 patients with cervical disc disease, cervical stenosis with or without myelopathy and cervical trauma (fractures or facet jumps with disrupted disc) were included in the study from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays and MRI scans of the cervical spine. All patients underwent anterior cervical decompression and fusion. In 45 patients (group A), cervical fusion was achieved with PEEK cage method and in other 45 patients (group B), autologous Iliac Crest Bone graft was used.

Results:  Mean age in group A was 57.1 years and in group B, it was 54.7 years. In group A, 31.1% patients were of cervical disc disease, 28.8% of cervical degenerative stenosis and 40% were of cervical trauma. In group B, 15 patients 33.3% were of cervical disc disease, 24.4% of cervical degenerative stenosis and 42.2% were of cervical trauma. The mean Postoperative Visual Analogue Scale (VAS) score for pain was 2.8 in group A and 5.4 in group B patients.

Conclusion:  The patients of group A (PEEK cage method) could be easily mobilized within bed and out of bed depending upon their neurological status. Decreased operative time and less post-operative pain makes PEEK cage method superior to autologous iliac crest bone graft in anterior cervical decompression and fusion.


1. Bjarne L, Paal AR, Sundseth J, Helseth E. Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surgery, 2010; 10: 10.
2. M. A. Pfallerand D. J. Diekema. Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem. Clin. Microbiol Rev, 2007; 20 (1): 133–163.
3. Korinth MC. Treatment of cervical degenerative disc disease: current status and trends. Zentralbl Neurochir. 2008; 69: 113–124.
4. Peolsson A: Investigation of clinically important benefit of anterior cervical decompression and fusion. Eur Spine J. 2007; 16: 507-514.
5. Fernandez-Fairen M, Sala P, Dufoo M Jr, Ballester J, Murcia A, Merzthal L. Anterior cervical fusion with tantalum implant: a prospective randomized controlled study. Spine, 2008; 33: 465-472.
6. Chi-Chien N, Jen-Chung, Chen L, Chen W-J, et al. Outcomes of Interbody Fusion Cages Used in 1 and 2-levels Anterior Cervical Discectomy and Fusion: Titanium Cages Versus Polyetheretherketone (PEEK) Cages. Journal of Spinal Disorders & Techniques, 2010; 23 (5): 310-316.
7. Z. Jian, X. Qing, D. Jian, L. Xilei, Z. Xiaogang, F. Taolin, L. Hong. Comparison of standalone polyetheretherketone cages and iliac crest autografts for the treatment of cervical degenerative disc diseases. Acta Neurochir (Wien). 2011; 153 (1): 115-22.
8. Hossam IM, Islam AF. Anterior Cervical Fusion of Single Level Cervical Disc Disease A Retrospective Analysis of Outcome. E.J.N.S. 2010; 25 (2): 95-112.
9. Skeppholm M, Olerud C. Pain from donor site after anterior cervical fusion with bone graft: a prospective randomized study with 12 months of follow-up. European Spine Journal, 2013; 22 (1): 142-147.
10. Ralph JM, MT. C. Anthony and D. Deniz. Biphasic Calcium Phosphate Contained within a Polyetheretherketone Cage with and without Plating for Anterior Cervical Discectomy and Fusion. Orthopaedic Surgery, 2012; 4 (3): 156-165.
11. Lemcke J, Al-Zain M, Meier U, Suess O. Polyetheretherketone (PEEK) Spacers for Anterior Cervical Fusion: A Retrospective Comparative Effectiveness Clinical Trial. Open Orthop J, 2011; 5: 348–353.
12. Faldini C, Chehrassan M, Miscione MT, Acri F, d’Amato M, Pungetti C, Luciani D, Giannini S. Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone. J Orthop Traumatol, 2011; 12 (4): 201–205.
13. Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine, 2000; 25: 2646-2654.
14. Goldberg EJ, Singh K, Van U, Garretson R, An HS: Comparing outcomes of anterior cervical discectomy and fusion in workman's versus non-workman's compensation population. Spine J, 2002; 2: 408-414.
15. Gore DR, Sepic SB, Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years. Spine, 1998; 23: 2047-2051.
16. Jagannathan J, Shaffrey CI, Oskouian RJ, Dumont AS, Herrold C, Sansur CA, et al. Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar. J Neurosurg Spine, 2008; 8: 420-428.
17. Jain V, Madan A, Thakur M, Thakur A. Functional Outcomes of Subaxial Spine Injuries Managed With 2-Level Anterior Cervical Corpectomy and Fusion: A Prospective Study. Neurospine, 2018; 15 (4): 368-375.
18. Madan A, Thakur M, Sud S, Jain V, Singh Thakur RP, Negi V. Subaxial Cervical Spine Injuries: Outcomes after Anterior Corpectomy and Instrumentation. Asian J Neurosurg. 2019; 14 (3): 843-847.
19. Yu-Cheng Chou, Der-Cherng DC, Hsieh WA, Cchen WF, Yen PS, Harnod T, et al. Efficacy of anterior cervical fusion: comparison of titanium cages, polyetheretherketone (PEEK) cafes and autogenous bone grafts. Journal of Neurosciences. 2008; 15 (11): 1240-1245.
20. Ni J, Zhenf Y, Liu N, Wang X, Fang X, Phukan R, Wood KB. Radiological evaluation of anterior lumbar fusion using PEEK cages with adjacent vertebral autograft in spinal deformity long fusion surgeries. Eur. Spine Journal, 2015; 24 (4): 791-799.
Original Article