Autologous Bone Graft vs PEEK Cage in Patients with Cervical Spondylotic Myelopathy


  • Ijaz Hussain Wadd Department of Neurosurgeries: 1Punjab Institute of Neurosciences, 2University of Lahore Teaching
  • Ammar Anwer
  • Liaqat Mehmood Awan
  • Arsalan Haider
  • Asif Shabbir
  • Zayed Qamar



autologous bone graft


Background:  Cervical spine stenosis is one of the most common degenerative changes of cervical spondylotic myelopathy (CSM) and results in severe dysfunction of the cervical spinal cord. The conventional treatment of such degenerative cervical spine conditions is anterior cervical discectomy and fusion (ACDF). Strut graft remains the gold standard in ACDF with excellent patient recovery but has many shortcomings. Polyetheretherketone (PEEK) cages have recently become popular as a replacement for strut grafts in patients undergoing ACDF.

Objective:  This study was carried out to compare the clinical and radiographic outcomes of autologous bone grafts versus PEEK cages in patients undergoing ACDF surgery.

Materials and Methods:  It was a randomized controlled trial conducted at the Neurosurgery Department Punjab Institute of Neurosciences for three years. Patients who consented to be a part of this study and fulfilled our predefined inclusion criteria were recruited and randomized into 2 groups. One group underwent ACDF with auto bone graft whereas the other group underwent ACDF with PEEK cage.

Results:  A total of 198 subjects were included in this study. The mean age was calculated as 47.60 ± 9.17 years in the PEEK cage group and 46.74 ± 8.87 years in the Autologous bone graft group. Males accounted for 59.6% of the study population.  The fusion rate was found to be higher in the PEEK cage group with a p-value of 0.002.

Conclusion:  PEEK cages are superior to strut grafts as they have lesser morbidity after ACDF surgery in patients with CSM.



Yin M, Xu C, Ma J, Ye J, Mo W. A bibliometric analysis and visualization of current research trends in the treatment of cervical spondylotic myelopathy. Global spine Journal, 2021; 11 (6): 988-98.

Perdomo-Pantoja A, Chara A, Liu A, Jin Y, Taylor M, El Demerdash N, Ahmed AK, Pennington Z, Cottrill E, Westbroek EM, Bydon A. Surgical Decompression for Cervical Spondylotic Myelopathy in Patients with Associated Hypertension: A Single-Center Retrospective Cohort and Systematic Review of the Literature. World Neurosurgery, 2021; 155: e119-30.

Ali MS, Abd Al-Rahman M, Bitar B. Peri-surgical Complications Related to Anterior Cervical Spine Surgery: Smith-Robinson Approach. Journal of Medical and Health Studies, 2022; 3 (2): 07-13.

Goldberg JL, Meaden RM, Hussain I, Gadjradj PS, Quraishi D, Sommer F, Carnevale JA, Medary B, Wright D, Riew KD, Hartl R. Titanium versus polyetheretherketone versus structural allograft in anterior cervical discectomy and fusion: A systematic review. Brain and Spine, 2022: 100923.

Kanna RM, Perambuduri AS, Shetty AP, Rajasekaran S. A randomized control trial comparing local autografts and allografts in single level anterior cervical discectomy and fusion using a stand-alone cage. Asian Spine Journal, 2021; 15 (6): 817.

Chen F, He W, Mahaney K, Noeller J, Mhanna N, Viljoen S, Torner J, Hitchon P. Alternative grafts in anterior cervical fusion. Clinical Neurology and Neurosurgery, 2013; 115 (10): 2049-55.

Sharma A, Kishore H, Singh V, Shawky Abdelgawaad A, Sinha S, Kamble PC, Jorule K, Agrawal R, Mathapati S, Deepak P. Comparative study of functional outcome of anterior cervical decompression and interbody fusion with tricortical stand-alone iliac crest autograft versus stand-alone polyetheretherketone cage in cervical spondylotic myelopathy. Global Spine Journal, 2018; 8 (8): 860-5.

Isogai N, Nagoshi N, Iwanami A, Kono H, Kobayashi Y, Tsuji T, Fujita N, Yagi M, Watanabe K, Kitamura K, Shiono Y. Surgical treatment of cervical spondylotic myelopathy in the elderly: Outcomes in patients aged 80 years or older. Spine, 2018; 43 (24): E1430-6.

Zhang RJ, Shen CL, Zhang JX, Zhang XJ, Dong FL, Tao H, Song PW, Ge P, Xu P, Zhang HQ. Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients of different ages: a retrospective study. Spinal Cord, 2018; 56 (1): 7-13.

Lv B, Fan X, Ding H, Ji P, Zhao Y, Wan B, Jiang Q, Luo Y, Xu T, Zhou Z, Chen J. Analysis of correlation between age and cervical facet joint degeneration and modic changes in patients with cervical spondylotic myelopathy. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 2019; 25: 7882.

Abraham TR, John A, Balakrishnan PK, Jose T. Functional outcome assessment for surgical decompression of cervical spondylotic myelopathy. International Surgery Journal, 2021; 9 (1): 70-4.

Lied B, Roenning PA, 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 (1): 1-9.

Cho DY, Liau WR, Lee WY, Liu JT, Chiu CL, Sheu PC. Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery, 2002 Dec; 51 (6): 1343-49; Discussion 1349-50. Erratum in: Neurosurgery, 2003; 52 (3): 693.

Jain A, Marrache M, Harris A, Puvanesarajah V, Neuman BJ, Buser Z, Wang JC, Yoon ST, Meisel HJ; AOSpine Knowledge Forum Degenerative. Structural Allograft Versus PEEK Implants in Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J. 2020 Sep; 10 (6): 775-783.

Fatima N, Massaad E, Shankar GM, Shin JH. Structural Allograft versus Polyetheretherketone Implants in Patients Undergoing Spinal Fusion Surgery: A Systematic Review and Meta-Analysis. World Neurosurg. 2020 Apr; 136: 101-109.

doi: 10.1016/j.wneu.2020.01.006. Epub 2020 Jan 10. PMID: 31931246.

Liu JM, Xiong X, Peng AF, Xu M, Chen XY, Long XH, Xu R, Liu ZL. A comparison of local bone graft with PEEK cage versus iliac bone graft used in anterior cervical discectomy and fusion. Clinical Neurology and Neurosurgery, 2017; 155: 30-5.






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