Comparative evaluation of bone–filled Polymethylmethacrylate implant, autograft fusion, and Polyetheretherketone cervical cage fusion for the treatment of single –level cervical disc disease.

BACKGROUND: The objective of this study is to compare the clinical, functional, and radiological outcomes of using bone-filled Polymethylmethacrylate (PMMA) implant as an inexpensive alternative to Polyetheretherketone (PEEK) cage and Autologous bone graft (ABG) fusion after anterior cervical discectomy (ACD) for the treatment of single level cervical disc disease. METHODS: 60 patients were prospectively randomized according to the material used for fusion after ACD into: 1) PMMA implant; 2) ABG; and 3) PEEK implant. The clinical outcomes were evaluated using Visual Analogue Scale (VAS), whereas the functional outcomes were evaluated using Odom's criteria. Radiological evaluations were also conducted using radiography and Computerized tomography (CT) scans and considered the following factors; bony fusion, cervical stability and disc space height (DSH) changes. The post- operative outcomes were evaluated at the following intervals; 2 weeks, 3 and 6 months. RESULTS: The clinical outcomes demonstrated insignificant difference among the three treated groups throughout their follow up period. ABG group showed significant lower satisfactory functional outcomes (68.1%) compared to PMMA and PEEK groups (85% and 88.9%, respectively) at the 2-week post operative evaluation, but the ABG group showed closer functional outcomes to the PMMA and PEEK groups at the 3 and 6-month post operative evaluations. Despite the inferior bony fusion rates of the PMMA group (30%) compared to ABG group (86.3%) and PEEK group (77.7%) at the 6-month post operative evaluation, the clinical and functional outcomes were comparable. CONCLUSIONS: Bone-filled PMMA implant is a reliable treatment option; despite its inferior fusion rate at the 6-month postoperative evaluation, it still provides acceptable segmental stability, satisfactory clinical and functional outcomes that are comparable to ABG and PEEK grafting procedures.