Tagged: ACDF graft choices; OPLL
Smitty123ParticipantJanuary 29, 2020 at 4:16 pmPost count: 4
Hi – I have recently been doing research on ACDF surgery here in CT/NY. I have 5 opinions that vary from top institutions. Majority are recommending the use of titanium cage but one just recommended PEEK.
It appears there may be a financial incentive with PEEK and although initial results seem good, long term fusion may be limited. With the titanium, there seems to be potential for future “intrusion” into vertebrae (not sure I have that correct).
Any feedback you can give, would be appreciated. I’m “only” 53 and my cervical spine is a bit a mess with the need for C4/5 and 5/6. I’ve been a very active runner, cyclist, mnt biker, skier over the years. I’m told I risk being paralyzed if I continue on, so I’m currently on hold and walking, but I would love to have some activity again that is a bit more than walking.
Thank you, SSDonald Corenman, MD, DCModeratorJanuary 30, 2020 at 6:58 amPost count: 8459
There are four different graft choices for an ACDF; autograft hip, allograft, PEEK cage and titanium cage. Each has benefits and issues. Autograft is the gold standard. It heals within 6-8 weeks, heals at a very high rate and incorporate fully. The obvious issue is you need a small incision and you have graft site discomfort for anywhere from 1-6 weeks.
Allograft is good as it is biologically active and incorporates well. The two problems are that allograft can collapse (fracture) as it is brittle in the beginning and does not heal as well as autograft.
PEEK cages are acceptable but have a problem in that the area of PEEK that touches the vertebra is biologically non-active. That means that some of the surface area is not capable of healing leading to a slower healing response and reduced chance of healing. There are some newer PEEK surfaces that are titanium coated so it remains to be seen if these are biologically more active.
Finally, titanium cages are making a come-back. These are more biologically active than PEEK but come with a real problem. They don’t allow MRI imaging at the implant level and even can obscure CT scans so if something does not go as well as to be expected, imaging is compromised.
You have to put a biological ingrowth material like autograft bone, demineralized bone matrix or allograft into the PEEK cage or titanium cage and that can also make a difference.
I personally like autograft, PEEK cages with titanium ingrowth and allograft.
Dr. CorenmanSmitty123ParticipantJanuary 31, 2020 at 5:08 amPost count: 4
Thank you – I really appreciate your quick response.Smitty123ParticipantFebruary 12, 2020 at 5:11 pmPost count: 4
Hi Dr. Corenman – I received additional information regarding my cervical spine. cat scan has indicated I have OPLL. So it seems ACDF is no longer a possible surgery. I’m contemplating sending you all of my discs for review to see what your opinion would be on how to proceed.
It seems there is no best practice and I’m at a loss as to what advice to follow. I wonder if you have experience with decompression and OPLL in a relatively young woman (53) and what the future may hold after a surgery to address. I’m told that the surgeries are to make me “safe” and that pain reduction and symptoms cannot be guaranteed. I’m someone that has enjoyed skiing, mountain biking, and numerous other activities. The person I spoke to today really only has experience with people that are probably at least 10 years older than I am.
I’m told options are: 1. posterior Laminoplasty 2. anterior corpectomy that comes with risk of dura tear 3. I think there was a third but cannot recall what it is – perhaps it was corpectomy coming from the back but this would not address radicular pain (but neither does the laminoplasty. One surgeon told me all three and expected me to decide. The other recommended laminoplasty.
I’m at a loss as to how to decide who to go with and what procedure will be right for me. Any thoughts you have would be helpful.
Thank you!Donald Corenman, MD, DCModeratorFebruary 14, 2020 at 7:14 amPost count: 8459
Your choice for surgical procedures depends upon many factors. Do you have central narrowing (stenosis) in the canal? Do you have nerve root compression? Do you have neck pain along with shoulder and arm symptoms? How significant is your OPLL? Did you have a CT scan along with the MRI to determine the extent of the OPLL? How many levels are involved? Do you have instability? What have the previous surgeons suggested and why?
Dr. CorenmanSmitty123ParticipantMarch 10, 2020 at 1:29 pmPost count: 4
Thank you! I’ve decided to send you my reports and image cd-roms and hope we can talk through. I followed up with Sara. At the end of the day, I’m most likely going with anterior corpectomy. My concerns are my age and what I may / may not be able to do again. I also know this procedure comes with potential complications. Looking for another expert to calmly talk through with.
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