Tools and techniquesComparison of allograft and polyetheretherketone (PEEK) cage subsidence rates in anterior cervical discectomy and fusion (ACDF)

- The subsidence rate does not seem to be affected by the use of either PEEK or allograft as spacers in ACDF.
- Higher incidence of cage subsidence is found on lower cervical levels as more weight is supported on these levels.
- Subsidence alone does not seem to be predictive of clinical outcomes of ACDF.

Structural allografts and PEEK cages are commonly used interbody fusion devices in ACDF. The subsidence rates of these two spacers have not yet been directly compared. The primary aim of this study was to compare the subsidence rate of allograft and PEEK cage in ACDF. The secondary aim was to determine if the presence of subsidence affects the clinical outcome. We reviewed 67 cases (117 levels) of ACDF with either structural allograft or PEEK cages. There were 85 levels (48 cases) with PEEK and 32 levels (19 cases) with allograft spacers. Anterior and posterior disc heights at each operative level were measured at immediate and 6 months post-op. Subsidence was defined as a decrease in anterior or posterior disc heights >2 mm. NDI of the subsidence (SG) and non-subsidence group (NSG) were recorded. Chi-square test was used to analyze subsidence rates. T-test was used to analyze clinical outcomes (α = 0.05). There was no statistically significant difference between subsidence rates of the PEEK (29%; 25/85) and allograft group (28%; 9/32) (p = 0.69). Overall mean subsidence was 2.3 ± 1.7 mm anteriorly and 2.6 ± 1.2 mm posteriorly. Mean NDI improvement was 11.7 (from 47.1 to 35.4; average follow-up: 12 mos) for the SG and 14.0 (from 45.8 to 31.8; average follow-up: 13 mos) for the NSG (p = 0.74). Subsidence rate does not seem to be affected by the use of either PEEK or allograft as spacers in ACDF. Furthermore, subsidence alone does not seem to be predictive of clinical outcomes of ACDF.