Cervical Intervertebral Cages: Past, Present, Innovations, and Future Trends with Review of the Literature.

Document Type : Review Articles

Authors

1 Neurosurgery, Faculty of medicine, Suez Canal University, Ismailia, Egypt

2 Kasr Alainy

3 Professor in Neurosurgery, Suez Canal University, Egypt

4 Neurosurgery Department, Mansoura University

5 Neurosurgery department, Suez canal university

Abstract

Abstract
Background Data: Anterior cervical discectomy and fusion (ACDF) has been the standard treatment for degenerative conditions of the cervical spine. Since the introduction of the procedure in the fifties, ACDF has become quite popular and a gold standard procedure. Autologous iliac crest bone grafts were used for fusion with associated drawbacks that mandated the introduction of new metallic substitutes with various fillers. Many improvements and enhancements to these cages were implemented with rising controversial issues.
Purpose: To review the available data of cervical cages and the recent status of ACDF using standalone cages.
Study Design: A narrative literature review.
Patients and Methods: We reviewed the English literature through the last two decades for the most up-to-date available data of the cervical cages and reported the current status of ACDF outcomes using standalone cages. We ran a search using PubMed, Cochrane, and Google Scholar using different relevant keywords and extracted the most relevant researches according to our study aim. We focused on special titles that we thought were most relevant to the spinal surgeon's daily practice.
Results: A great number of cervical cages with different shapes and designs are available for ACDF. Spinal surgeons are confronted with a huge array of cervical cages introduced every day by many medical industry competitors. Clinical and radiological outcomes are generally very satisfactory regardless of the type and material of cages used. Composite or titanium-coated PEEK cervical cages and 3D-printed and porous titanium cages are under evaluation. Self-locking standalone cages showed great advancement and development with promising outcomes.
Conclusion: ACDF is a well-established surgical technique in the management of cervical spondylotic radiculopathy and/or myelopathy. Large numbers of cervical cages with different shapes, designs, and compositions are available in the market with generally satisfactory clinical and radiological outcomes. Spinal surgeons should be aware of the available cervical cages and choose the most suitable to their patient’s medical and socioeconomic status. New industrial technology has the potential to improve the load-bearing surface, lower cage dislocation and subsidence, and osteointegration. Composite cages, self-locking cages, and absorbable cages are fairly newly introduced cages and still under evaluation. Multicenter long-term prospective randomized controlled trials are mandatory for obtaining first-class evidence-based medical data on ACDF. (2020ESJ213)
 
Abstract
Background Data: Anterior cervical discectomy and fusion (ACDF) has been the standard treatment for degenerative conditions of the cervical spine. Since the introduction of the procedure in the fifties ACDF have become quite popular and gold standard procedures. Autologous iliac crest bone grafts were used for fusion with associated drawbacks that mandates the introduction of new metallic substitutes with various fillers. Lots of improvements and enhancements of these cages were supposed with arising controversial issues.
Purpose: To review the available data of cervical cages and the recent status of ACDF using standalone cages.
Study Design: narrative literature review.
Patients and Methods: We reviewed the English literature for the most up-to-date available data of the cervical cages and reported the current status of ACDF outcomes using standalone cages. We ran a search using PubMed, Cochrane, and Google Scholar using different relevant keywords and extracted the most relevant researches according to our study aim. We focused on special titles that we thought they are most relevant to the spinal surgeon daily practice.
Results: a great number of cervical cages with different shape and designs are available for ACDF. Spinal surgeons are confronted with a huge array of cervical cages introduced every day by many medical industrial competitors. Clinical and radiological outcomes are generally very satisfactory regardless the type and material of cages used. Composite or titanium coated PEEK cervical cages are under evaluation as well as 3D print and porous titanium cages. Self-locking standalone cages showed a great advancement and development with promising outcomes.
Conclusion: ACDF is a well-established surgical technique in the management of cervical spondylotic radiculopathy and/or myelopathy. Large numbers of cervical cages with different shapes, designs, and compositions are available in the market with generally satisfactory clinical and radiological outcomes. Spinal surgeons should be aware of available cervical cages and choose the most suitable to their patient’s medical and socioeconomic status. New industrial technology has the potentials of improving load-bearing surface, lower cage dislocation and subsidence, and improve osteointegration. Composite cages, self-locking cages, absorbable cages are fairly introduced cages and still under evaluation. Multicenter long-term prospective randomized controlled trials are mandatory for first class evidence based medical data in ACDF.
(2020ESJ213)

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Main Subjects