Mid‐ and Long‐Term Follow‐Up Efficacy Analysis of 3D‐Printed Interbody Fusion Cages for Anterior Cervical Discectomy and Fusion

• Published in: Orthopaedic surgery 2021-10, Vol.13 (7), p.1969-1978
• Main Authors: Jin, Yuan‐zhang, Zhao, Bin, Lu, Xiang‐dong, Zhao, Yi‐bo, Zhao, Xiao‐feng, Wang, Xiao‐nan, Zhou, Run‐tian, Qi, De‐tai, Wang, Wen‐xuan
• Format: Article
• Language: English
• Subjects: 3-D printers; 3D printed cage; ACDF; Back surgery; Biocompatibility; Clinical; Efficacy analysis; Fractures; Mid‐ and long‐term follow‐up; Patients; Physiology; Quality of life; Skin & tissue grafts; Spinal cord; Titanium alloys; Transplants & implants
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13005

Objective To evaluate the safety and stability of 3D‐printed interbody fusion cages (3D‐printed cages) in anterior cervical discectomy and fusion (ACDF) by investigating the mid‐ and long‐term follow‐up outcomes. Methods In this prospective study, the clinical data of 30 patients with CSM admitted to the Second Hospital of Shanxi Medical University from May 2012 to May 2014 were analyzed. The cohort comprised 18 males and 12 females with an average age of 60.22 ± 3.2 years. All patients were examined by X‐ray, CT and MRI before the operation. A total of 30 cases of CSM were treated by ACDF with 3D printed cage implantation. Mid‐ and long‐term follow‐ups were performed after the surgery. Clinical efficacy was evaluated by comparing the JOA score, SF‐36 score, change in neurological function, cervical curvature index (CCI), vertebral intervertebral height (VIH) and fusion rate before the operation, 6 months after the operation, and at the last follow‐up. Results Two of the 30 patients were lost to follow‐up. The remaining patients were followed up for 48–76 (65.23 ± 3.54) months. The patients recovered satisfactorily with a significant clinical effect. The JOA score increased meanfully and the improvement rate was 89.4% at the final follow‐up. The SF‐36 score increased significantly from pre‐ to postoperatively. The height of the intervertebral space at the last follow‐up was not statistically significantly different from that at 6 months after surgery (P > 0.05), showing that the height of the intervertebral space did not change much and the severity of cage subsidence (CS) decreased. The CCI improved from pre‐ to postoperatively. The CCI did not change much from the 6‐month follow‐up to the last follow‐up. and the cage rate (CR) was 100% at the 6‐month and last follow‐ups. No severe complications, such as spinal cord injury, esophageal fistula, cerebrospinal fluid leakage, cervical hematoma or wound infection, occurred in any of the patients. Conclusion The clinical and radiological results show that the application of 3D‐printed cages in ACDF can significantly relieve symptoms. Moreover, 3D‐printed cages can restore the curvature of the cervical spine, effectively maintain the intervertebral height for a long time, and prevent complications related to postoperative subsidence. The working principle of the 3D printed cage (coronal plane)