Abstract
PURPOSE: The titanium mesh cage (TMC) is a typical metal cage device which has been widely used in cervical reconstruction for decades. Nano-hydroxyapatite/polyamide-66 (n-HA/PA66) cage is a novel biomimetic non-metal cage device growing in popularity in many medical centres in recent years. There has been no comparison of the efficacy between these two anterior reconstructing cages. The purpose of this study was to compare the radiographic and clinical outcomes of these two different devices. METHODS: Sixty-seven eligible patients with single-level ACCF using TMC or n-HA/PA66 cage for cervical degenerative diseases, with four-year minimum follow-up, were included in this prospective non-randomised comparative study. Their radiographic (cage subsidence, fusion status, segmental sagittal alignment [SSA]) and clinical (VAS and JOA scales) data before surgery and at each follow-up was recorded completely. RESULTS: The fusion rate of the n-HA/PA66 group was higher than TMC at one year after surgery (94% vs. 84%) though their finial fusion rates were similar (97% vs. 94%). Finial n-HA/PA66 cage subsidence was 1.5 mm with 6% of severe subsidence over three millimetres, which was significantly lower than the respective 2.9 mm and 22% of TMC (P < 0.0001). Lastly, SSA, VAS and JOA in TMC group were worse than in the n-HA/PA66 group (P = 0.235, 0.034 and 0.007, respectively). CONCLUSIONS: The n-HA/PA66 cage is associated with earlier radiographic fusion, less subsidence and better clinical results than TMC within four years after one-level ACCF. With the added benefit of radiolucency, the n-HA/PA66 cage may be superior to TMC in anterior cervical construction.