THE TWO FACES OF MODERN SURGERY: A COMPARATIVE ANALYSIS OF PEEK CAGE VERSUS DISC ARTHROPLASTY IN THE TREATMENT OF CERVICAL DISC HERNIATION

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Saraç M. E., Boğa Z.

Journal of Turkish Spinal Surgery, cilt.36, sa.3, ss.110-119, 2025 (Scopus, TRDizin)

Özet

Objective: The research analyzed long-term results between polyetheretherketone (PEEK) cage fusion and disc prosthesis procedures in patients operated for C4-C5 or C5-C6 cervical disc herniation. Materials and Methods: Between January 2019-January 2024, 137 patients undergoing surgery for cervical disc herniation at our clinic were retrospectively analyzed. Pain [visual analog scale (VAS)], neck function [neck disability index (NDI)], range of motion (ROM), and neurological findings were recorded preoperatively and at 1, 6, and 12 months postoperatively. Radiological assessments were performed via dynamic radiographs, computed tomography and magnetic resonance imaging. Motion preservation analysis and propensity score matching were performed to address confounding factors. Statistical analyses employed Shapiro-Wilk, Mann-Whitney U, chi square/Fisher’s exact, and repeated measures analysis of variance tests (p<0.05). Results: PEEK cage group showed 47% NDI improvement and 54% VAS reduction, versus 40% and 47% in the prosthesis group (p<0.01). Total cervical ROM was 47.5° in PEEK versus 52° in prosthesis group (p<0.001), while segmental ROM was 0° versus 52° respectively (p<0.001). The motion preservation analysis showed that 79% of disc prosthesis patients maintained full segmental motion (>45°), while 11% experienced significant motion loss (<25°). Progressive motion loss occurred in 3%, 7%, and 11% of patients at 1, 6, and 12 months respectively. Fusion was achieved in 95% of PEEK cases with adjacent-segment degeneration in 6%, versus 4% in prosthesis group (p=0.42). Complications were 3% for PEEK and 5% for prosthesis (p=0.54). Patient satisfaction (88% vs. 92%, p=0.02) and short form-36 scores (78±10 vs. 82±9, p=0.01) were higher in the prosthesis cohort. Propensity score matching (n=58 per group) confirmed robustness of findings with excellent covariate balance. Conclusion: PEEK cages provide high fusion rates and early pain relief. Disc prostheses preserve motion and enhance long-term quality of life. Approximately 1 in 9 patients may experience significant motion loss over time with disc prosthesis.