Spine Cage containing a biphasic calcium phosphate ceramic (Triosite) for the treatment of cervical spondylosis Der-Yang Cho, MD * , Wuen-Yen Lee, MD, Pon-Chun Sheu, MD, Chun-Chung Chen, MD Department of Neurosurgery, China Medical University Hospital, Taichung, Taichung, Taiwan 404, Republic of China Received 1 March 2004; accepted 5 October 2004 Abstract Background: We evaluated the fusion efficacy and clinical outcomes of a cage containing a biphasic calcium phosphate ceramic (Triosite) in treating cervical spondylosis. Methods: We randomly divided 100 patients with cervical spondylosis undergoing anterior discectomy with interbody polyetheretherketone (PEEK) fusion into 2 groups in the past 2 years: group A (n = 50), PEEK cage containing a biphasic calcium phosphate ceramic (Triosite), and group B (n = 50), PEEK cage containing an autogenous iliac bone graft. We compared the fusion rate, fusion time, spinal curvature, and neuroforamen size between the 2 groups. We also compared excess operation time, excess blood loss, hospital stay, complications, and neurological recovery status between the groups. Results: The fusion rates were 57%, 67%, 77%, 82%, 92%, and 100% in group A and 81%, 86%, 95%, 95% 100%, and 100% in group B in the first 6 postoperative months. The fusion rate in group A was significantly lower than that in group B in the first 5 months after the procedure ( P b .05 and P b .01, respectively), but the fusion rate reached 100% in both groups by the sixth month. Within the first 6 months, as the fusion level increased, the fusion rates reduced and time to fusion was delayed in both groups. There were no donor site complications in group A. However, 3 patients (6%) from group B experienced complications (1, wound infection; 1, numbness of thigh; and 1, subcutaneous hematoma) ( P b .001). The hospital stay was shorter in group A (4.43 F 2.36 days) than in group B (7.00 F 3.77 days) ( P = .001). The mean excessive blood loss and excessive operative time for an iliac bone graft in group B were 15 F 5 mL and 10 F 6 minutes. There was no statistical significance in spinal curve correction, neuroforamen enlargement, and neurological recovery. Conclusions: A cage containing a biphasic calcium phosphate ceramic resulted in complete fusion by the sixth postoperative month, although the fusion rate was lower than that in a cage containing an autograft during the first 5 months after the operation and the time to fusion was delayed. Using a cage containing a biphasic calcium phosphate ceramic leads to a shorter hospital stay, less blood loss, shorter operative time, and no donor site complications. It seemed to be a good substitute for cervical spondylotic fusion. D 2005 Elsevier Inc. All rights reserved. Keywords: Autograft; Biphasic Calcium Phosphate Ceramic; Cage; Cervical spondylosis; Hydroxyapatite; Time to fusion; Polyetheretherketone (PEEK); Triosite 1. Introduction Interbody cervical fusion with an iliac autograft is an effective treatment for degenerative cervical diseases [32]. It does not only provide an enlarged neuroforamen but also offers solid spinal fusion. However, 2 major pitfalls from the 0090-3019/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2004.10.016 * Corresponding author. Tel.: +886 42 2052121x4434; fax: +886 42 2052121x4435. E-mail address: d5057@www.cmuh.org.tw (D.-Y. Cho). Surgical Neurology 63 (2005) 497 – 504 www.surgicalneurology-online.com