Observation of stand-alone MC+polyether-ether-ketone (PEEK) Cage in anterior cervical double-level fusion for more than 2 years follow-up / 中国修复重建外科杂志

Objective: To investigate the effectiveness of stand-alone MC+polyether-ether-ketone (PEEK) Cage (single blade type) in anterior cervical double-level fusion for more than 2 years follow-up. Methods: A clinical data of 30 patients who were treated with anterior cervical fusion surgery with stand-alone MC+PEEK Cage (single blade type) between January 2013 and December 2016 and followed up for more than 2 years, was retrospectively analyzed. There were 16 males and 14 females, aged from 34 to 72 years with an average of 52.2 years. There were 16 cases of cervical spondylotic myelopathy, 8 cases of cervical spondylotic myelopathy, and 6 cases of traumatic cervical disc herniation. The continuous double segments were C 4, 5, C 5, 6 in 12 cases and C 5, 6, C 6, 7 in 18 cases; and the disease duration ranged from3 days to 24 months (mean, 12 months). Postoperative neck hematoma and wound healing were observed; dysphagia was assessed by Bazaz system; and bone fusion was assessed by Suk method. Before operation, at 1 week after operation, and at last follow-up, the Japanese Orthopaedic Association (JOA) score was used to evaluate the neurological recovery; the cervical X-ray film was performed to record the cervical curvature (C 2-C 7 Cobb angle), the height of the intervertebral space of the fusion segment, and to judge the occurrence of the fusion Cage subsidence. Results: No complication such as neck hematoma, incision infection, or esophageal fistula was found, primary healing of incisions was obtained in all cases. All patients were followed up 24-72 months (mean, 46 months). Neurological symptoms such as limb numbness and pain gradually disappeared after operation; during the follow-up period, the cervical curvature could be effectively maintained; dysphagia and internal fixation related complications such as displacement of Cages were not found. All patients obtained bony fusion from 3 to 8 months with an average time of 4.3 months. Compared with preoperative ones, the JOA score, intervertebral space height, and Cobb angle of cervical spine were significantly improved at 1 week after operation and at last follow-up ( P0.05). Conclusion: The application of stand-alone MC+PEEK Cage (single card type) in anterior cervical fusion can provide early cervical stability, effectively maintain the physiological curvature of cervical spine and the height of fusion intervertebral space.

Clinical Efficacy of Cages in Anterior Cervical Fusion for Degenerative Cervical Disease

STUDY DESIGN: Review of the literature.OBJECTIVES: To present up-to-date information on the use of cages in anterior cervical fusion for degenerative cervical disease.SUMMARY OF LITERATURE REVIEW: The use of cages in anterior cervical fusion for degenerative cervical disease remains controversial.MATERIALS AND METHODS: Review of the relevant literature.RESULTS: The use of cages in anterior cervical fusion of one and multiple disc levels was effective in terms of biomechanical stability and clinical outcomes without complications at the donor site compared with use of an autograft. However, the use of only a cage had many drawbacks, so the combined use of a cage and a cervical plate is recommended.CONCLUSIONS: The use of cages in anterior cervical fusion was effective in terms of clinical outcomes, and the combined use of a cage and a cervical plate is recommended.

Perforación esofágica cervical tardía por rotura y desplazamiento de placa de artrodesis cervical anterior / Delayed cervical esophageal perforation by rupture and displacement of anterior cervical arthrodesis plaque

Resumen Introducción: La perforación esofágica es una posible complicación de la artrodesis cervical anterior. Sin embargo, estas suelen ocurrir intraoperatoriamente o en el posoperatorio precoz. Caso clínico: Mujer de 35 años sometida, 3 años antes, a artrodesis de C3-C5, que tras sufrir un traumatismo leve con latigazo cervical, comienza con disfagia. Se objetiva un absceso retroesofágico por perforación esofágica, causado por rotura de la placa protésica y extrusión de un tornillo.

Introduction: Esophageal perforation is a possible complication after anterior cervical fusion. However, these complications usually appear intraoperatively or in the early postoperative course. Case report: A 35-years-old females, who underwent a C3-C5 anterior cervical fusion 3 years ago, after suffering a mild cervical trauma, she complained of dysphagia. A retroesophageal abscess was observed, caused by esophageal perforation, secondary to plaque rupture and screw extrusion.

Clinical Outcomes of a Zero Profile Implant for Single-Level Anterior Cervical Discectomy and Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate and compare the clinical results of a zero profile implant with a conventional stand-alone cage. SUMMARY OF LITERATURE REVIEW: A new zero-profile interbody fusion implant named Zero-P was developed in order to avoid plate-related complications. MATERIALS AND METHODS: Twenty-three patients with cervical degenerative disc disease were enrolled. Twelve of these were implanted with a stand-alone cage, and 11 patients received a Zero-P. The mean follow-up time was 16.7 months, ranging from 12 to 34 months. Intraoperative parameters, clinical outcomes (Korean Neck Pain Disability Index [K-NDI], visual analog scale [VAS] score for neck/arm pain), dysphagia scores, and device-related complications were recorded. RESULTS: At the 6-week, 3-month, 6-month, and 12-month follow up, the K-NDI and VAS scores significantly improved in both groups. Dysphagia scores in both groups have no significant differences (p>0.05). However, the cage subsidence rate was significantly higher in the stand-alone cage group (p<0.05). CONCLUSIONS: Clinical outcomes of ACDF with the Zero-P were satisfactory. The incidence of cage subsidence was lower than with the conventional stand-alone cage.

Clinical significance of X-ray lateral radiograph for evaluating the postoperative prevertebral soft tissue swelling after anterior cervical fusion / 局解手术学杂志

Objective To explore the relationship among the prevertebral soft tissue swelling, surgical extent, surgical segments, and complications and to investigate the clinical significance of lateral radiographs for evaluating the postoperative prevertebral soft tissue swelling. Methods 123 patients who underwent anterior cervical fusion with plate augmentation for cervical spondylosis were included in this study. The postoperative prevertebral soft tissue swelling was measured by lateral radiographs. The data were analysed according to surgical extent and surgical segments. Patients were divided into the swelling group (61cases, >9. 98 mm) and the non-swelling group (62 cases, <9. 98 mm) based on the degree of prevertebral soft tissue swelling. The incidences of complications, such as dyspnea and dysphagia, were ana-lysed. Results The rate of dyspnea was 21. 3% in swelling group, which was higher than 8. 1% in non-swelling group (P<0. 05). The rate of dysphagia was 83. 6% in swelling group, which was higher than 25. 8% in non-swelling group (P<0. 05). In addition, postoperative prevertebral soft tissue swelling was 8. 29 mm averagely after one-level fusion, which was less than that after two or more levels fusion (11. 55 mm and 10. 40 mm) (P<0. 05). Postoperative prevertebral soft tissue swelling was 10. 94 mm after high-level fusion (above C4), which was more than that low-level fusion (below C5) (8. 63 mm) (P<0. 05). Conclusion After anterior cervical fusion for cervical spondylosis, when the degree of prevertebral soft tissue swelling is greater the incidences of complications such as dyspnea and dysphagia might be higher. In addition, prevertebral soft tissue swelling increments are significantly greater in patients who had undergone multi-level or high-level fusion ( above C5 ) . Evaluation of prevertebral soft tissue swelling using lateral radiographs is a clinically meaningful procedure.

Complications of Anterior Cervical Fusion using a Low-dose Recombinant Human Bone Morphogenetic Protein-2

OBJECTIVE: There are several reports, which documented a high incidence of complications following the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior cervical fusions (ACFs). The objective of this study is to share our experience with low-dose rhBMP-2 in anterior cervical spine. METHODS: We performed a retrospective analysis of 197 patients who underwent anterior cervical fusion (ACF) with the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) during 2007-2012. A low-dose rhBMP-2 (0.7mg/level) sponge was placed exclusively within the cage. In 102 patients demineralized bone matrix (DBM) was filled around the BMP sponge. Incidence and severity of dysphagia was determined by 5 points SWAL-QOL scale. RESULTS: Two patients had prolonged hospitalization due to BMP unrelated causes. Following the discharge, 13.2%(n=26) patients developed dysphagia and 8.6%(n=17) patients complained of neck swelling. More than half of the patients (52.9%, n=9) with neck swelling also had associated dysphagia; however, only 2 of these patients necessitated readmission. Both of these patients responded well to the intravenous dexamethasone. The use of DBM did not affect the incidence and severity of complications (p>0.05). Clinico-radiological evidence of fusion was not observed in 2 patients. CONCLUSION: A low-dose rhBMP-2 in ACFs is not without risk. However, the incidence and severity of complications seem to be lower with low-dose BMP placed exclusively inside the cage. Packing DBM putty around the BMP sponge does not affect the safety profile of rhBMP-2 in ACFs.

Subsidence of Polyetheretherketone Cage after Anterior Cervical Fusion / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the rate and direction of subsidence that occurred after anterior cervical discectomy and fusion using the polyetheretherketone (PEEK) cage and to analyze the risk factors of subsidence. MATERIALS AND METHODS: Thirty two patients (36 segments) who underwent anterior cervical discectomy and fusion using the PEEK cage and autologous cancellous iliac bone graft from July 2003 to November 2011 were enrolled in this study. anterior segmental height (ASH), posterior segmental height (PSH) and cage corner distance (CCD) were measured on plain radiographs. Subsidence was defined as > or =2 mm decrease in the average of ASH and PSH at the final follow up compared to that measured in the immediate postoperative period. A decrease of more than 3 mm was defined as severe subsidence for further statistical analysis. RESULTS: Subsidence of more than 2 mm was observed in 14 segments (38.9%) and severe subsidence (> or =3 mm) was observed in seven segments (19.4%). The direction of subsidence was examined by comparison of means of decreased ASH and PSH and anterior subsidence outweighed posterior subsidence (p<0.001). Examination of CCD showed that inferior subsidence was more frequent than superior subsidence (p<0.001, p=0.047). Among the suspicious risk factors for subsidence, intraoperative disc space distraction (anterior distraction: p=0.031, posterior distraction: p=0.007) and height of inserted cage (p=0.032) showed statistical significance. CONCLUSION: Considerable incidence of subsidence was observed after use of the cage. Using a cage of appropriate height and prevention of intraoperative over-distraction of disc space will be helpful to prevention of subsidence of the cage after anterior cervical discectomy and fusion using the PEEK cage.

Does Preoperative Cervical Sagittal Alignment And Range of Motion Affect Adjacent Segment Degeneration After Anterior Arthrodesis In Degenerative Cervical Spinal Disorders?: Midterm Follow up Study

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to investigate whether preoperative sagittal alignment and range of motion (ROM) affect adjacent segment degeneration (ASD) and disease after anterior arthrodesis in degenerative cervical spinal disorders. Summary of Literature Review:There is no study about the relationship between preoperative ROM and sagittal alignment and the development of ASD yet. MATERIALS AND METHODS: We took a retrospective approach to study 136 patients who underwent an anterior arthodesis for less than 2 segments with PEEK cage and plate construct method for degenerative cervical diseases and who have a minimum of 3 years of follow-up. We analyzed ASD and cervical ROM, such as less than 40degrees(group A) and more than 40degrees(group B) and sagittal alignment, such as lordosis or kyphosis with less than 10degrees(group a), 10degrees~30degrees(group b) and more than 30degrees(group c). Adjacent segment degeneration was graded according to Park's classification and Hillibrand method. RESULTS: There was no statistically significant difference between group A(1.35+/-0.48) and group B (1.44+/-0.50) in the correlation between the cervical ROM and the variation of disc height(p=0.07). Concerning the relationship between the ROM and osteophyte formation on adjacent segment, no statistically significant difference has been found between group A(1.64+/-0.88) and group B(1.43+/-0.67) (p=0.06). The disc height change at the final follow up after cervical sagittal alignment showed no statistically significant difference among the groups: Group A presented with 1.53+/-0.50, group B with 1.30+/-0.46 and group C with 1.40+/-0.50.(p=0.08) Regarding sagittal alignment and osteophyte change, there was no statistically significant difference among the groups as group A showed an average of 1.33+/-0.48, group Ban average of 1.56+/-0.88 and group Can average of 1.60+/-0.82(p=0.07). CONCLUSION: Although the preoperative sagittal alignment and ROM did not significantly affect adjacent segment degeneration and diseases in a mid-term follow-up evaluation after anterior arthrodesis with PEEK cage and plate in degenerative cervical spinal disorders, we think a future study is required with a sufficient number of patients and a long term follow-up because there were borderline statistical significances shown in the present study.

Radiologic Changes of Anterior Cervical Discectomy and Fusion Using Allograft and Plate Augmentation: Comparison of Using Fixed and Variable Type Screw

OBJECTIVE: To evaluate radiologic result of anterior cervical discectomy and fusion with allobone graft and plate augmentation, and the change of radiologic outcome between screw type and insertion angle. METHODS: Retrospective review of clinical and radiological data of 29 patients. Segmental angle, height and screw angles were measured and followed. The fusion rate was assessed by plain radiography and CT scans. We divided the patients into two groups according to screw type and angles. Group A: fixed screw, Group B: variable screw. Interscrew angle was measured between most upper and lower screws with Cobb's methods. RESULTS: Overall fusion rate was 86.2% on plain radiography. Fusion was also assessed by CT scan and Bridwell's grading system. There was no difference in fusion and subsidence rates between two groups. Subsidence was found in 5 patients (17.2%). Segmental lordotic angle was increased from preoperative status and maximized at the immediate postoperative period and then reduced at 1 year follow up. Segmental height showed similar increase and decrease values. CONCLUSION: ACDF with allograft and plate showed favorable fusion rates, and the screw type and angle did not affect results of surgery.

ACDF Using the Solis Cage with Iliac Bone Graft in Single Level: Clinical and Radiological Outcomes in Average 36 months Follow-up

OBJECTIVE: To evaluate the utility of anterior cervical discectomy and fusion (ACDF) with polyetheretherketone (PEEK) cage and autograft through long term(average 36 months) follow-up. METHODS: Thirty selected patients (male:20/female:10) who suffered from cervical radiculopathy, myelopathy or radiculomyelopathy underwent a single level ACDF with PEEK cage and autograft from iliac crest from March 2006 to July 2008 in single institute. We followed patients for an average 36.4+/-8.1 months (ranged from 23 to 49 months). The Japanese Orthopedic Association (JOA) score for evaluation of myelopathy and visual analogue scale (VAS) for radiating pain was used to estimate postoperative clinical outcome. Plain x-ray on true lateral standing flexion, extension and neutral position view and 3D CT scan were used every 6 months after surgery during follow-up period. RESULTS: The mean VAS and JOA scoring improved significantly after the surgery and radiological fusion rate was accomplished by 100% 36 months after the surgery. We had no complication related with the surgery except one case of osteomyelitis. There was one case of Grade I fusion, four cases of grade II, and 25 cases of grade III by radiologic evaluation. CONCLUSION: This long term follow-up study for ACDF with PEEK cage shows that this surgical method is comparable with other anterior cervical fusion methods in terms of clinical outcomes and radiologic fusion rate.

Radiographic Comparison of Four Anterior Fusion Methods in Two Level Cervical Disc Diseases : Autograft Plate Fixation versus Cage Plate Fixation versus Stand-Alone Cage Fusion versus Corpectomy and Plate Fixation

OBJECTIVE: To evaluate radiographic results of anterior fusion methods in two-level cervical disc disease : tricortical autograft and plate fixation (ACDF-AP), cage and plate fixation (ACDF-CP), stand-alone cage (ACDF-CA), and corpectomy and plate fixation (ACCF). METHODS: The numbers of patients were 70 with a minimum 6 month follow-up (ACDF-AP : 12, ACDF-CP : 27, ACDF-CA : 15, and ACCF : 16). Dynamic simple X-ray and computed tomography were evaluated preoperatively, postoperatively, 6 month, and at the final follow-up. The fusion and subsidence rates at the final were determined, and global cervical lordosis (GCL), cervical range of motion, fused segment angle (FSA), and fused segment height (FSH) were analyzed. RESULTS: Nonunion was observed in 4 (25%) patients with ACDF-CA, 1 (8%) patient with ACDF-AP, 1 (4%) patient with ACDF-CP. The number of loss of FSH (%) more than 3 mm were 2 patients (16%) in ACDF-AP, 3 patients (11%) in ACDF-CP, 5 patients (33%) in ACDF-CA, and 3 patients (20%) in ACCF. The GCL was decreased with ACDF-CA and increased with others. The FSA was increased with ACDF-AP, ACDF-CP, and ACCF, but ACDF-CA was decreased. At the final follow-up, the FSH was slightly decreased in ACDF-CP, ACDF-AP, and ACCF, but ACDF-CA was more decreased. Graft related complication were minimal. Screw loosening, plate fracture, cage subsidence and migration were not identified. CONCLUSION: ACDF-CP demonstrated a higher fusion rate and less minimal FSH loss than the other fusions in two-level cervical disc disease. The ACDF-AP and ACCF methods had a better outcome than the ACDF-CA with respect to GCL, FSA, and FSH.

Subsidence and Nonunion after Anterior Cervical Interbody Fusion Using a Stand-Alone Polyetheretherketone (PEEK) Cage

BACKGROUND: The purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications. METHODS: Thirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as > or = a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being > or = 2 mm in the interspinous distance on the flexion-extension lateral radiographs. RESULTS: The anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 +/- 1.46 mm and 0.81 +/- 1.27 mm, respectively. Subsidence > or = 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001). CONCLUSIONS: Anterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention for avoiding nonunion.

A Comparative Study of the Anterior Cervical Fusion with Harms Cage versus Iliac Bone Block: Clinical and Radiological Outcomes

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes of anterior cervical fusion within Harms cage versus an iliac bone block graft. SUMMARY OF LITERATURE REVIEW: There is no current consensus regarding the optimal material for anterior cervical fusion. MATERIALS AND METHODS: This was a single-center study of 107 patients who either underwent anterior cervical fusion with an iliac bone block graft (n=56; group A) or a cancellous bone graft within the cervical Harms titanium cage (n=51; group B). Anterior plating occurred in all cases. Clinical outcomes and complications were evaluated using Visual Analogue Scale (VAS) scores and Odom's Criteria. Radiological outcomes were evaluated by the height of vertebral bodies, sagittal lordosis, the rate of bony union, and the subsidence of cage. RESULTS: The VAS of donor site pain was significantly higher in group A than in group B at the final follow-up. Sagittal lordosis was increased in both groups, but was significantly higher in group B than group A. The rate of bony union was 95% and 91% for both groups 6 months after surgery and reached 100% for both groups at the final follow-up. In terms of cage subsidence, the highest point of subsidence was at the inferior and posterior aspect of the cage and the average amount of subsidence was approximately 1.3 mm at final follow-up. CONCLUSIONS: Anterior cervical fusion using a cancellous bone graft within Harms titanium cage is a good method for anterior cervical fusion with iliac bone block.

Comparing anterior cervical fusion using titanium cage with hydroxyapatite and with autograft

Background: Anterior cervical discectomy and fusion using autogenous iliac bone graft may lead to donor site pain. This has led some surgeons to use hydroxyapatite but it has greater rates of complications. Objective: Analyze results of the treatment of cervical spine spondylosis by anterior cervical discectomy, and to compare fusion using titanium cage with hydroxyapatite and with autograft. Methods: We evaluated eighty patients (at 146 cervical levels) that had been treated by anterior cervical discectomy and fusion with hydroxyapatite or autograft. In a prospective study, patients were divided into two groups: 1) 77 levels of anterior cervical fusion from in 40 patients who were treated with cage and hydroxyapatite, and 2) 69 levels of anterior cervical fusions in 40 patients who were treated with cage and autograft. Results were evaluated using the Japanese Orthopedic Association (JOA) scoring system before and after surgery, subsidence, non-union and complication. Results: According to JOA score, the first group (hydroxyapatite) had improved from 9.8 preoperation to 14.5 postoperation. The subsidence rate was 26.0%, the non-union rate was 10.4%, and there was no intra and post-operative complication. In the other group (autograft), the preoperative JOA score had improved from 9.3 to 14.1. The subsidence rate was 11.6%, and there were no non-union and complications. Statistical significance was found in non-union and subsidence aspect between groups, but the clinical outcome of JOA score was not significantly different. Conclusion: Anterior cervical discectomy and fusion in cervical spondylosis patients, titanium cage implantation with hydroxyapatite is a highly useful alternative to autograft.

Clinical and Radiographic Analysis of Cervical Total Disc Replacement Versus Anterior Cervical fusion using Stand-alone Cage

OBJECTIVE: Total intervertebral disc replacement is designed to preserve motion and avoid limitations of fusion after removing local pathology. The authors report the results of a signle-center study to determine functional and radi- ologic outcomes associated with cervical total disc replacement versus those of cervical fusion. METHODS: We retrospectively reviewed the charts and radiographs of patients who underwent a total intervertebral disc replacement(TDR) or a single-level anterior cervical fusion(ACDF) between January 1, 2004, and September 31, 2007. Clinical symptom was assessed using the Visual Analog Scale(VAS) of the neck and of the arm pain. Range of motion was determined by radiologic assessment of flexion-extension radiographs. Data were collected before surgery and at 6 weeks, 3, 6, 12, and 24 months after surgery. RESULT: A total of 125 patients were identified with 63 having TDR(43 males and 20 females) and 62 having fusion(42 males and 20 females). The average age was 49.1 years(TDR) and 51.7 years(ACDF)(p=0.229). The mean neck pain VAS before surgery was 6.52(TDR) and 6.61(ACDF)(p=0.732). At 2-year follow-up, the average neck pain VAS for the TDR group was 1.59 and ACDF 1.85(p=0.168). The mean arm pain VAS before surgery was 6.37(TDR) and 6.60(ACDF)(p=0.335). At 2 years: 1.41(TDR) and 1.65(ACDF)(P = 0.148). More motion(an average of 9.00 degrees at 24 months) was retained after surgery in the TDR group than the fusion group at the treatment level. There was no significant diffe- rence in motion at adjacent levels. CONCLUSION: Total disc replacement maintained physiological segmental motion at the 2-year follow-up. The finding that there was no statistically significant difference between the groups in motion at adjacent levels must be verified on further studies.

Cervical Disc Herniation Producing Acute Brown-Sequard Syndrome

Brown-Sequard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. This syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has been rarely reported as a cause of this syndrome. We present a case of a 28-year-old male patient diagnosed as large C3-C4 disc herniation with spinal cord compression. He presented with left hemiparesis and diminished sensation to pain and temperature in the right side below the C4 dermatome. Microdiscectomy and anterior cervical fusion with carbon fiber cage containing a core of granulated coralline hydroxyapatite was performed. After the surgery, rapid improvement of the neurologic deficits was noticed. We present a case of cervical disc herniation producing acute Brown-Sequard syndrome with review of pertinent literature.

Anterior Cervical Fusion with Autogenous Iliac Bone Graft with or without Plate Fixation for Degenerative Cervical Spinal Disorders / 대한정형외과학회잡지

PURPOSE: This study compared the results of anterior cervical discectomy and fusion with autogenous bone graft (AFA) with or without plate fixation through a retrospective review of one or two-level degenerative cervical disorder, and the average follow-up was 6 years. MATERIALS AND METHODS: Group A (n=40) underwent one-level (A-1/26) or two-level (A-2/14) fusion and AFA alone. Group B (n=36) underwent one-level (B-1/24) or two-level (B-2/12) fusion and AFA with plate construct. The following parameters were analyzed: the fusion rate, the change of Cobb's angle, the adjacent level degeneration (ALD), the clinical outcome and the rate of complications. RESULTS: There was a significant difference in the fusion rate between group A and B (p=0.028). Group B had a significant increase in the change of Cobb's angle compared to groups A (p=0.004). ALD were developed in 16 of 40 cases (40%) in group A, and in 4 of 36 cases (11%) in group B. There was a significant difference in ALD between group A and group B (p=0.004). CONCLUSION: We think that plate augmentation is necessary for the maintenance of lordosis, for reducing the pseudarthrosis and adjacent level degeneration, and to improve the clinical outcome after treatment of degenerative cervical disorders.

Esophageal Fistula Formation by MetalLoosening following Anterior Cervical Arthrodesis: A Case Report / 대한정형외과학회잡지

An esophageal injury after an anterior cervical discectomy and fusion with plating is a well known but a fatal complication. If the diagnosis is delayed, inflammation can spread out into the neighboring main organs resulting in a very poor prognosis despite vigorous treatment. We report a case of esophageal fistula formation as a result of infected metal loosening after an anterior cervical discectomy and fusion with plating, which was treated successfully with a satisfactory clinical outcome.

Subsidence of Cylindrical Cage (AMSLUTM Cage): Postoperative 1 Year Follow-up of the Cervical Anterior Interbody Fusion

OBJECTIVE: There are numerous reports on the primary stabilizing effects of the different cervical cages for cervical radiculopathy. But, little is known about the subsidence which may be clinical problem postoperatively. The goal of this study is to evaluate subsidence of cage and investigate the correlation between radiologic subsidence and clinical outcome. METHODS: To assess possible subsidence, the authors investigated clinical and radiological results of the onehundred patients who underwent anterior cervical fusion by using AMSLUTM cage during the period between January 2003 and June 2005. Preoperative and postoperative lateral radiographs were measured for height of intervertebral disc space where cages were placed. Intervertebral disc space was measured by dividing the sum of anterior, posterior, and midpoint interbody distance by 3. Follow-up time was 6 to 12 months. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. RESULTS: Subsidence was found in 22 patients (22%). The mean value of subsidence was 2.21 mm, and mean subsidence rate was 22%. There were no cases of the clinical status deterioration during the follow-up period. No posterior or anterior migration was observed. CONCLUSION: The phenomenon of subsidence is seen in substantial number of patients. Nevertheless, clinical and radiological results of the surgery were favorable. An excessive subsidence may result in hardware failure. Endplate preservation may enables us to control subsidence and reduce the number of complications.

Subsidence Ratio after Anterior Cervical Interbody Fusion Using an Intraoperative Custom-made Cervical Cage

OBJECTIVE: The postoperative subsidence of anterior cervical interbody fusion for cervical degenerative diseases gives rise to segmental kyphotic collapse, screw loosening, and chronic neck pain. So, intraoperative custom-made polymethylmethacrylate (PMMA) C-cage has been developed to prevent subsidence following anterior cervical fusion. METHODS: A total of patients who underwent anterior cervical interbody fusion with a intraoperative custom - made cervical cage filled with local bone and demineralized bone matrix (group A) were analyzed prospectively from June 2004 to June 2005. These were compared with 40 patients who were treated with iliac bone graft (group B). We evaluated subsidence ratio, change of segmental angle, distraction length and segmental angle. Statistical analysis was performed using independent sample t-test and Pearson correlation coefficient. RESULTS: Group A had a statistically significant decrease in subsidence ratio (0.64+/-0.43%, p=0.00), distraction length (2.42+/-1.25 mm, p=0.02), and follow angle change (1.78+/-1.69degrees, p=0.01) as compared with Group B. However, there was no statistically significant difference in postoperative segmental angle change (p=0.66). On the analysis of the correlation coefficient, the parameters showed no interrelationships in the group A. On the other hand, subsidence ratio was affected by distraction length in the group B (Pearson correlation=0.448). CONCLUSION: This operative technique would be contributed for the reduction of a postoperative subsidence after the anterior cervical interbody fusion procedure for cervical disc disease with moderate to severe osteoporotic condition and segmental loss of lordosis.