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PURPOSE: The purpose of this study is to determine the usefulness of locally harvested autobone as a filling material for fusion. MATERIALS AND METHODS: Retrospective study was conducted for 21 patients diagnosed as cervical disc herniation with cervical myelopathy or radiculopathy who underwent anterior cervical fusion using locally harvested autobone and polyetheretherketone solis cage from June 2006 to September 2009, with a follow-up period of longer than 5 years. Radiologic outcomes were evaluated by the rate of bone union, the change of intervertebral height, and the subsidence of the cage. RESULTS: In clinical results, visual analogue scale score was 5.8±0.71/7.7±0.78 at preoperative, 1.6±0.58/2.3±0.97 at 1-year follow-up, 1.8±0.81/2.7±1.28 at 5-year follow-up, and neck disability index score was 34.3±6.2 in preoperative stage, 6.25±3.21 at 1-year follow-up, and 6.51±4.05 at 5-year follow-up. Radiologically intervertebral height was reduced from average 6.31±0.93 mm in 1-year follow-up to average 6.22±0.85 mm in 5-year follow-up. Subsidence of cage was average 1.28±0.41 mm at 1-year follow-up and average 1.31±0.43 mm at 5-year follow-up, with no statistically significant difference (p>0.05). Average subsidence of cage in these cases was 3.25 mm. In postoperative complication, screw breakage occurred in 1 case, screw pull out occurred in 1 case, and there was no postoperative infection. CONCLUSION: Using locally harvested autobone as filling material for fusion resulted in outstanding bone union and improvement of clinical results. In long term follow-up, there was no significant difference in union rate and complication incidence. Therefore use of locally harvested autobone as a filling material for fusion is considered an effective method.
Subject(s)
Humans , Follow-Up Studies , Incidence , Methods , Neck , Postoperative Complications , Radiculopathy , Retrospective Studies , Spinal Cord DiseasesABSTRACT
OBJECTIVE: We performed the surgery using titanium double cylindrical cage for anterior cervical discectomy and interbody fusion in various degenerative cervical diseases. We compared the clinical results and radiologic results in cervical anterior disectomy. Method: From October 2007 to October 2008, 19 patients diagnosed with degenerative disease underwent anterior cervical disectomy and interbody fusion. The postsurgical clinical results were analyzed retrospectively by classifying them into four levels based on Odom's criteria(excellent, good, fair, and poor) after a more than 6-month follow-up period. RESULTS: In all cases, a single segment was involved, and surgery was performed for 19 segments. The C5-C6 inter-vertebral disc was the most commonly affected(9 cases). The clinical outcome was excellent, good, and fair in 5(26.3 %), 10(52.6%), and 4(21.0%) cases, respectively. An excellent or good outcome was considered as a successful result, showing an approximately 78.9% cure rate. No patient had aggravated symptoms compared with their preoperative status. CONCLUSION: Relatively satisfactory clinical and radiographic results were obtained with double cylindrical cages. The surgical method is relatively simple, allows good synostosis, and prevents many complications associated with autografting. It is also less traumatic to the spinal cord during cage insertion. Therefore, double cylindrical cages are generally more recommended for treating cervical spondylosis accompanied with flat cages.
Subject(s)
Humans , Diskectomy , Follow-Up Studies , Retrospective Studies , Spinal Cord , Spondylosis , Synostosis , Titanium , Transplantation, AutologousABSTRACT
PURPOSE: We attempted to evaluate the effectiveness of the new modified Smith-Robinson bone graft method for performing cervical anterior interbody fusion. MATERIALS AND METHODS: Forty-two patients had anterior interbody fusion on the cervical spine, using an anterior approach and the new modified Smith-Robinson's method (NMSR), between September 2001 and June 2006. There were 30 males and 12 females, with an average age of 51.2 years and the mean follow up period was 39.5 months. We measured the area from C4 to C6 in 32 cases. This was compared with the contact area of the bone graft of the NMSR method and the Original Smith-Robinson method (OSR). We also checked the time to bone union and changes of Cobb's angle at the final follow-up to evaluate the effectiveness of the NMSR. RESULTS: Bony fusion was obtained in all cases. The average size of the OSR were 169 and 152 mm2, in the males and females respectively, whereas those of the NMSR were 263, and 228 mm2. Therefore, the average size of the NMSR increased to 94 mm2 and 76 mm2 than those of the OSR method in the males and females. The average time to radiological bone union was 9.6 weeks and the changes of Cobb's angle at final follow-up were 2.5+/-2.6degrees. CONCLUSION: The NMSR technique was a very effective method for cervical anterior interbody fusion. It could enlarge the bone graft size about 50-56% compared with the OSR technique. It also shortened the period of bone union and also increased the bone union rate.
Subject(s)
Female , Humans , Male , Follow-Up Studies , Spine , TransplantsABSTRACT
OBJECTIVE: This purpose of this study was to determine the clinical efficiency and applicability, and to analyze the radiologic findings of the anterior cervical approach using two synthetic cages for interbody fusion. METHODS: A total of 41 patients with cervical diseases underwent anterior discectomy and interbody fusion with the PEEK Solis(TM) cage in 21 patients and the carbon composite Osta-Pek(TM) cage in 20 patients. Outcome assessment was done using Odom's criteria. Radiological assessment was performed with respect to subsidence, bony fusion and lordosis. The mean follow-up period was 13 months. RESULTS: There were 34 (92.9%) successful cases. The average height of the disc space 12 months after surgery compared to the height before surgery was increased in 28 cases. The height of the disc space 12 months after surgery compared to the height just after surgery was decreased over 3mm in 4 cases, indicating severe subsidence. The use of these synthetic cages have provided the increase in postoperative cervical lordosis. CONCLUSION: There were no significant differences between the Solis(TM) and Osta-Pek(TM) cages on clinical and radiologic outcomes. Both Solis(TM) and Osta-Pek(TM) cages showed low subsidences and complications associated with hardware with good clinical outcomes, high fusion rates, restored disc heights, and restored cervical lordosis.
Subject(s)
Animals , Humans , Carbon , Diskectomy , Follow-Up Studies , LordosisABSTRACT
[Objective]To observe the effect of Solis cage made of polyether ether ketone(PEEK)for the cervical interbody fusion after anterior discoidectomy of two levels cervical spondylotic myelopathy.[Method]We retrospectively analyzed the clinical outcome of 16 patients with two levels cervical spondylotic myelopathy underwent anterior discoidectomy and stabilized the operative segment using Solis cage from September 2002 to September 2004.Sequent X-ray examination was taken after operation to observe the stability and fusion of the operative segments.[Result]All of the segments were mobilized at the next day after operation.The patients were followed up from 14 months to 36 months(averaged 18 months).The operative segments were stable instantly and solid fusion was observed at 3 to 6 months after operation.15/16 of patients were satisfactory,no complication was found.[Conclusion]The immediate stability of the operative segments can be obtained by Solis cage,the Solis cage is safe and simple,complication is relatively few.It has a special advantage in the treatment of the discontinuous two levels cervical spondylotic myelopathy.
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[Objective]The present study was undertaken to investigate the incidence of symptomatic adjacent segment disease after anterior cervical interbody fusion(ACIF),and to identify the factors which are related to the development of this disease.[Method]From 1981 to 1997,a total of 160 patients underwent anterior cervical in terbody fusion for intervertebral disc herniation and cervical spondylosis.A total of 112 patients were followed up clinically and radiologically for more than two years.Of them,74 were men and 38 were women,the average age at operation was 51 years(ranged,31~70 years).Of the 112 patients,66 had one,44 had two and 2 had three levels of fusion.Follow-up evaluation was primarily viaclinical visited.The post-operative course of any symptoms,the findings of neurological examination and serial follow-up radiographs were performed in all patients.The diagnosis of symptomatic adjacent segment disease was based on the presence of new radiculopathy or myelopathy symptoms referable to an adjacent level,and the presence of a compressive lesion at an adjacent level by magnetic resonance imaging or myelography.We evaluated the correlation between the incidence of symptomatic adjacent segment disease and the following clinical parameters(age at operation sex,number of the levels fused)and radiological parameters(preoperative cervical spine alignment,preoperative range of motion of C_(2~7) cervical spine,antero-posterior spinal canal diameter,preoperative existence of an adjacent segment degeneration on plain radiograph,myelography and magnetic resonance imaging(MRI).[Result]The average length of follow-up was 9.4 years(ranged,2 to 19 years).Symptomatic adjacent segment disease developed in 19 out of 112 patients(19%)followed.A Kaplan-Meier survival analysis was performed in order to follow the disease-free survival of the entire series of patients.The disease free survival rates were 89% at 5 years,84% at 10 years and 67% at 17 years.The incidences of indentation of dura matter on pre-operative myelography or disc protrusion on MRI at the adjacent level were significantly higher in disease cases(P=(0.0 087),(0.0 299),respectively;Chi-square test).Howerer,the other parameters did not show a statistically significant difference.There were 7 cases(37%)who had failure of non-operative treatment and additional operations were performed.[Conclusion]The incidence of symptomatic adjacent segment disease after ACIF was higher when pre-operative myelography or MRI revealed asymptomatic disc degeneration at that level regardless of the number of the level number fused,pre-operative alignment,spinal canal diameter of fusion alignment.
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OBJECTIVE: The retrospective study is undertaken to report clinical results of anterior cervical interbody fusion with an intradiscal cage with an integrated plate (PCB cervical plating system). METHODS: 38 patients underwent anterior cervical interbody fusion with PCB cervical plating system and followed 6~24 months. The authors investigated overall surgical results; clinical outcome, fusion rate, change of interspace height & lordotic angle, and complications. RESULTS: No complication was observed during the operation. Clinical improvement was identified in 34 cases (89.5%). Bone fusion observed in 44 out of 49 sites (90.7%). After operation, the interspace height increased from 5.4+/-1.3 mm to 7.8+/-1.5 mm and maintained 7.4+/-1.1 mm and, interspace angle went up from 4.2+/-0.7 degrees to 4.8+/-1.1 degrees and maintained 4.6+/-0.9 degrees. The loosening of screw was observed in 6 cases, one of which had reoperation because of the expulsion of the device accompanied. CONCLUSION: PCB cervical plating system could restore interbody height and lordosis in anterior cervical interbody fusion. But, if the insertion of the spacer is not precise, the frequencies of hardware failure are relatively high. It is considered necessary for the operator to be careful in the procedure.
Subject(s)
Animals , Humans , Lordosis , Reoperation , Retrospective StudiesABSTRACT
OBJECTIVE: The authors investigate the effectiveness and the demerits of the AMSLU(TM) cervical cage used in cervical spinal fusion for correction of cervical degenerative disc disease. METHODS: A total of 19 patients with cervical degenerative disc disease underwent anterior microdiscectomy and the AMSLU(TM) cage fusion. We made a retrospective comparative analysis between cases using the AMSLU(TM) cage and the classical autogenous iliac crest graft(AICG) with plate fixation about operative time, blood loss and hospital stay. The patient's neurological and functional outcomes were assessed on the basis of the modified Odom's criteria. RESULTS: The use of the AMSLU(TM) cage was found to save operative time(mean, 153+/-52min: P=0.004) and blood loss(mean, 236+/-171cc: P=0.032) as compared with the use of AICG. There was no donor-site complications and all patients were tolerable to ambulation at 1 day postoperatively. The patient's clinical success rate was 89% on discharge and 84% at 6 months postoperatively. CONCLUSION: The use of the AMSLU(TM) cage provides several advantages: no donor-site complications, brief instrument procedures, short operative time, small amount of blood loss and satisfactory clinical success rate. But it also has many limitations: short follow up period, kyphotic change and subsidence. Further investigations and clinical applications are necessary to use AMSLU(TM) cage in cases of spondylolisthesis and traumatic cervical disease.
Subject(s)
Humans , Follow-Up Studies , Length of Stay , Operative Time , Retrospective Studies , Spinal Fusion , Spondylolisthesis , WalkingABSTRACT
OBJECTIVE: The aim of this study is to assess the technical feasibility, the clinical and radiological results of the interbody fusion with a carbon-composite cage and local autobone following anterior cervical discectomy. METHODS: From November 2001 to April 2002, fifteen patients with symptomatic degenerative cervical disc disease underwent this procedure. After standard microsurgical anterior approach, cervical interbody fusion was performed with carbon-composite cage and local autobone of operative site. The average follow-up period was 8.7 months. RESULTS: Postoperatively, all patients experienced clinical improvement and follow-up cervical X-ray films checked six months postoperatively demonstrated complete interbody fusion. One patient complained of transient swallowing difficulty, one patient noticed operative site hematoma and four patients noticed implant subsidence. CONCLUSION: This technique is considered as an easier implantation procedure than the previous techniques. The other advantages of this interbody fusion are immediate stability with good clinical response, no complication at donor site and easy to assess the fusion.
Subject(s)
Humans , Deglutition , Diskectomy , Follow-Up Studies , Hematoma , Tissue Donors , X-Ray FilmABSTRACT
OBJECTIVE: The plate cage system is an intradiscal cage combining with an integrated plate. To evaluate its suitability for an clinical application, the authors present a retrospective analysis of outcome assessment of our series. METHODS: From March 1998 to November 2001, fifty three patients with degenerative cervical disease underwent anterior cervical interbody fusion with the PCB(R)(PCB(R) instrument, SCIENT'X, Paris, France). Single level fusion was accomplished in 31 patients, two levels in 19 patients, and three levels in two patients. RESULTS: All patients were improved without intraoperative complications ; excellent in 28(52.9%), good in 15(28.3%), and satisfactory in 10(18.8%). Four cases of screw loosening were identified, however, there was no cage backout, worsening of symptom or reoperation due to screw loosening. The bony fusion was confirmed in all patients by cervical flexion and extension X-ray and computed tomography during follow-up. CONCLUSION: The design of this plate cage system appears to prevent bone-graft recipient site and donor site complications, provides immediate stability, and restores height and lordosis.
Subject(s)
Animals , Humans , Follow-Up Studies , Intraoperative Complications , Lordosis , Reoperation , Retrospective Studies , Tissue DonorsABSTRACT
OBJECTIVE: The authors report a result of application of cervical hollow cage(RABEA(TM)) without bone graft to the patients of one-level cervical spondylosis or acute cervical disc herniation to fill and stabilize a vacant space following anterior decompression. METHODS: Twenty-one patients from May 1999 to April 2001 had been taken procedure with cervical hollow cage system following anterior decompression and there had been no additional bone graft or screw fixation or fusion. Pain relief and clinical outcome were evaluated, and the intervertebral disc height and segmental angle for radiological assessment were examined. All patient were followed up for 12 months at least. RESULTS: The result was excellent in 14 cases(66.7%), good in 6 cases(28.6%) and poor in 1 case(4.8%). In the lateral projection, the mean of preoperative disc height and segmental angle were significantly improved after surgery and maintained during follow-up periods. No abnormal displacement were recorded at dynamic flexion and extension lateral X-ray and no cage rotation or retropulsion was noted in follow-up periods. Three patients(14.3%) was observed to subside of disc height on the postoperative periods and only one of their patients was dissatisfied with surgery. CONCLUSION: Cervical hollow cage is simple to perform and reduces the operation time. Besides clinical improvement, it improves mechanical stability and radiological profile as the physiologic level. The cervical hollow cage might be an alternative to traditional cervical interbody fusion with bone graft.
Subject(s)
Humans , Decompression , Follow-Up Studies , Intervertebral Disc , Postoperative Period , Spondylosis , TransplantsABSTRACT
OBJECTIVE: PCB cervical instrument is a newly introduced fusion device which comprises cervical plate, cage (spacer) and screw system. It is developed to enhance fusion rate and stability, as well as to reduce complications related to hardware failure. We investigated the efficacy of clinical and radiological results of PCB instrument and Lubboc bone. METHODS: From August, 1998 to October, 1999, authors performed 54 cases of anterior cervical interbody fusion with PCB instrument and Lubboc bone. Retrospective analysis was undertaken based on clinical and radiological findings. Clinical improvement was evaluated according to Odom's criteria. Cervical plain films and tomography were taken every 2 months to evaluate the degree of interbody fusion and disc height changes. RESULTS: Bone fusion was observed in 36 cases(90%) over 6 months after operation, and during which time there was no significant interval change. There were 3 cases of hardware dislodgement. Disc height was increased significantly and preserved in all cases. Clinical outcome over good degree was seen more than 94% of patients. CONCLUSION: Longer follow-up period and comparative studies to similar instrument appear to be necessary, but this instrumentation system has shown high fusion rate and fewer adverse effects in our series. We believe this system might be indicated for the treatment of cervical trauma and degenerative disease in selective cases.
Subject(s)
Humans , Follow-Up Studies , Retrospective StudiesABSTRACT
The use of metallic plate and screws in the anterior cervical fusion has become generally acceptable and popular. Mainly, there are two different plating systems available. However, there has been few attempts to compare their clinical results with and without a plating system or between two different systems in a single series of clinical study. The authors reviewed 117 patients who underwent anterior cervical fusion during the period of January 1992 to September 1996. Simple fusion without a plating system was applied in 55 cases(group 1), a bicortical non-locked plate screw system in 25(group 2), and a monocortical locked plate screw system in 37(group 3). The average follow-up period was 13. 2 months. In group 1, twenty-two patients(40%) with fracture-dislocation or corpectomy required a rigid brace such as halo brace and Minerva cast for 3 months postope ratively and seven patients(13%) experienced graft complications, mainly graft extrusion. In group 2 and 3, the patients required only soft b races for 4 to 8 weeks and no patients experienced serious graft complications like ones in group 1 but, instead two patients with screw breakages, two back-outs and one non-union were observed. In comparison of the clinical complications such as hoarsness, there were no significant differences between the groups. In conclusion, the plating system in anterior cervical fusion appears to be safe despite the facts that mo re technical demands are required during surgery. It also provides better postoperative stability in the spine and permits earlier ambulation without a rigid brace. A monocortical locked plate screw system appears to have less hardware failures and better su rgical results than a bicortical non-locked plate screw system.
Subject(s)
Humans , Allografts , Braces , Racial Groups , Follow-Up Studies , Spine , Transplants , WalkingABSTRACT
Eighty-four patients whose cervical lesions not associated with any trauma or tumor were operated for anterior cervical interbody fusion. The patients were separated into two groups, one group operated with a cervical plate and the other group, without the cervical plate. The mean follow-up duration in anterior cervical interbody fusion with cervical plate cases was 16 months(from 6 months to 30 months), without cervical plate 35 months(from 6 months to 84 months). Retrospective analysis of the two groups were done in order to compare the incidence of postoperative complications, clinical outcome, and radiological changes. The most notable postoperative complications of the group operated without the cervical plate were migration of the bone graft(3.3%) and angulation(3.3%), whereas of the group operated with the cervical plate were screw loosening(4.2%) and infection of the operative wound(4.2%). Comparative analysis of the postoperative clinical outcome and changes in radiological measurement of the intervertebral heights and angles showed no statistically significant difference between the two groups. The results of this study suggest that whether or not the cervical plate should be used for anterior cervical interbody fusions requires a decision made carefully and meticulously by the operator, so that the possibility of any postoperative complications can be minimized.
Subject(s)
Humans , Follow-Up Studies , Incidence , Postoperative Complications , Retrospective StudiesABSTRACT
OBJECTIVES: Anterior approach to achieve arthrodesis of the cervical spine has become a widely accepted and often-used approach since its earliest reports by Bailey and Badgley, Smith and Robinson and Cloward. However, anterior interbody fusion in the presence of the presence of the posterior instability may be complicated by the bone graft dislodgement, kyphotic defomity or nonunion. As an attemp to prevent this undesirable complication, additional methods such as skeletal traction, halo appratus or even posterior fusion has been utilized. Therefore, The cervical spine locking plate(CSLP) with the anterior intervertebral body bone grafting provide immediate cervical stabilization and widely successful in achieving fusion. MATERIAL AND METHODS: This study analysed 14 patients who underwent a single anterior procedure and application of CSLP for the treatment of the cervical spinal disorder. Eleven patients were disc herniations and three patients were traumatic lesion. The average ago of the patient was 47 years and the mean follow up periods was 20 months ranging from 13 to 27 months. RESULTS: Ambulation was started 2nd day after the operation with the aid of the Philadelpia orthoses. Bone union was observed 13 cases on average 12 weeks after operation. The one case was nonunion with plate breakage without clinical symptom. CONCLUSION: Anterior fusion with CSLP are thought to be a safe and valuable method for treating cervical spine disorder.