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

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.

The Correlation Between Radiographic and Clinical Results after Anterior Cervical Discectomy and Fusion / 대한척추외과학회지

STUDY DESIGN: This is a prospective study. OBJECTIVES: We wanted to analyse the correlation between the radiographic and clinical results after anterior cervical discectomy and fusion (ACDF) for treating degenerative cervical diseases. Summary of Literature REVIEW: ACDF is a successful procedure for treating the degenerative cervical spine. Many studies have reported on radiographic results and clinical outcomes of this procedure. However, few studies have examined the relationships between the changes of the radiographic parameters and the clinical results after ACDF. MATERIALS AND METHODS: 26 patients who had single level ACDF performed for degenerative cervical diseases during the period between Jan, 2000 and Dec, 2004 were evaluated. All the patients underwent autologous iliac bone graft and plate fixation. The radiographic parameters, including the disc height, the disc space angulation and the spinous process distance were measured at the preoperative period, post operative 1 month and the last follow up period, respectively. The clinical changes were measured using the visual analogue scale (VAS) for neck and arm pain at the preoperative and last follow up period. The correlations between the radiographic parameters and the clinical outcomes were assessed by Pearson correlation. RESULTS: There were significant changes in disc height (6.7-7.9 mm) as well as disc space angulation (kyphosis: 1.1degrees, lordosis: 3.4degrees). The reduction in the neck pain VAS score (63.9-33.1) and the arm pain VAS score (57.9-29.7) was significant. None of the correlations between the radiographic parameters and the clinical outcomes were significant (p>0.05). CONCLUSION: Although the clinical outcomes improved significantly, there was no significant correlation between the radiographic parameters and clinical results after performing single level anterior cervical discectomy and fusion for the degenerative cervical disease.

Anterior Cervical Instrumentation Using Intradiscal Cage with Integrated Plate

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.

Preliminary Experiences with Interbody Titanium Cage(RABEA(TM)) Fusion in Patients with Degenerative Cervical Disease

OBJECTIVE: The purpose of this study is to evaluate the safety and efficacy of cervical interbody fusion with implantable titanium cage(RABEA(TM)). The authors retrospectively analysis the result of application of cervical hollow cage(RABEA(TM)) without bone graft to the patients of degenerative cervical disease. METHODS: 78 patients with radiculopathy with or without myelopathy due to degenerative cervical diseases were underwent anterior cervical discectomy and interbody fusion with titanium cages(RABEA(TM)) which were not filled with autogenous bone from June 1999 to December 2002. Among them, 33 patients could be followed-up for at least 6 months. Mean follow-up period was 13.3 months(ranged 6-30 months). RESULTS: Good or excellent results were found in approximately 82.0%. Preoperatively, the mean height of the disc space was 4.27mm(range 3~6mm), and at 1 day postoperatively it was 7.87mm(range 7~9mm). The mean height of the disc space after 1 year was 6.07mm(range 1~8mm). Due to subsidence of cage, 7 patients showed decrease of disc space height to preoperative disc space height. Among them, 1 patients showed poor results. A solid fusion was achieved in all patients. In this context, causes of subsidence are represented by osteoporosis and degree of cage recess. CONCLUSION: Titanium cages appear safe and effective in the treatment of degenerative cervical disease. But subsidence of cage, so far limited in number, appeared to be important risk factor for recurrence of the symptoms.

Anterior Cervical Bisegmental Interbody Fusion with Titanium Cage(RABEA) in Degenerative Cervical Disease: Comparative Analysis with Monosegmental Interbody Fusion

OBJECTIVE: It is not uncommon to perform anterior discectomy for two adjacent disc levels in degenerative cervical disease due to diagnostic problems. The purpose of this study is to assess the effectiveness of titanium cage(RABEA) applied to two-level cervical degenerative disc disease, which is compared with the result of fusion with the same cage for one-level disc disease. METHODS: Between January 1999 and March 2003, 52 patients with degenerative cervical disease underwent anterior discectomy and interbody fusion with titanium cage(RABEA). Among them, 23 patients could be followed-up for more than 1 year. Ten patients received interbody fusion at one disc level(Group A), and 13 patients at two adjacent disc levels(Group B). Clinical outcome, fusion rate, disc space height and change of lordotic angle were analyzed in both groups. RESULTS: Clinical outcome according to Odom's criteria was excellent and good in 9(90%) of Group A and 11(84.6%) of Group B. The bone fusion rate of Group B was slightly lower than that of Group A. The height of disc space was well maintained until 1 year postoperatively in both groups. The change of the cervical lordotic angle has no significant difference between the two groups. CONCLUSION: Interbody fusion with titanium cage(RABEA) for two-level degenerative cervical disease may be an acceptable treatment modality due to relatively good clinical outcome despite slightly low fusion rate.

Anterior Cervical Interbody Fusion Using a Plate Cage System in Degenerative Cervical Disease

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.

Analysis of Noninstrumented Anterior Cervical Discectomy and Interbody Fusion in Degenerative Cervical Disease

OBJECTIVES: We retrospectively studied the efficacy of anterior cervical discectomy and interbody fusion without plate fixation in degenerative cervical disease. METHODS: Thirty two consecutive patients with degenerative cervical disease treated by decompression and interbody fusion(Smith-Robinson technique) without anterior cervical plating were studied for postoperative complication rate as well as the clinical and radiologic outcomes and were compared the result of ours with other reported series where the anterior cervical plating was used. RESULTS: All cases were reviewed after average period of 13 months for the purpose of this study. There were 4 postoperative complications related to grafting. A solid fusion was obtained in all cases with single-level fusion(n=21) and 81.8 % of the cases with a two-level fusion(n=11). The overall fusion rate was 93.8 % and fusion rate per level fused was 95.3%. The clinical outcome of the patients was comparable with that in the literature, with one patient having a poor result. Comparing the result of this study with others of the anterior cervical plating, clinical outcome and fusion rate were not superior in plate fixation group in single-level fusion, but increased fusion rate and decreased graft-related complication rate were noted in multilevel fusion with plate fixation. However, the clinical outcome was not superior to noninstrumented fusion group of this study. CONCLUSION: These results demonstrate that anterior cervical discectomy and interbody fusion(Smith-Robinson technique) without instrumentation is safe and reliable method of single-level fusion in degenerative cervical disease. Plate fixation system doesn't seem necessary in single level fusion in degenerative cervical disease.

Anterior Cervical Interbody Fusion with versus without Plating System in Degenerative Cervical Disease

Anterior cervical interbody fusion(ACIF) is an effective method for the treatment of various cervical diseases, but complications from such procedure include non-union, absorption, collapse and displacement of graft bone, kyphosis and pseudoarthrosis. A retrospective study of 67 cases with ACIF with versus without plating system in degenerative cervical disease was performed to compare the arthrodesis level, average admission period, average ambulation period, fusion rate, complications, clinical outcome and reoperation rate for complications and to provide a efficacy and role of internal fixation(IF) after ACIF. Forty-five patients were operated through ACIF without IF and twenty-two patients were operated through ACIF with IF. In the group of ACIF without IF, the average admission period was 20.31 days, postoperative average ambulation period was 6.48 days, fusion rate was 97.7%, the rate of graft related complication was 31.1%, reoperation rate for graft related complications was 8.9%. In the group of ACIF with IF, the average admission period was 17.64 days, postoperative average ambulation period was 3.19 days, fusion rate was 100%, the rate of graft and plate related complications was 13.6%, reoperation rate for plate related complications was 9.1%. There was no reoperation for graft related complication in group of ACIF with IF. In conclusion, ACIF with IF had less chance of serious graft related complications and reoperation for graft related complications.

The Efficacy of the Unicortical Screw in the Anterior Cervical Fusion of the Degenerative Cervical Spine Disease

Anterior cervical fusion without internal fixation destabilizes an already unstable spine and can result in tenuous bone graft stability and potential for incorporation. Anterior fusion of cervical spine with screw-plates is gaining in popularity in the management of anterior cervical spine instability. Eighty six cases that underwent anterior fusion with or without internal fixation and autogenous iliac bone graft were compared and analyzed. The pathologies included 40 cases of cervical disc disease, 43 of cervical spondylosis and 3 of ossification of posterior longitudinal ligament. Changes in the alignment of the total cervical spine and of the fused segment were evaluated in both groups. Dislodgement of the grafted bone, which was observed in 2 of 11 cases in the nonplate group, was not seen in the plate group. Hardware failure was developed in 3 of 24 cases in the bicortical group, but not in 51 cases in the unicortical group. Alignment of the cervical spine was corrected and relatively well manintained in the plate group compared with the nonplate group. We concluded that a unicortical screw fixation was superior than a bicortical screw and a fusion without plating system could not keep a cervical lordotic curve in the treatment of the degenerative cervical disease.