ABSTRACT
BACKGROUND: Anterior cervical discectomy and fusion is a classic surgical procedure for the treatment of cervical spondylosis. At present, we can use a Zero-P interbody fusion fixture and a traditional cervical anterior plate plus cage as an internal fixation material. The Zero-P has less postoperative esophageal interference and lower incidence of postoperative dysphagia compared with traditional anterior cervical plate fixation. Besides, the Zero-P could avoid the risk of excessively long or pooriy placed plate injury to adjacent segmental intervertebral discs. OBJECTIVE: To compare the safety and effectiveness between two-level anterior cervical discectomy and fusion using Zero-P and using traditional anterior cervical plate plus cage. METHODS: Clinical data of sixty patients who underwent two-level anterior cervical discectomy and fusion in the Chengdu Third People’s Hospital from May 2016 to May 2018 were retrospectively analyzed. The patients were divided into Zero-P group (Zero-P fusion, n=30) and plate group (anterior cervical plate fixation combined with cage implantation, n=30). All patients in the two groups had informed consent to the treatment plan. This study was approved by the hospital ethics committee. The Japanese orthopedic association score, neck disability index score and Bazaz swallowing function score were used to evaluate the clinical efficacy. Cervical X-ray and cervical CT scans were performed to assess cervical curvature, observe bone graft fusion, and implant displacement, loosening and breakage. RESULTS AND CONCLUSION: (1) All surgeries were successfully completed in 60 patients. The wounds healed in stage I after operation. There were no serious complications such as nerve injury, esophageal fistula, and cerebrospinal fluid leakage. (2) During the follow-up, there was no significant difference in neck disability index, Japanese orthopedic association score and bone graft fusion rates between the two groups (P > 0.05). (3) The incidence and severity of dysphagia in the Zero-P group were lower than those in the plate group at various time points after operation (all P < 0.05). (4) The overall curvature and operative segments curvature were better in the plate group than in the Zero-P group 6 months after surgery and in final follow-up (P < 0.05). (5) Two-level anterior cervical discectomy and fusion using Zero-P is a safe and effective operative method. The operation time, bleeding volume, number of fluoroscopy and postoperative dysphagia incidence were better than the traditional anterior cervical plate plus cage fixation system, but it is not as good as the traditional anterior cervical plate plus cage system in the curvature of the cervical spine. Zero-P is not recommended for patients with obvious abnormal cervical curvature before operation.
ABSTRACT
[Objective]To investigate the application value of the iliac allograft combined with anterior plate in the cervical anterior operation.[Method]Sixty-eight cases of anterior cervical decompression and fusion were performed with the iliac allograft combined with anterior plate.The data such as operative time,blood loss during operation and continue X-ray on their cervical spine were recorded,and were compared with the correspondent data of the control group which were transplanted of the iliac autograft combined with anterior plate.[Result]Compared with that of the control group(iliac autograft combined with anterior plate),the operative time and blood loss during operation in the group of iliac allograff combined with anterior plate was less(P
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OBJECTIVE: The biomechanical stabilities between the anterior plate fixation after anterior discectomy and fusion (ACDFP) and the posterior transpedicular fixation after ACDF(ACDFTP) have not been compared using human cadaver in bilateral cervical facet dislocation. The purpose of this study is to compare the stability of ACDFP, a posterior wiring procedure after ACDFP(ACDFPW), and ACDFTP for treatment of bilateral cervical facet dislocation. METHODS: Ten human spines(C3-T1) were tested in the following sequence: the intact state, after ACDFP(Group 1), ACDFPW(Group 2), and ACDFTP(Group 3). Intervertebral motions were measured by a video-based motion capture system. The range of motion(ROM) and neutral zone(NZ) were compared for each loading mode to a maximum of 2.0Nm. RESULTS: ROMs for Group 1 were below that of the intact spine in all loading modes, with statistical significance in flexion and extension, but NZs were decreased in flexion and extension and slightly increased in bending and axial rotation without significances. Group 2 produced additional stability in axial rotation of ROM and in flexion of NZ than Group 1 with significance. Group 3 provided better stability than Group 1 in bending and axial rotation, and better stability than Group 2 in bending of both ROM and NZ. There was no significant difference in extension modes for the three Groups. CONCLUSION: ACDFTP(Group 3) demonstrates the most effective stabilization followed by ACDFPW(Group 2), and ACDFP(Group 1). ACDFP provides sufficient strength in most loading modes, ACDFP can provide an effective stabilization for bilateral cervical facet dislocation with a brace.
Subject(s)
Humans , Braces , Cadaver , Diskectomy , Joint Dislocations , SpineABSTRACT
As a complication following anterior cervical spine screw or plate fixation, a pharyngoesophageal diverticulum (Zenker's diverticulum) is rare in comparison with iatrogenic esophageal perforation or tracheo-esophageal fistula. Esophageal perforation or fistula usually develop abrupt and severe symptoms such as fever, dyspnea, coughing or swelling on the cervical area. However. there is no definite symptoms except mild and chronic dysphagia in case of pharyngoesophageal diverticulum. Therefore, it is very likely that the diagnosis will be delayed and serious complication will be occurred. We report a case of 58-year-old spinal cord injured man with a Zenker's diverticulum following anterior cervical plate fixation.
Subject(s)
Humans , Middle Aged , Cough , Deglutition Disorders , Diagnosis , Dyspnea , Esophageal Perforation , Fever , Fistula , Spinal Cord , Spine , Zenker DiverticulumABSTRACT
OBJECTIVES: The rates of pseudarthrosis for two- and three level fusion have been reported to be 17-63 and 50% without anterior cervical plating. The purpose of this study is to assess the effects of anterior cervical plating in the treatment of multilevel degenerative cervical disease such mostly the additional risks associated with hardware implants and its benefits, fusion rate and radiographic results, and clinical outcomes. METHODS: Forty-seven patients who underwent operations between 1993 and 1997 were retrospectively reviewed. The technique for operation was same for both groups(Smith Robinson with autologous iliac bone graft). Group I consisted of 35 consecutive patients treated with anterior cervical decompression and fusion with anterior cervical plate fixation. Group II consisted of 12 consecutive patients treated without plate fixation. We compared clinical outcomes by Prolo score, radiographic results in the rate of fusion, cervical lordosis by Gore angle, disc height by Farfan method, and surgical complications between two groups. RESULTS: The favorable clinical outcomes(excellent and good) by Prolo score were observed with the use of anterior cervical plate fixation(89% vs 75%). The successful fusion rate of multilevel cervical fusion was as seen with anterior cervical plate fixation(97% vs 75%). The overall graft complication rate in multilevel fusions was decreased, with anterior cervical plate fixation, and the hardware related complications were relatively minimal without serious consequences. CONCLUSION: Anterior cervical plate fixation in the treatment of multilevel cervical disorders is an effective stabilizing method which provides increased bony fusion rate, decreased graft complications, maintained cervical lordosis, early mobilization of the these patients without serious hardware related complications.
Subject(s)
Animals , Humans , Decompression , Early Ambulation , Lordosis , Pseudarthrosis , Retrospective Studies , TransplantsABSTRACT
The purpose of this study was to evaluate the role of anterior cervical plate after discectomy and autologous iliac bone graft in the treatment of cervical spondylosis. One hundred and seven cervical spondylotic patients from Jan. 1995 to Mar. 1998 were separated into two groups: Group 1. consisted of 58 patients treated with anterior discectomy, bone fusion, and anterior cervical plate fixations(54 cases of Caspar nonlocking plate and 4 cases of Orion locking plate system), Group 2. consisted of 49 patients treated with anterior discectomy and bone fusion. The mean follow-up duration was 26.5 months(from 6 to 45 months). The overall fusion rate did not showed any difference between the two groups, but in multi-level patients, graft materials related complications(extrusion or collapse of graft) were significantly high in group 2.(p<0.01). Group 1. patients ambulated on POD 1 with Philadelphia collar. The average admission period was 8.4 days following operation. Group 2. patients ambulated on POD 5-7 with Philadelphia collar. The average admission period was 11.9 days after surgery. In conclusion, bony fusion was successfully achieved in both groups and graft materials related complication rate showed no difference in the single level, but was significantly low in group 1 in the multilevel.
Subject(s)
Humans , Diskectomy , Follow-Up Studies , Spondylosis , TransplantsABSTRACT
Anterior cervical discectomy and fusion is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, and degenerative disc diseases. Refinements in instrumentation for the cervical spine have led to an increase in experience with these devices during the past decade. The need for postoperative immobilization, required to stabilize the patient while the fusion mass heals, is decreased or negated by internal fixation. The authors analyzed the results in 30 patients(22 traumatic; 8 non-traumatic) with lower cervical lesions, who underwent anterior interbody fixation with cervical plates between April, 1994 and June, 1996. We used either a unicortical(Orion TM) or bicortical screw system(Top TM): these two types of plates had no specific differences, but the Orion TM was easier and safer to operate. Although postoperative stability was successfully attained in all patients, two screw-related complications, which were fully resolved without causing any specific problems, were detected during the postoperative follow-up period. In nontraumatic lesions, we measured pre-and postoperative interbody heights at ten levels; postoperative interbody height was well preserved for one year. In conclusion, internal fixation may provide added security to the nervous system before bony fusion occurs, may lessen the number of levels requiring fusion, may increase the probability of successful fusion, and is conducive to early patient mobilization.
Subject(s)
Humans , Diskectomy , Follow-Up Studies , Immobilization , Intervertebral Disc Displacement , Nervous System , Spinal Cord Diseases , Spine , SpondylosisABSTRACT
The anterior interbody fusion combined with internal metal plate fixation was performed from January, 1988 in seven patients with unstable mid and lower cervical spine. The insertion of the metal plate was simple and maintained the block bone graft in satisfactory position. We concluded from this early follow-up that, this alternative method of internal fixation of cervical spine allowed not only effective stabilization for the unstable spine but also early mobilization and short hospital stay.