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.

HDR syndrome in a Colombian woman with a genital tract malformation: first case report in Latin America / Síndrome HDR en una mujer colombiana con una malformación genitourinaria: primer reporte de caso en Latinoamérica

ABSTRACT Objectives Hypoparathyroidism, sensorineural deafness and renal disease (HDR) syndrome, also known as Barakat syndrome, is an autosomal dominant transmission hereditary disease with a wide range of penetrance and expressivity. Haploinsufficiency of the GATA3 two finger zinc transcription factor is believed to be its cause. This is the first time this orphan disease is reported in Latin America, so the publishing of this report is expected to raise awareness on these types of syndrome, that are usually underdiagnosed in our region, which in turn causes an increase in the years lost to disability (YLDs) rates, as well as higher costs to be assumed by public health systems. Methods A 36-year-old Colombian woman diagnosed with parathyroid gland agenesis was referred from the Endocrinology Service to the Outpatient Service. According to her medical record, in the past she had developed hypocalcaemia, left renal agenesis, hypoparathyroidism, bicornate uterus and sensorineural hearing loss. Through a genetic analysis a pathological mutation on the short arm of the GATA 3 gen (c.404dupC, p Ala136 GlyfsTER 167) was confirmed, which led to a HDR syndrome diagnosis. Discussion This case proves that there is a possibility that mutations described in other continents may be developed by individuals from our region. Regardless of ethnicity, Barakat syndrome should be considered as a possible diagnosis in patients presenting the typical triad that has been described for this condition, since there could be underdiagnosis of this disease in Latin-America due to the lack of knowledge on this condition in said region, and that genetic counseling in these patients is of great importance for the implications of the syndrome in future generations.(AU)

RESUMEN Objetivos El síndrome de hipoparatiroidismo, sordera neurosensorial y displasia renal (HDR) también llamado síndrome de Barakat, es una enfermedad hereditaria de transmisión autosómica dominante con amplia penetrancia y expresividad genética. El síndrome es causado por la haploinsuficiencia del factor de transcripción de dedos de Zinc GATA3. Esta es la primera vez que esta enfermedad huérfana es reportada en latinoamerica, y buscamos generar consciencia de la presencia de estas enfermedades, las cuales usualmente son infradiagnósticadas en nuestro medio y llevan a un aumento de años perdidos por discapacidad y costos para el sistema de salud pública. Métodos Una mujer colombiana de 36 años ingresó a consulta externa de genética referida por el servicio de endocrinología por una agenesia de paratiroides. La paciente tenía antecedentes de hipocalcemia, agenesia renal izquierda, hipoparatiroidismo, sordera neurosensorial y útero bicorneo. Se realizó un análisis genético que confirmo una mutación patológica en el brazo corto del gen GATA3 (c.404dupC, p Ala136 GlyfsTER 167) diagnóstica del síndrome de Barakat. Discusión Este caso demuestra la posibilidad de existencia de mutaciones descritas en otros continentes en nuestra población. Sin importar la etnia, el síndrome de Barakat debe ser estudiado en pacientes que presenten la triada típica, ya que podría existir un infra diagnóstico de la enfermedad secundario al desconocimiento de la misma en Latinoamérica y teniendo en cuenta la importancia que tiene la consejería genética en estos pacientes por las implicaciones de la enfermedad en futuras generaciones.(AU)

HPV Genotyping and Clinical Studies of Women in Yan'an Area / 现代检验医学杂志

Objective To contrast HPV genotyping and clinical characteristics of women in Yan'an and provide data support for cervical cancer screening and prevention.Methods The genotyping of HPV infection was carried out by the method of PCR amplification and reverse hybridization.To statistical analysis clinical infection distribution data.Results Found 16.48％ (332 of 2014) were positive for HPV DNA in these women.HPV-16,52 and 53 were in the top three HPV high-risk types.HPV-81,6 and 44 were in the top three HPV low-risk types.There were 219 cases (65.96％) with pure high-risk type infection,74 cases (22.29％) with pure low-risk type infection and 39 cases (11.75％) with mixed infection in positive specimens.The HPV infection rate had showed first increasing then decreasing with age,and there were significant differences among the each groups (x2=34.238,P＜0.01).There were also differences in HPV positive detection rates in different occupations and there were significant differences among the each groups (x2=50.35,P＜0.01).There were also differences in HPV positive detection rates in different regions,and there were significant differences among the each groups (x2 =12.084,P＜0.05).Single infection was highest in HPV infection.Conclusion HPV infection was different in different populations,regions and ages,and it is of great significance to carry out HPV screening for early prevention and treatment of cervical cancer.

Comparative effects of ultra-aged patients with multilevel cervical surgical treatment options / 重庆医学

Objective To investigate the effect of super-aged multilevel cervical spondylosis different surgical treatment op tions Abstract Objective.Methods Selected July 2010 Ultra old multilevel cervical spondylosis March 2015 in our hospital 80 ca ses,the anterior cervical corpectomy and fusion (ACCF) and by anterior discectomy and fusion (ACDF) included anterior group,the posterior laminoplasty (PCL) included in the posterior group,the clinical efficacy of two groups were compared,and postoperative conditions and cervical spinal cord injury rates before and after treatment (JOA score),cervical Disability index (NDI index),lordosis and cervical spine.Results Anterior group of 43 cases,including 28 cases of excellent(65.12％),5 cases of good (11.63％),7 cases of moderate(16.28％),3 cases of poor(6.98％),the good rate was 76.74％;posterior group 37 cases,including 24 cases of excellent(64.86％),3 cases of good(8.l1％),6 cases of moderate(16.22％),4 cases of poor(10.81％),the good rate was 72.97 ％.The difference has no statistically significant (P＞0.05) in good rate.Anterior operative time was significantly higher than the posterior group (P＜0.05),blood loss,hospital stay was significantly lower than the posterior group (P＜0.05),the time of symptoms disappeared has no significant difference in two groups(P＞0.05).After treatment,patients in posterior group,the JOA score,cervical activity significantly were higher than the anterior group,lordosis anterior group were significantly higher than the posterior group,the difference was statistically significant (P＜0.05).Conclusion Anterior super aged multilevel cervical disease,posterior approach has achieved good clinical efficacy but greater advantage posterior surgery in patients with long term im provement in the cervical spine function.

Study on relationship between human papilloma virus,telomerase gene and chromosome 3 number with cervical lesions / 国际检验医学杂志

Objective To explore the relationship between the expression of human telomerase RNA component (TERC) gene , human papilloma virus (HPV) infection and mutation of chromosome 3 number with cervical lesions .Methods 81 women received the treatment in the Gynecology Department of the Second Affiliated Hospital of Kunming Medical University from June 2008 to February 2009 ,including the healthy group(normal pathological examination ,20 cases) ,CIN1 group(28 cases) ,CIN2 group(12 ca‐ses) ,CIN3 group(9 cases) and cervical cancer group(12 cases) .The TERC gene expression in uterine epithelial exfoliated cells was detected by using the fluorescence in situ hybridization (FISH) method ,meanwhile the HPV infection was detected by using the real time fluorescence quantitative polymerase chain reaction (FQPCR) technology .The correlation between cervical cancer with TERC gene and HPV was analyzed .At the same time the number of chromosome 3 mutations in 81 cases was recorded .Results In the cervical lesion detection ,the detection positive rate had no statistical difference between the TERC gene detection and HPV detec ‐tion (P> 0 .05) ,their positive rates in the CIN 1 ,CIN2 ,CIN3 and cervical cancer groups were significantly higher than that in the healthy group (P 0 .05) , while between the CIN3 group and the cervical cancer group had statistical significance (P< 0 .05) ,the higher the malignant degree , the higher the positive rate .The abnormal mutation rate of chromosome 3 number was 0% in the healthy group and the CIN1 group ,16 .7% in the CIN2 group ,66 .7% in the CIN3 group and 100 .0% in the cervical cancer group ,the positive rate in the CIN3 group and the cervical cancer group was significantly higher than that in the healthy group ,CIN1 group and CIN2 group ,the differ‐ences were statistically significant (P< 0 .05) .Conclusion The TERC abnormal gene expression ,high risk HPV infection and mutation of chromosome 3 number could play an important synergistic effect during the process of occurrence and progression of cervical cancer .

Comportamiento de las lesiones intraepiteliales de alto grado en la consulta de patología de cuello / Behavior of high-grade intraepithelial lesions on the Cervix Pathology Consultation

Introducción: el cáncer cérvicouterino (CCU) es la segunda neoplasia maligna más frecuente en mujeres. Objetivo: determinar el comportamiento de las lesiones intraepiteliales cervicales de alto grado. Métodos: se realizó una investigación cuantitativa y cualitativa de tipo descriptivo transversal de las pacientes atendidas en la consulta de patología de cuello del Hospital Universitario "Mártires del 9 de Abril" de Sagua la Grande, en el período comprendido entre enero y diciembre de 2011. El universo estuvo constituido por 158 mujeres que asistieron a consulta con citología alterada, la muestra fue de 70 mujeres con diagnóstico de lesión de alto grado. Se revisaron las historias clínicas, tarjetas de citodiagnóstico y se entrevistaron las pacientes, se confeccionó la base de datos. Resultados: la edad más frecuente fue 25-44 años. El 67,1 % inició su vida sexual entre los 16 y 20 años. Existió una relación directa entre la infección por el VPH y la aparición de las lesiones intraepiteliales cervicales, dado que en 53 pacientes (72,6 %) existió el hallazgo citológico del VPH. Hubo una correspondencia adecuada entre los resultados de la biopsia por ponchamiento y la biopsia por cono. En cuanto al tratamiento definitivo, a 53 pacientes se les realizó cono por bisturí frío y solo a 9 histerectomía total. Conclusiones: una de cada 10 pacientes afectada por una lesión de alto riesgo es menor de 25 años. A mayor tiempo transcurrido desde el inicio de las relaciones sexuales se incrementa la aparición de lesiones de alto grado.

Introduction: cervical cancer (CCU) is the second most common malignancy in women. Objective: to determine the behavior of high grade cervical intraepithelial lesions. Methods: a quantitative and qualitative cross descriptive study was conducted in patients treated in the cervix pathology service at the University Hospital Mártires del 9 de Abril , Sagua la Grande, from January to December 2011. The universe of our study consisted of 158 women who were assisted at consultation with abnormal cytology; the sample was 70 women diagnosed with high-grade lesion. We reviewed the medical records, greeting cytodiagnosis and interviewed the patients. Data were entered in a database. Results: the most common age was 25-44 years. 67.1 % started their sexual life between 16-20 years old. There was a direct relationship between HPV infection and the development of cervical intraepithelial lesions, since 53 patients (72.6 %) showed HPV cytologic finding. There was a suitable correspondence between the results of punch biopsy and cone biopsy. As for the definitive treatment, 53 patients underwent cold blade cone and only 9 underwent total hysterectomy. Conclusions: one in 10 patients affected by high-risk injury is younger than 25 years. A longer time since the onset of sexual intercourse increases the appearance of high-grade lesions.

Initial clinical application results of dual energy CT angiography on head and cervical vessel diseases / 中华神经医学杂志

Objective To explore the clinical application value of dual-energy CT angiography (DECTA) for head and cervical vessel diseases. Methods The imaging data and diagnosis results of 146 patients suspected as having head and cervical vascular diseases and underwent DECTA in our hospital from February 2009 to August 2009 were analyzed, retrospectively and compared. Sixteen of them with positive results were also performed whole cerebral vessels DSA. Results Seventy-seven patients (52.74%) were found to have head and cervical vessel diseases under DECTA; 17 patients were diagnosed as having intracranial aneurysm, 13 with carotid artherosclerosis and stenosis, 13 with intracranial and vertebral artery stenosis, 9 with intracranial arteriovenous malformation (AVM), 7 with internal carotid artery (ICA) or vertebral artery occlusion, 4 with neck-face AVM, 3 with Moyamoya disease, 3 with intracranial tumors, 2 with cerebral infarction, 2 with intracranial phlebothrombosis, 1 without imaging in bilateral ICA, 1 with Sturg-Webber syndrome and 1 with primitive trigeminal artery.DSA results were concordant with the DECTA results by finding 15 of 16 patients (93.75%) with head and cervical vessel diseases; 8 patients were detected as having intracranial aneurysm, 4 with ICA or vertebral artery occlusion, 1 with carotid artherosclerosis and stegnosis, 1 with intracranial AVM and 1 with neck-face AVM. The one that DSA did not find any tumors was noted as having 2 microaneurysms by CTA. Conclusion The head and cervical vascular diseases and the feeding artery of tumor can be demonstrated distinctly with DECTA with high diagnosis accuracy and sensitivity.

The diagnostic value of Reid's coloposcompic index in uterine cervical diseases / 中华全科医师杂志

Clinical data of 899 patients,who received colposcopic examination,were retrospectively analyzed.Both Reid's colposcopic index(RCI)score and biopsy were performed.The study showed that the value of RCI score was positively related to the severity of cervical lesions(F=2.043,P=0.03).The specificity of RCI for cervicitis,cervical intraepithelial neoplasia(CIN)Ⅰ were 98.8%,95.7% respectively;while sensitivity and negative predictive value for CIN Ⅱ,CIN Ⅲ were 77.7%,70.0%and 96.8%.97.4%,respectively.So RCI scoring can increase the diagnostic value of colposcope.

Adjacent segment disease after anterior cervical interbody fusion / 中国矫形外科杂志

[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.

Clinical study of Jingtongping pills in treating the cervical spondylotic radiculopathy / 中国矫形外科杂志

[Objective]To observe and evaluate the clinical effect of Jingtongping pills on the cervical spondylotic radiculopathy(CSR).[Method]Eighty patients with CSR were assigned into two groups,40 patients were treated with Jingtongping pills(as therapeutic group)and the others were treated with Jingfukang(as control group).The clinical curative effect and adverse effect were evaluated at the end of 3 weeks.[Result]There was statistical difference between two groups when effective powers assessed with disease curative effect standard(P0.05).There was no adverse reactions founded in two groups.[Conclusion]Jingtongping pills has a certain therapeutic value for CSR.

Validity of FASTIN anchor in cervical laminoplasty / 中国矫形外科杂志

[Objective]To evaluate the efficacy and short-term results of FASTIN anchor in cervical expansive open-door laminoplasty(ELAP).[Method]From February 2005 to February 2006,a total of 89 cases of cervical spondylotic myelopathy(CSM) were assessed in this study.Forty patients undergoing expansive open-door laminoplasty(ELAP) by FASTIN anchor were classified as study group.Fouty-nine patients undergoing conventional ELAP served as controls.The clinical results and radiological examinations of both groups were evaluated at 24 months after surgery.[Result]There were no significant differences in operation time,bleeding quantity and recovery rate of Japanese Orthopaedic Association(JOA) scores.The incidences of axial symptoms and C5 palsy in the study group were significantly lower than those in the control group(P

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.

Diagnostic value of pap's smear, colposcopy and cervical biopsy in cervical diseases

A cross sectional retrospective study was conducted on 290 patients aged 19- 78 years old at Hung Vuong Hospital from July 2000 to July 2003, with PAP's smear, colposcopy and biopsy. Result showed that non benignant smear accosted for 16,9% non benignant colposcopy 28,6%, non benignant biopsy 35,2%. In comparing with the number of patients submited to consultation, the rate of smear 78,04% among then 0,13% were detected with any pathology and the rate of colposcopy 20,91% and 0,98% with any pathology

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.

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.

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.

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.

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.