Subsidence and Nonunion after Anterior Cervical Interbody Fusion Using a Stand-Alone Polyetheretherketone (PEEK) Cage
Clinics in Orthopedic Surgery
;
: 16-23, 2011.
Artigo
em Inglês
| WPRIM
| ID: wpr-115536
ABSTRACT
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.
Texto completo:
DisponíveL
Índice:
WPRIM (Pacífico Ocidental)
Assunto principal:
Complicações Pós-Operatórias
/
Radiculopatia
/
Doenças da Medula Espinal
/
Fusão Vertebral
/
Materiais Biocompatíveis
/
Falha de Prótese
/
Vértebras Cervicais
/
Análise de Regressão
/
Fatores de Risco
/
Fixadores Internos
Tipo de estudo:
Estudo diagnóstico
/
Estudo de etiologia
/
Fatores de risco
Limite:
Adulto
/
Idoso
/
Feminino
/
Humanos
/
Masculino
Idioma:
Inglês
Revista:
Clinics in Orthopedic Surgery
Ano de publicação:
2011
Tipo de documento:
Artigo
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