ABSTRACT
BACKGROUND: Decompression and fusion with autograft is the gold standard technique in the treatment of cervical canal strait. Using PEEK cages or boxes of non-absorbable polymer with elasticity similar to bone, radiolucent, reduces morbidity and same degree of fusion. METHODS: A case series, prospective, longitudinal, deliberate intervention, evaluation panel before and after 2 years follow-up. Discectomy and PEEK housing placement with autologous graft. Arthrodesis were evaluated, cervical lordosis, intervertebral space height, pain evaluated with Visual Analogue Scale, Neck Disability Index, operative time, intraoperative bleeding, hospital stay and complications. Statistical analysis with t Sudent, Wilcoxon and Fisher's exact text. RESULTS: Of 17 patients studied, 9 (53%) were female. Average age 62 years. The most affected level was C5-6, C6-7 with 5 patients. Melting was found at 100%. There was no sag or migration of the box, space height was conserved, but segmental lordosis was not retained. Clinical improvement in all patients as well as disability index was seen. Bleeding was on average 187 mL. CONCLUSION: With regard to symptom improvement, conservation of interspace height and back, no segmental lordosis conservation and fusion using PEEK box is consistent with the literature. We suggest using anterior plate to maintain cervical lordosis. We found a melt index of 100%. We found clinical improvement of symptoms, pain and disability, and a global loss of cervical lordosis.
Antecedentes: la descompresión y artrodesis con auto-injerto es el patrón de referencia para el tratamiento del conducto cervical estrecho. El uso de cajas de PEEK polímero no reabsorbible, con elasticidad similar al hueso, radiolúcido, y mismo grado de fusión reduce la morbilidad. aterial y métodos: estudio de serie de casos, prospectivo, longitudinal, de intervención deliberada, evaluación en grupol antes y después, seguimiento a dos años. Discoidectomía y colocación de caja de PEEK con injerto autólogo. Se evaluaron artrodesis, lordosis cervical, altura del espacio intervertebral, dolor mediante escala visual análoga, índice de discapacidad cervical, tiempo quirúrgico, sangrado transoperatorio, estancia intrahospitalaria y complicaciones. Análisis estadístico con t de Student, Wilcoxon y exacta de Fisher. Resultados: de 17 pacientes estudiados, 9 (53%) eran del sexo femenino. La edad promedio 62 años. Sangrado promedio de 187 mL. El nivel más afectado fue C5-C6, C6-C7 en cinco pacientes. Se encontró fusión al 100% sin hundimiento ni migración de la caja, altura del espacio conservada, pero no se conservó la lordosis segmentaria. Mejoría clínica en todos los pacientes, y del índice de discapacidad. Conclusión: la disminución de los síntomas, la conservación de la altura del espacio anterior y posterior, la no conservación de la lordosis segmentaria y la fusión con caja de PEEK fueron congruentes con lo reportado en la bibliografía. Se sugiere utilizar la placa anterior para mantener la lordosis cervical. El índice de fusión encontrado fue de 100%, con disminución de los síntomas de dolor y discapacidad. Pérdida de lordosis cervical global.
Subject(s)
Biocompatible Materials , Ketones , Polyethylene Glycols , Spinal Fusion/instrumentation , Spondylosis/therapy , Adult , Aged , Aged, 80 and over , Benzophenones , Biocompatible Materials/adverse effects , Bone Matrix/transplantation , Diskectomy/methods , Female , Humans , Ketones/adverse effects , Male , Middle Aged , Patient Selection , Polyethylene Glycols/adverse effects , Polymers , Prospective Studies , Radiculopathy/etiology , Radiculopathy/prevention & control , Spinal Cord Compression/etiology , Spinal Cord Compression/prevention & control , Spinal Fusion/methods , Spondylosis/etiology , Transplantation, Autologous , Treatment OutcomeABSTRACT
BACKGROUND: Semirigid posterior stabilization is an alternative, avoiding arthrodesis in operated segments. However, this results in the need for dynamic stabilization to allow a stable feature function. METHODS: We conducted a prospective longitudinal self-reported interventional study. We included 46 patients with dynamic Dallostype interspinous stabilization between 1997 and 2004. A 4-year follow-up analysis was performed using clinical and radiographic studies, preoperatively and 4 years later evaluating lumbar disability, pain, disc height, disc angle (neutral, flexion, and extension). Descriptive statistics were used along with Wilcoxon signed range test. Statistical significance was accepted when p < 0.05. RESULTS: Of 46 patients, 39 completed a 4-year follow-up. Included in the study were nine females and 30 males with an average age of 30.74 years. Affected levels were L4 and L5 (21 patients); L5/S1 (17 patients) and L3/L4 (one patient). An improvement was reported of 80.3% according to the Oswestry scale (p = 0.0001). Preoperative pain decreased 6.8 points VAS. Disc height decreased 0.1 mm on average without significance. Disc angle (neutral) increased 1.13° without statistical difference. For flexion the increase was 2.641° (p = 0.0002), and extension decreased 0.817° on average without statistical significance. Range of mobility decreased 3.416° (p = 0.004). CONCLUSIONS: Interspinous ligamentoplasty improves segmental stability, allowing mobility within normal ranges and preserving disc height at 4 years of follow-up, as well as offering greater dynamic stability. Successful clinical improvement was demonstrated.
