Long-Term Results After Cervical Interbody Fusion with Polymethylmethacrylate

A simple method for making a hollow cylindrical polymethylmethacrylate strut for cervical spinal reconstruction

Object

The purpose of this study was to introduce a method for making a hollow cylindrical polymethylmethacrylate (PMMA) strut for perioperative anterior spinal reconstruction after discectomy and/or corpectomy.

Methods

For use after anterior cervical discectomy or corpectomy, the authors created a hollow cylindrical PMMA strut using 10- and 3-ml disposable plastic syringes filled with PMMA containing 10% BaSO4 for anterior spinal reconstruction.

Results

With this method, the authors were able to make a PMMA strut that was approximately 50 mm in length with a 14-mm outer diameter and a 10-mm inner diameter. The PMMA strut could easily be cut with a saw to any desired length and molded with a cutting bur. The PMMA strut was used as a substitute for the cortical bone and was filled with bone graft for cervical spinal reconstruction after discectomy and/or corpectomy. The whole process of making the PMMA strut can be completed within 30 minutes, and it reduces costs by at least $1000 US (in 1-level discectomy), making the procedure cost effective.

Conclusions

It is simple to make a hollow cylindrical PMMA strut with plastic syringes during a discectomy and/or corpectomy. The strut can provide adequate support at less cost than other methods. The hollow cylindrical strut is also of suitable size and length for anterior spinal reconstruction. It serves as an alternative for patients who cannot afford the expense of similar instruments or who cannot or do not want to take the risk of a human graft for anterior spinal reconstruction.

Antibiotic–polymethylmethacrylate strut: an option for treating cervical pyogenic spondylitis

✓ Antibiotic–polymethylmethacrylate (PMMA) cement and beads constitute an effective system of local drug delivery of antibiotic agents in patients with bone and soft-tissue infections. Debridement followed by implantation of antibiotic–PMMA beads and systemic administration of antibiotic agents has achieved a 100% success rate in treating chronic osteomyelitis; however, there have been no reports of an antibiotic–PMMA strut for treating spinal pyogenic spondylitis. In this case report we describe a 57-year-old woman with C5–6 pyogenic spondylitis, progressive kyphotic deformity, and neurological deficits. The patient underwent anterior C-5 and C-6 corpectomy and spinal reconstruction in which we used an antibiotic–PMMA strut. The strut was 14 mm in diameter and contained PMMA and vancomycin powder. The operation was technically successful, and no complication related to anesthesia or the surgical procedure occurred. At the 12-month follow-up examination, dynamic radiographs revealed cervical spine stabilization. The patient’s neck pain subsided and she recovered neurologically with no residual infection. No antibiotic–PMMA strut dislodgment or failure was identified; however, 9.8% subsidence of the strut into the vertebrae was observed. The long-term outcome in this case requires further evaluation.

Use of a polymethylmethacrylate cervical cage in the treatment of single-level cervical disc disease

OBJECT

Polymethylmethacrylate (PMMA) bone cement has been used as a spacer in the treatment of patients with cervical disc disease with good long-term outcomes, but solid bone fusion has not been demonstrated in all cases. To achieve cervical interbody fusion, the authors designed a modified PMMA cervical cage that they filled with spongy bone for the treatment of single-level cervical disc herniation.

METHODS

Sixty-three patients underwent anterior cervical microdiscectomy and implantation of a PMMA cervical cage filled with autograft cancellous bone and were followed for a minimum of 2 years. The fusion rates were 90.5 and 100% at the 6- and 12-month follow-up examinations, respectively. The mean intervertebral disc height gain was 3.4 +/- 1.9 mm when preoperative and 24-month postoperative values were compared. Neck pain, measured using the Huskissan visual analog scale (0 mm, no pain; 100 mm, worst possible pain), decreased from 71 +/- 13 mm at preoperative baseline to 28 +/- 17 at 6, 23 +/- 19 at 12, and 31 +/- 19 mm at 24 months. Based on the same scale, radicular pain decreased from 83 +/- 15 mm at preoperative baseline to 24 +/- 11 at 6, 27 +/- 13 at 12, and 22 +/- 11 mm at 24 months. The self-rated clinical outcome was excellent in 45 (71.4%) and good in 18 (28.6%) of the 63 patients.

CONCLUSIONS

The autograft cancellous bone-filled PMMA cage is safe and effective for cervical interbody fusion in the treatment of single-level cervical disc herniation and monoradiculopathy.

Ventral discectomy with pmma interbody fusion for cervical disc disease: long-term results in 249 patients

STUDY DESIGN

Retrospective study of patients who underwent ventral discectomy and polymethyl-methacrylate (PMMA) interbody fusion for cervical radiculopathy.

OBJECTIVES

To evaluate the long-term outcome after ventral discectomy and PMMA interbody fusion and to compare it with previous data from other surgical techniques for the treatment of cervical radiculopathy.

SUMMARY OF BACKGROUND DATA

Because PMMA interbody fusion after ventral discectomy does not result in solid bony fusion in all cases, a good long-term outcome using this surgical technique has been questioned.

METHODS

Long-term follow-up evaluation after surgery was performed in 249 patients (96 women and 153 men) with radicular signs only. The mean age was 46.0 +/- 8.7 years (range, 24-74 years), and the observation time ranged from 10-15 years (mean, 12.2 +/- 1.2 years). Clinical grading after surgery according to Odom's criteria was based on a questionnaire. The outcome was related to morphologic findings, lumbar symptoms, physical stress, duration of symptoms, age, sex, and cervical level involved.

RESULTS

Complications related to surgery occurred in 13 (5.2%) patients, but only three (1.2%) had persistent problems. Of the 249 patients, 101 (40.6%) were without any symptoms (Odom I), 92 (36.9%) had a good outcome (Odom II), and 47 (18.9%) a fair outcome (Odom III). Only nine patients (3.6%) reported an unchanged or worse status than before surgery (Odom IV). Additional lumbar symptoms, high occupational physical stress, and discrepancy of preoperative findings were significantly correlated with a worse outcome. Short duration of symptoms and soft disc disease were favorable prognostic factors.

CONCLUSIONS

PMMA interbody fusion after ventral discectomy in cervical disc surgery is a safe and reliable method with few complications and an outcome comparable with other ventral procedures.