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Razzouk J, Cheng D, Vyhmeister E, Danisa O, Cheng W. Double-Plate Technique for Long-Construct Anterior Cervical Discectomy and Fusion. Cureus 2023; 15:e47407. [PMID: 38021579 PMCID: PMC10657910 DOI: 10.7759/cureus.47407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
The standard technique for multilevel anterior cervical discectomy and fusion (ACDF) uses a single plate to span multiple vertebral levels. However, the usage of single long plates is linked to potential hardware failure and screw pullout from stress overload. A single long plate is also more likely to fail at the caudal levels. Furthermore, centering a long plate spanning multiple levels requires simultaneous exposure to anatomy that may require more traction, technical expertise, and a potential increase in operative time. The use of a double-plate technique may be less technically demanding and, at the same time, allow for future revision to be confined to a shorter segment rather than requiring the removal of the entire single plate. In this study, we describe a surgical technique that involves using two plates during three or more levels of ACDF, discussing its advantages and limitations.
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Affiliation(s)
- Jacob Razzouk
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Debra Cheng
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Ethan Vyhmeister
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis VA Medical Center, Loma Linda, USA
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Suk KS, Jimenez KA, Jo JH, Kim HS, Lee HM, Moon SH, Lee BH. Anterior Plate-Screws and Lower Postoperative T1 Slope Affect Cervical Allospacer Failures in Multi-Level ACDF Surgery: Anterior Versus Posterior Fixation. Global Spine J 2023; 13:89-96. [PMID: 33648356 PMCID: PMC9837507 DOI: 10.1177/2192568221991515] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Prospective observational study. OBJECTIVE In ACDF, graft failure and subsidence are common complications of surgery. Depending on the cervical fixation, different biomechanical characteristics are applied on the grafts. This aims to describe the incidence of cervical spacer failure in patients with cervical degenerative condition according to the cervical fixation method and sagittal balance. METHOD From November 2011 to December 2015, 262 patients who underwent cervical spine surgery were enrolled prospectively. Patients were divided into 3 groups based on fixation method: anterior plate/screw (APS), posterior lateral mass screw (LMS), pedicle screw (PPS) groups. Serial X-rays and CT scans were utilized to evaluate radiologic outcomes. RESULTS Mean patient ages were 56.1 years in the APS group, 61.5 years in the LMS group, and 57.6 years in the PPS group (P = 0.002). Allospacer failure was most common in the APS group, compared to the LMS and PPS groups (chi-square, P = 0.038). Longer fusion level was associated with greater allospacer failure (Baseline 2 level surgery; Odds ratio (OR) 3.4 in 3 level, 15.2 in 4 level, P = 0.036,0.013). Higher T1 slope was correlated with less allospacer failure (OR 0.875, P = 0.001). ORs of allospacer failure in the LMS and PPS groups were 0.04 and 0.02, respectively, (P = 0.01, 0.01), compared with the APS group. CONCLUSION This study was able to show that allospacer failure in multi-level ACDF surgery is more common with a longer fusion length, less postoperative T1 slope, and an anterior plate-screws technique. Pedicle screws provided the best biomechanical stability among the 3 constructs.
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Affiliation(s)
- Kyung-Soo Suk
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Kathryn Anne Jimenez
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Je Hyung Jo
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea,Byung Ho Lee, Department of Orthopedic
Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu,
Seoul, 120-752, Korea.
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Lynch CP, Cha EDK, Patel MR, Jadczak CN, Mohan S, Geoghegan CE, Singh K. Effects of Anterior Plating on Achieving Clinically Meaningful Improvement Following Single-Level Anterior Cervical Discectomy and Fusion. Neurospine 2022; 19:315-322. [PMID: 34990538 PMCID: PMC9260542 DOI: 10.14245/ns.2142214.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The clinical utility of anterior cervical plating for anterior cervical discectomy and fusion (ACDF) procedures remains controversial. This study aims to compare the impact of cervical plating on achievement of minimum clinically important difference (MCID) up to 2 years following ACDF.
Methods Patients undergoing primary, single-level ACDF procedures were grouped based on whether their procedure included application of an anterior cervical plate. Demographics, preoperative spinal diagnoses, operative characteristics, and patient-reported outcome measures (PROMs) were compared between plating groups. Achievement of an MCID was assessed using the following previously established thresholds: 12-item Short Form health survey physical component summary (SF-12 PCS) 8.1, visual analogue scale (VAS) neck 2.6, VAS arm 4.1, Neck Disability Index (NDI) 8.5. Rates of MCID achievement were compared between groups.
Results The cohort included 192 patients of whom 102 received plating and 90 received no plating. Plating status was significantly associated with Charlson Comorbidity Index and insurance status. Operative duration and estimated blood loss were significantly greater for the plating group. Both groups demonstrated significant improvements at the majority of postoperative timepoints. Significant intergroup differences in PROM improvement were demonstrated for VAS neck and NDI at 6 weeks. Rates of MCID achievement differed significantly between groups for NDI at 6 weeks, and 12 weeks, and SF-12 PCS overall.
Conclusion Patients improved significantly in terms of pain, disability and physical function, regardless of plating status, and with the exception of early neck pain and disability, these improvements were similar between groups. Patients that underwent plating as part of their ACDF procedure achieved an MCID for physical function at lower rates overall.
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Affiliation(s)
- Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Prokopienko M, Sobstyl M. Subjective and Objective Quality-of-Life Assessment of Outcome Measures in Cervical Spine Surgery for Degenerative Changes. J Neurol Surg A Cent Eur Neurosurg 2021; 83:275-282. [PMID: 34897625 DOI: 10.1055/s-0041-1739227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cervical spine diskectomy is a commonly used procedure in degenerative disease of cervical spine surgery. However, it is difficult to assess the quality of life after this widely applied and variously modified procedure. This literature review presents cervical diskectomy results, according to various scales and measures in multidirectional surgical strategies. Using relevant databases, we tried to find the best treatment options for degenerative disk disease and the best method of quality-of-life assessment, searching for modalities that may influence the outcome.
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Affiliation(s)
- Marek Prokopienko
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warszawa, Poland
| | - Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warszawa, Poland
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Huang C, Mobbs R, Selby M, Phan K, Rao P. Adjacent-Level Ossification Development in Single-Level Standalone Anterior Cervical Discectomy and Fusion Versus Anterior Cervical Discectomy and Fusion With Plate. Global Spine J 2021; 11:292-298. [PMID: 32875862 PMCID: PMC8013952 DOI: 10.1177/2192568220902749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Retrospective case control study. OBJECTIVES Adjacent-level ossification development (ALOD) is a distinct form of adjacent segmental degeneration that has been recognized to occur after anterior cervical discectomy and fusion (ACDF). It is unclear whether ACDF with plate versus standalone has an effect on rates of ALOD. This retrospective case-control study aims to assess the rate of ALOD in a large series of patients undergoing ACDF with and without plate and factors causing ALOD. METHODS Data was collected for patients undergoing ACDF from January 2009 to July 2016. Data collected was from multiple centers and included demographic data, surgical data, radiological imaging at time of surgery, and serial follow-up imaging. The radiology for ALOD was independently reviewed. Cohorts were divided into ACDF with plate (Group P = plate) and ACDF without plate (Groups S = standalone) and outcomes were compared. RESULTS There were 260 patients with 138 (53%) in Group P and 122 (47%) in Group S. ALOD was observed in 15.3% of patients overall, 29% in group P and 2.8% in group S (P < .001). Following multivariate adjustment, statistically significant association was found between use of plate and ALOD (odds ratio = 12.8, 95% confidence interval = 3.52-45.45, P < .001). Plate-to-disc distance <5 mm was significantly associated with ALOD (odds ratio = 13.5, 95% confidence interval = 3.83-47.62, P < .001). CONCLUSION The use of anterior plate with ACDF was associated with ALOD. Plate-to-disc distance <5 mm was significantly associated with ALOD even after adjustment for confounding factors. We conclude utilization of standalone cages or cages with plate with more than 5 mm distance from adjacent disc to minimize ALOD.
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Affiliation(s)
- Christopher Huang
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia,Christopher Huang, St Vincents Hospital, 390 Victoria St, Darlinghurst, New South Wales 2010, Australia.
| | - Ralph Mobbs
- Prince of Wales Public and Private Hospitals, Randwick, New South Wales, Australia
| | - Michael Selby
- Adelaide Spine Clinic, North Adelaide, South Australia, Australia
| | - Kevin Phan
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Prashanth Rao
- Prince of Wales Private Hospital, Westmead Hospital, Westmead, New South Wales, Australia
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Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The design and ratio of the cortico-cancellous composition of allograft spacers are associated with graft-related problems, including subsidence and allograft spacer failure. Methods: The study analyzed stress distribution and risk of subsidence according to three types (cortical only, cortical cancellous, cortical lateral walls with a cancellous center bone) and three lengths (11, 12, 14 mm) of allograft spacers under the condition of hybrid motion control, including flexion, extension, axial rotation, and lateral bending,. A detailed finite element model of a previously validated, three-dimensional, intact C3–7 segment, with C5–6 segmental fusion using allograft spacers without fixation, was used in the present study. Findings: Among the three types of cervical allograft spacers evaluated, cortical lateral walls with a cancellous center bone exhibited the highest stress on the cortical bone of spacers, as well as the endplate around the posterior margin of the spacers. The likelihood of allograft spacer failure was highest for 14 mm spacers composed of cortical lateral walls with a cancellous center bone upon flexion (PVMS, 270.0 MPa; 250.2%) and extension (PVMS: 371.40 MPa, 344.2%). The likelihood of allograft spacer subsidence was also highest for the same spacers upon flexion (PVMS, 4.58 MPa; 28.1%) and extension (PVMS: 12.71 MPa, 78.0%). Conclusion: Cervical spacers with a smaller cortical component and of longer length can be risk factors for allograft spacer failure and subsidence, especially in flexion and extension. However, further study of additional fixation methods, such as anterior plates/screws and posterior screws, in an actual clinical setting is necessary.
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Kwon JW, Bang SH, Kwon YW, Cho JY, Park TH, Lee SJ, Lee HM, Moon SH, Lee BH. Biomechanical comparison of the angle of inserted screws and the length of anterior cervical plate systems with allograft spacers. Clin Biomech (Bristol, Avon) 2020; 76:105021. [PMID: 32416405 DOI: 10.1016/j.clinbiomech.2020.105021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Comparative studies of the biomechanical effects of plates of varying lengths and different screw insertion angles on allograft spacers are lacking. METHODS Finite element model analysis of a previously validated, three-dimensional, intact cervical spinal segment model of C3-6 was conducted in the present study. On the C5-6 segment, anterior discectomy and fusion were performed using allograft spacers and different combinations of anterior plates and screws. The biomechanical characteristics of combinations of short, medium, and maximal length plates with screw insertion angles of 0°, 8°, 16°, and 32° were analyzed. FINDINGS In flexion and extension, the risk of allograft spacer subsidence decreased as screw angles increased. Short plates with a screw insertion angle of 32° posed the lowest subsidence risk, similar to medium length plates with a screw insertion angle of 16°, in all motion conditions. The risk of bone yielding increased as plate length increased, but decreased as the screw insertion angle increased. INTERPRETATION Short plates with a large screw insertion angle (32°) showed the highest mechanical stability and load sharing of allograft spacers and the lowest risk of screw loosening. Accordingly, we recommend the use of a short plate and large screw insertion angle for anterior cervical discectomy and fusion.
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Affiliation(s)
- Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sun-Hee Bang
- Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, Gyeongnam, Republic of Korea
| | - Young-Woo Kwon
- Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, Gyeongnam, Republic of Korea
| | - Jae-Yong Cho
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hyun Park
- Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, Gyeongnam, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, Gyeongnam, Republic of Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Kwon JW, Bang SH, Park TH, Lee SJ, Lee HM, Lee SB, Lee BH, Moon SH. Biomechanical comparison of cervical discectomy/fusion model using allograft spacers between anterior and posterior fixation methods (lateral mass and pedicle screw). Clin Biomech (Bristol, Avon) 2020; 73:226-233. [PMID: 32062472 DOI: 10.1016/j.clinbiomech.2020.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study is to investigate effects of different fixation methods on the physical stress on allospacers, endplate-vertebral body, and implants using finite element model analyses. METHODS Stress distribution and subsidence risk according to the fixation methods under the condition of hybrid motion control were analyzed. The detailed finite element model of a previously validated, three-dimensional, intact cervical spinal segment model, with C5-C6 segmental fusion using allospacer, was used to evaluate the biomechanical characteristics of different fixation combinations, such as anterior plate/screws, lateral mass screw, and posterior pedicle screw. FINDINGS The load sharing on allospacers increased in extension in order of posterior pedicle screws (21.4%), lateral mass screws (31.5%), and anterior plate/screws (56.6%). lateral mass screw demonstrated the highest load sharing (68.1%) on the allospacer in flexion. The Peak von Mises stress of the allospacer was the lowest in flexion and axial rotation but the highest in extension with anterior plate/screws. Allospacer subsidence risk was the lowest in extension, lateral bending, and axial rotation with posterior pedicle screws but the lowest in flexion with anterior plate/screws. The bone-screw loosening risk was the lowest in all modes with posterior pedicle screws but the highest with anterior plate/screws. INTERPRETATION Posterior pedicle screws demonstrated the best mechanical stability of allospacer failure-subsidence and the lowest risk of screw loosening. Different motion restrictions depending on the fixation method should be considered for implant and allospacer safety.
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Affiliation(s)
- Ji-Won Kwon
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Goyang 10444, Republic of Korea
| | - Sun Hee Bang
- School of Biomedical Engineering, Inje University, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
| | - Tae Hyun Park
- School of Biomedical Engineering, Inje University, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
| | - Sung-Jae Lee
- School of Biomedical Engineering, Inje University, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Soo-Bin Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
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Zawy Alsofy S, Nakamura M, Ewelt C, Kafchitsas K, Fortmann T, Schipmann S, Suero Molina E, Welzel Saravia H, Stroop R. Comparison of stand-alone cage and cage-with-plate for monosegmental cervical fusion and impact of virtual reality in evaluating surgical results. Clin Neurol Neurosurg 2020; 191:105685. [PMID: 32000041 DOI: 10.1016/j.clineuro.2020.105685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/10/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES After ventral decompression of monosegmental cervical spondylotic stenosis, a stand-alone cage (SC) or cage-with-plate (CP) can be inserted for fusion. Postoperative radiological evaluation can be achieved using different imaging modalities. We retrospectively compared complications, as well as clinical and radiological outcomes for both fusion techniques, and analyzed the possible role of virtual reality (VR) in evaluating the postoperative results. PATIENTS AND METHODS One hundred seventeen patients were included (SC/CP: 54/63). Complications, as well as clinical and radiological outcomes of both fusion techniques were compared. Computed tomography (CT) scans were visualized via VR to measure the smallest cross-sectional area of the intervertebral neuroforamen in the lateral resection region, and to assess the degree of the intersegmental ossification. RESULTS There were no significant differences between the two fusion techniques regarding perioperative complication rates, fusion rates, or pain parameter (visual analogue scale (VAS) of arm pain, neck disability index). However, advantages regarding subsidence, kyphosis, and VAS of neck pain were found when using the CP versus SC. Using the VR technique, there was no significant difference between the two fusion techniques in the mean size of the cross-sectional area at the end of follow-up. CONCLUSION Due to the long-term advantages of CP fusion, we prefer a monosegmental cervical spinal fusion using CP. Reconstruction of postsurgical two-dimensional CT images into three-dimensional images, and the spatial and anatomical presentation in VR models, improved the evaluation of these postoperative results.
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Affiliation(s)
- Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany.
| | - Makoto Nakamura
- Department of Neurosurgery, Academic Hospital Köln-Merheim, Witten/Herdecke University, Köln, Germany
| | - Christian Ewelt
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | | | - Thomas Fortmann
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | | | | | - Heinz Welzel Saravia
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Ralf Stroop
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Stereotactic Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
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Jiang B, Tao Y, Chen H, Huang X. [Observation of stand-alone MC+polyether-ether-ketone (PEEK) Cage in anterior cervical double-level fusion for more than 2 years follow-up]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1151-1155. [PMID: 31512458 PMCID: PMC8355849 DOI: 10.7507/1002-1892.201901036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/16/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of stand-alone MC+polyether-ether-ketone (PEEK) Cage (single blade type) in anterior cervical double-level fusion for more than 2 years follow-up. METHODS A clinical data of 30 patients who were treated with anterior cervical fusion surgery with stand-alone MC+PEEK Cage (single blade type) between January 2013 and December 2016 and followed up for more than 2 years, was retrospectively analyzed. There were 16 males and 14 females, aged from 34 to 72 years with an average of 52.2 years. There were 16 cases of cervical spondylotic myelopathy, 8 cases of cervical spondylotic myelopathy, and 6 cases of traumatic cervical disc herniation. The continuous double segments were C 4, 5, C 5, 6 in 12 cases and C 5, 6, C 6, 7 in 18 cases; and the disease duration ranged from3 days to 24 months (mean, 12 months). Postoperative neck hematoma and wound healing were observed; dysphagia was assessed by Bazaz system; and bone fusion was assessed by Suk method. Before operation, at 1 week after operation, and at last follow-up, the Japanese Orthopaedic Association (JOA) score was used to evaluate the neurological recovery; the cervical X-ray film was performed to record the cervical curvature (C 2-C 7 Cobb angle), the height of the intervertebral space of the fusion segment, and to judge the occurrence of the fusion Cage subsidence. RESULTS No complication such as neck hematoma, incision infection, or esophageal fistula was found, primary healing of incisions was obtained in all cases. All patients were followed up 24-72 months (mean, 46 months). Neurological symptoms such as limb numbness and pain gradually disappeared after operation; during the follow-up period, the cervical curvature could be effectively maintained; dysphagia and internal fixation related complications such as displacement of Cages were not found. All patients obtained bony fusion from 3 to 8 months with an average time of 4.3 months. Compared with preoperative ones, the JOA score, intervertebral space height, and Cobb angle of cervical spine were significantly improved at 1 week after operation and at last follow-up ( P<0.05), but there was no significant difference between 1 week after operation and last follow-up ( P>0.05). CONCLUSION The application of stand-alone MC+PEEK Cage (single card type) in anterior cervical fusion can provide early cervical stability, effectively maintain the physiological curvature of cervical spine and the height of fusion intervertebral space.
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Affiliation(s)
- Bing Jiang
- Department of Orthopedics, Anqing Hospital Affiliated to Anhui Medical University, Anqing Anhui, 246003,
| | - Yuefeng Tao
- Department of Orthopedics, Anqing Hospital Affiliated to Anhui Medical University, Anqing Anhui, 246003, P.R.China
| | - Haiyun Chen
- Department of Orthopedics, Anqing Hospital Affiliated to Anhui Medical University, Anqing Anhui, 246003, P.R.China
| | - Xiaodong Huang
- Department of Orthopedics, Anqing Hospital Affiliated to Anhui Medical University, Anqing Anhui, 246003, P.R.China
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11
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Etemadifar M, Andalib A, Shafiee H, Samani MK. Comparison of the outcomes of cage-stand-alone with cage-with-plate fixation in one level and two levels for treating cervical disk diseases. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:170-174. [PMID: 30443136 PMCID: PMC6187895 DOI: 10.4103/jcvjs.jcvjs_74_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) surgery is an accepted method for many spinal cord abnormalities. The purpose of this study was to evaluate the outcomes of treating patients with spinal cord lesions at one level or two levels through ACDF with cage-stand-alone (ACDF-CA) and ACDF with cage-with-plate fixation (ACDF-CP) surgery and comparing these results with each other. Methods: In this prospective, cross-sectional, descriptive study, eighty patients undergoing ACDF surgery were enrolled according to the inclusion and exclusion criteria. Demographic data, before and after surgery findings, and clinical symptoms were investigated. Data were collected by means of visual analog scale (VAS) and Neck Disability Index (NDI) questionnaires. The adverse effects and surgical outcomes were evaluated based on Odom's criteria and patients’ satisfaction. The collected data of the groups were then compared and assessed. Results: There was no significant difference between the groups in regards of gender, age, duration of surgery to visit, surgical level, preoperative and postoperative VAS and cervical range of motion, preoperative NDI, results based on Odom's criteria, and satisfaction of patients (P > 0.05). The VAS, NDI, and range of motion scores were significantly reduced in the four groups after the operation compared to the preoperative stage. Postoperative NDI scores in the ACDF-CA group at one level were significantly lower than other groups (P < 0.05). Conclusion: Both of the methods revealed acceptable outcomes in comparison to the preoperative stage, and despite some minor differences, there are generally no significant differences in outcomes and complications.
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Affiliation(s)
- Mohammadreza Etemadifar
- Department of Orthopedic Surgery, Al Zahra Educational Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Andalib
- Department of Orthopedic Surgery, Al Zahra Educational Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Shafiee
- Department of Orthopedic Surgery, Al Zahra Educational Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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