Anterior decompression and hybrid reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of three-level cervical spondylotic myelopathy

Zhou, Jian; Li, Xilei; Zhao, Xiaogang; Lin, Hong; Dong, Jian

doi:10.1016/j.jocn.2017.04.022

Cited by 10 publications

(7 citation statements)

References 32 publications

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“…For clinical outcomes, the Japanese Orthopedic Association (JOA) scoring system is used to assess the improvement rate of relevant segmental function, and the visual analog scale (VAS) and the neck disability index (NDI) are used to compare the degree of pain before and after surgery. Numerous studies have demonstrated an overall improvement in criteria scores immediately after surgery and at next follow-up, accompanied by disappearance of neurological symptoms [ 14 , 23 , 24 , 28 , 45 , 48 – 50 ]. TMC subsidence is another phenomenon frequently observed in the postoperative period.…”

Section: The Radiological and Clinical Assessment Of Tmcsmentioning

confidence: 99%

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Anterior Cervical Corpectomy and Fusion and Anterior Cervical Discectomy and Fusion Using Titanium Mesh Cages for Treatment of Degenerative Cervical Pathologies: A Literature Review

et al. 2018

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Anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) are 2 effective and safe surgical treatments of degenerative cervical pathologies and are associated with a high percentage of excellent clinical outcomes when a graft or device must be used during the surgery, such as an allograft, autograft, nano-hydroxyapatite/polyamide cages, poly-ether-ether-ketone (PEEK) cages, and titanium mesh cages (TMCs). Although TMCs have been used in cervical surgeries for almost 2 decades, no specific reviews have been performed introducing the state of this material. Thus, in the present review, we discuss the status of using TMCs in anterior cervical surgeries.Studies that tested the usage of TMCs in treating degenerative cervical pathologies were included in this review. The development and progress of TMCs, the biomechanical analysis of TMCs, the radiological and clinical assessment of TMCs, the advantages and disadvantages of using TMCs, and their prospects for future applications as a device of ACCF and ACDF in treating degenerative cervical pathologies are discussed.Studies included in this review showed that TMCs can provide sufficient biomechanical stability. Furthermore, the TMCs used in anterior cervical fusion avoid the donor-site morbidity and achieve a solid bony fusion. However, there are some shortcomings. The structural characteristics and the design of TMCs cause the TMC subsidence rate to remain high, thus resulting in multiple related complications.We believe that due to the virtues of TMCs, they are worthy of application and promotion. However, the structure of TMCs should be further optimized to reduce the TMC subsidence rate and subsidence-related complications, ultimately achieving excellent clinical results.

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Section: The Radiological and Clinical Assessment Of Tmcsmentioning

confidence: 99%

“…For bone fusion, most studies have shown that almost all patients using TMCs achieved solid bone fusion at their final follow-up [ 14 , 20 , 23 – 25 , 28 , 45 , 51 , 54 – 56 ]. Furthermore, the mean time to achieve solid fusion was 5~7 months [ 20 , 50 , 57 , 58 ].…”

Section: The Radiological and Clinical Assessment Of Tmcsmentioning

confidence: 99%

Anterior Cervical Corpectomy and Fusion and Anterior Cervical Discectomy and Fusion Using Titanium Mesh Cages for Treatment of Degenerative Cervical Pathologies: A Literature Review

et al. 2018

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“…[1,4,8,16,30,44] Another anterior surgical approach is HDF, namely ACCF combined with ACDF. [3,12] Generally, the most severely compressed vertebral body is removed in HDF, and discectomy is performed only at the less compressed sites, which reduces the number of resected vertebral bodies. While achieving full decompression, this approach also reduces damage to the anterior vertebral column, which shortens the length of the bone graft, reduces the graft-host bone interface, and theoretically, lowers the probability of upper false joint formation.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] An anterior, posterior, or combined anterior-posterior approach can be employed according to the clinical situation and the experience of surgeons, and each approach has its unique advantages and disadvantages. [3][4][5][6][7][8][9][10][11][12] The anterior techniques such as multilevel anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), and hybrid decompression and fusion (HDF) have been proved to be reliable and effective in spinal cord decompression, and sagittal alignment restoration and maintenance thus achieved a good clinical outcome. To increase the stability of cervical vertebrae and the fusion rate of bone graft after surgery, anterior cervical titanium plate fixation is widely used.…”

Section: Introductionmentioning

confidence: 99%

A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

Liu

Yang

Zhang

2021

Preprint

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Background: The decision to treat multilevel cervical spondylotic myelopathy (MCSM) remains controversial. The purpose of this study is to compare the biomechanical characteristics of the intervertebral discs at the adjacent segments and internal fixation, and to provide scientific experimental evidence for surgical treatment of MCSM. Methods: An intact C2-C7 cervical spine model was developed and validated. Four additional models were developed from the fusion model, including multilevel anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), hybrid decompression and fusion (HDF), and mACDF with cage alone (mACDF-CA). Biomechanical characteristics on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed. Results: Of the four models, stress on the upper (C2/3) adjacent intervertebral disc was the lowest in the mACDF-CA group and highest in the ACCF group. Stress on the intervertebral discs at adjacent segments was higher for the upper C2/3 than the lower C6/7 intervertebral disc. In all models, the mACDF-CA group had the lowest stress on the intervertebral disc, while the ACCF group had the highest stress. In the three surgical models with titanium plate fixation (mACDF, ACCF, and HDF), the ACCF group had the highest stress at the titanium plate-screw interface, while the mACDF group had the lowest stress Conclusion: Among the four anterior cervical reconstructive techniques for MCSM, mACDF-CA makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment degeneration (ASD) after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.

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“…24 C-TDR may diminish the stress on adjacent discs and thereby, potentially reducing the rate of ASD, which is estimated to be 3% per year. 25 Compensatory hyperkinesis is less likely to occur in adjacent segments if the segment involved in surgery maintains mobility. 16 A systematic review by Lu et al had shown that the Rom at levels C2 -C7 was signi cantly higher than ACDF after HC, and adjacent upper ROM and lower ROM were signi cantly lower.…”

Section: Discussionmentioning

confidence: 99%

Anterior Hybrid Construction of Multilevel Cervical Disc Disease and Spondylotic Spinal Stenosis: Surgical Results and Factors Affecting Adjacent Segment Problems

Yılmaz

Yücesoy

Erbayraktar

et al. 2021

Preprint

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Objective: We aimed to evaluate reliability, radiological outcomes and the impacts of anterior cervical hybrid construction on the adjacent segments for the multilevel cervical degenerative disc disease (mCDDD) and spondylotic spinal stenosis (SSS).Methods: A retrospective analysis was performed using data extracted from the medical files of 195 patients (105 males, 90 females; mean age: 47.7 years). From 2008 to 2018, these patients underwent anterior cervical hybrid construction for symptomatic contiguous at least 2-level cervical degenerative disc diseases and cervical spondylosis. Clinical and radiological data including Neck Disability Index (NDI), Visual Analogue Scale (VAS), local cervical degenerative disk disease in adjacent segments on magnetic resonance imaging (MRI) views and complications were reviewed. Results: The mean clinical and radiological follow-up was 45.2 months (range: 24 to 102). Radiculopathy and/or myelopathy were the main clinical problems in all patients. The mean VAS scores of HC for arm pain were 7.4±0.8 preoperatively; 2.8±0.6, 1 month after surgery; 2.3±0.6, 6 months after surgery; 1.8±0.6, 12 month after surgery; and 1.6±0.6, 24 months after surgery. The mean NDI scores (mean±SD) of HC significantly improved after surgery (on admission, 57.2±5.5%; 1 month after surgery, 27.35±5.3%; 6 month after surgery, 21.43±2.8%; 12 months after surgery, 21.9±2.3%; 24 months after surgery, 20.6±2.6%, p=0.006). Hoarseness and dysphagia were the most common complications and osteophyte formation was the most frequent radiographic change.Conclusion: Anterior cervical hybrid construction appears to be an acceptable option in the management of multilevel cervical degenerative disc diseases and spondylotic spinal stenosis.

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Anterior decompression and hybrid reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of three-level cervical spondylotic myelopathy

Cited by 10 publications

References 32 publications

Anterior Cervical Corpectomy and Fusion and Anterior Cervical Discectomy and Fusion Using Titanium Mesh Cages for Treatment of Degenerative Cervical Pathologies: A Literature Review

Anterior Cervical Corpectomy and Fusion and Anterior Cervical Discectomy and Fusion Using Titanium Mesh Cages for Treatment of Degenerative Cervical Pathologies: A Literature Review

A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

Anterior Hybrid Construction of Multilevel Cervical Disc Disease and Spondylotic Spinal Stenosis: Surgical Results and Factors Affecting Adjacent Segment Problems

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