Increased Fusion Rates With Cervical Plating for Three-Level Anterior Cervical Discectomy and Fusion

Wang, Jeffrey C.; McDonough, Paul W.; Kanim, Linda E.A.; Endow, Kevin K.; Delamarter, Rick B.

doi:10.1097/00007632-200103150-00015

Cited by 315 publications

(122 citation statements)

References 19 publications

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“…19 However, multilevel fusions are associated with high pseudarthrosis rates, iliac crest donor site morbidity, persistent postoperative dysphagia, and the development of adjacent-level degeneration and disease. 2,8,11,17,20 Arthroplasty may be the solution to these comorbidities. Sekhon 15 was the first to report that cervical arthroplasty in the setting of cervical myelopathy was a safe and excellent alternative to fusion.…”

Section: Discussionmentioning

confidence: 99%

Multilevel cervical arthroplasty with artificial disc replacement

Cardoso¹,

Rosner²

2010

FOC

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Object In this study, the authors review the technique for inserting the Prestige ST in a contiguous multilevel cervical disc arthroplasty in patients with radiculopathy and myelopathy. They describe the preoperative planning, surgical technique, and their experience with 10 patients receiving a contiguous Prestige ST implant. They present contiguous multilevel cervical arthroplasty as an alternative to multilevel arthrodesis. Methods After institutional board review approval was obtained, the authors performed a retrospective review of all contiguous multilevel cervical disc arthroplasties with the Prestige ST artificial disc between August 2007 and November 2009 at a single institution by a single surgeon. Clinical criteria included patients who had undergone a multilevel cervical disc arthroplasty performed for radiculopathy and myelopathy without the presence of a previous cervical fusion. Between August 2007 and November 2009, 119 patients underwent cervical arthroplasty. Of the 119 patients, 31 received a Hybrid construct (total disc resection [TDR]–anterior cervical decompression and fusion [ACDF] or TDR-ACDF-TDR) and 24 received a multilevel cervical arthroplasty. The multilevel cervical arthroplasty group consisted of 14 noncontiguous and 10 contiguous implants. This paper examines patients who received contiguous Prestige ST implants. Results Ten men with an average age of 45 years (range 25–61 years) were treated. Five patients presented with myelopathy, 3 presented with radiculopathy, and 2 presented with myeloradiculopathy. Twenty-two 6 × 16–mm Prestige ST TDRs were implanted. Six patients received 2-level Prestige ST implants. Five patients received TDRs at C5–6 and C6–7, and 1 patient received TDRs at C3–4 and C4–5. One patient received a TDR at C3–4, C5–6, and C6–7 where C4–5 was a congenital block vertebra. Three patients (2 with 3-level disease and 1 with 4-level disease) received contiguous Prestige ST implants as well as a Prevail ACDF as part of their constructs. The mean clinical and radiographic follow-up was 12 months. There has been no case of screw backout, implant dislodgment, progressive kyphosis, formation of heterotopic bone, evidence of pseudarthrosis at the Prevail levels, or development of symptomatic adjacent level disease. Conclusions Multilevel cervical arthroplasty with the Prestige ST is a safe and effective alternative to fusion for the management of cervical radiculopathy and myelopathy.

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Section: Discussionmentioning

confidence: 99%

Multilevel cervical arthroplasty with artificial disc replacement

Cardoso¹,

Rosner²

2010

FOC

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“…2,6,13,15,17,18,20 Despite the widespread application of anterior plates, clinicians have not been able to eliminate the development of pseudarthrosis. 11,24,25 Complaints associated with a cervical nonunion include persistent or recurrent axial neck pain, radiculopathy, and myelopathy. Development of a pseudarthrosis has also been associated with kyphotic deformity, potentially leading to pain and neurological deficits.…”

Section: Rationalementioning

confidence: 99%

Management of anterior cervical pseudarthrosis

Kaiser

Mummaneni

Matz

et al. 2009

SPI

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Object The objective of this systematic review was to use evidence-based medicine to identify the best methodology for diagnosis and treatment of anterior pseudarthrosis. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to pseudarthrosis and cervical spine surgery. Abstracts were reviewed, after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Evaluation for pseudarthrosis is warranted, as there may be an association between clinical outcome and pseudarthrosis. The strength of this association cannot be accurately determined because of the variable incidence of symptomatic and asymptomatic pseudarthroses (Class III). Revision of a symptomatic pseudarthrosis may be considered because arthrodesis is associated with improved clinical outcome (Class III). Both posterior and anterior approaches have proven successful for surgical correction of an anterior pseudarthrosis. Posterior approaches may be associated with higher fusion rates following repair of an anterior pseudarthrosis (Class III). Conclusions If suspected, pseudarthrosis should be investigated because there may be an association between arthrodesis and outcome. However, the strength of this association cannot be accurately determined. Anterior and posterior approaches have been successful.

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“…Numerous published studies have shown considerable variation in the incidence of non-union. The lowest rates (3-20%) are reported in patients after singlelevel procedures [2,8,12,16,19,22,26,27,29,30], while the incidence of pseudoarthrosis increases to 44% with a greater number of levels fused [4,12,16,22,26,27,30,34,35,36,38,39].…”

Section: Petr Suchomel Pavel Barsa Pavel Buchvald Adam Svobodnik Eva mentioning

confidence: 99%

“…The lower fusion rates have been attributed to the increased amount of graft material and number of interfaces that must be consolidated with multi-level surgery, as well as the increased compressive loads on the multiple graft sites resulting in micro-motions [35]. Although non-fusion is not typically associated with poor clinical outcomes, its significant role in postoperative morbidity is well documented [4,5,10,14,23].…”

Section: Petr Suchomel Pavel Barsa Pavel Buchvald Adam Svobodnik Eva mentioning

confidence: 99%

Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern

et al. 2004

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IntroductionAnterior cervical discectomy and fusion (ACDF) in the subaxial cervical spine as originally suggested by Badgley in 1939 and described by Robinson and Smith in 1955 [28] and Cloward in 1958 [8] has established itself as a method of treatment for patients with neural compression by disc material or osteophytes.Although the interbody location of applied bone graft is a favourable healing environment, because of the relatively large surface area of subchondral cancellous bone Abstract Background. The purpose of this prospective semi-randomised comparative study was to compare fusion rates, course of fusion, and occurrence of collapse and subsidence of autologous and allogenic bone grafts in instrumented anterior cervical fusion. The number of fused levels and the smoking status were investigated as potential factors influencing the bone-healing process. No similar prospective study on instrumented anterior cervical discectomy and fusion was found in the literature. Methods. Seventy-nine consecutive patients were operated on using the Smith-Robinson technique with a single instrumentation system at one or two levels. Seventy-six cadaverous fibular bone grafts and 37 autologous iliac-crest bone grafts were inserted. All patients were followed up for at least 2 years. Results.The radiographs obtained during the follow-up were analysed, and showed no statistical difference in fusion and collapse rate between autografts and allografts. Allografts showed significantly longer time to union. No case of graft migration was observed. No difference was found between fusion and collapse rate with respect to the number of fused levels in general, but greater time to union was seen in two-level fusions. When one-and two-level subgroups were compared, there was no evidence of any significant difference in fusion or collapse rates between autografts and allografts, and the healing process took longer in allogenic grafts. Smoking status did not alter any of the fusion or collapse rates, or the course of bone fusion.Conclusions.This study demonstrates that allografts are suitable substitutes for autografts in instrumented ACDF. Prolonged time to union observed in allogenic bone grafts does not seem to be an important factor in instrumented procedures. Two-level grafting does not imply a significantly lower fusion rate, but longer time to union can be expected than with single-level instrumented procedures in both allograft and autograft subgroups. Our relatively small number of patients may not have been sufficient to decipher significant differences between smokers and nonsmokers in the rate or course of fusion as previously reported.

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Increased Fusion Rates With Cervical Plating for Three-Level Anterior Cervical Discectomy and Fusion

Cited by 315 publications

References 19 publications

Multilevel cervical arthroplasty with artificial disc replacement

Multilevel cervical arthroplasty with artificial disc replacement

Management of anterior cervical pseudarthrosis

Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern

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