Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

Wilke, Hans–Joachim; Kettler, Annette; Claes, Lutz

doi:10.1007/s005860000168

Cited by 78 publications

(53 citation statements)

References 35 publications

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“…Bilateral neural foramina were significantly decompressed up to 1 year after placement [4]. Biomechanical evaluation suggests that hollow carbon fiber wedge cages have the highest stabilizing effect and resistance to subsidence due to its geometry versus titanium mesh cylinders and threaded cages [2,28]. Another study of eight different cervical cage designs (not including the current spacer), however, noted that design variations may be of little importance [15].…”

Section: Rationale For Carbon Fiber Cagesmentioning

confidence: 99%

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A prospective randomized study comparing a cervical carbon fiber cage to the Smith–Robinson technique with allograft and plating: up to 24 months follow-up

2005

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IntroductionSymptomatic cervical disc herniation and degeneration are routinely treated by anterior decompression; however, the options for subsequent fusion and stabilization are numerous and ever increasing. The original anterior discectomy and fusion by Cloward [11] described interbody fusion with an autograft bone dowel. This was followed by the technique of Smith-Robinson describing the harvest of a rectangular tricortical iliac bone Abstract Introduction: Intervertebral carbon fiber cages may reduce graft collapse and promote bony fusion. Their safety and efficacy in the cervical spine have been investigated; however, no study has compared the outcomes of anterior cervical decompression and placement of a carbon fiber cage with placement of allograft and plate. Methods: Forty consecutive patients who met inclusion criteria were enrolled and randomized to anterior cervical discectomy with carbon fiber cage alone (n=20) or with allograft with plating (n=20). Clinical and radiographic evaluations were performed at baseline and at 6 weeks, 3, 6, 12 and 24 months. Neck and arm pain as well as neck disability index (NDI) were assessed at every visit. The Short Form (SF)-36 was completed prior to operation and at 12-month intervals. Cervical radiographs were evaluated pre-op and at every follow-up for evidence of fusion and instability. Results: No significant difference was found between the two randomized groups with respect to pre-operative age (mean 50 years), sex, employment status, duration of pain or cervical levels affected. The mean followup period was 14 months (range, 6-26 months). The clinical pain and disability improvements were similar for both treatments. Post-operative donor site pain was only present in the cage group, but not of significant long-term disability. At up to 24 months, NDI scores were significantly improved in both groups when compared with baseline. At 12 and 24 months, all SF-36 questionnaire responses were also improved in both the treatment groups. However, there was no statistically significant difference in outcomes between the two groups at any time. The fusion rate was 100% in both groups by 12 and 24 months, without evidence of instability. There were no differences in complications between both groups. Conclusions: The outcomes after cervical decompression and placement of a carbon fiber cage appear to be similar to cervical decompression with allograft and plating by the Smith-Robinson technique.

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Section: Rationale For Carbon Fiber Cagesmentioning

confidence: 99%

“…Carbon fiber implants are at least as stiff and elastic as cortical bone resulting in a physiologic distribution of load to the bone graft [21]. Consequently, this may stimulate bone formation and improve fusion [16,28].…”

mentioning

confidence: 99%

A prospective randomized study comparing a cervical carbon fiber cage to the Smith–Robinson technique with allograft and plating: up to 24 months follow-up

2005

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“…Reconstruction of the defect after discectomy is still a matter of debate among spine surgeons. Autogenous tricortical iliac graft, femoral ring allograft, bone cement, artificial disc, PEEK cages and titanium cages have all been applied [2,4,7,12,13,17,23]. However, the choices become limited in fourlevel disease.…”

Section: Introductionmentioning

confidence: 99%

Four-level anterior cervical discectomies and cage-augmented fusion with and without fixation

2012

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Purpose Anterior cervical decompression and fusion is a well-established procedure for the treatment of cervical spinal canal stenosis. In this study, we evaluated the necessity of spinal instrumentation after four-level anterior cervical decompression and cage fusion. Methods From January 2006 until August 2008, 25 patients (8 females and 17 males) (mean age 63.9 ± 7.9 years) suffering from spinal stenosis C3-C7 underwent anterior decompression and interbody fusion. The patients were divided into two groups. Four-level discectomy and cage fusion was performed in all patients. In group A including nine patients, posterior instrumentation with a lateral mass screw-rod system was added, while in group B including 16 patients, additional instrumentation was not performed. The mean duration of follow-up was 48.6 months (average 25-67 months). Results Clinically, the mean value for the Neck Disability Index improved from 40 ± 23.25 at presentation to 16.31 ± 15.09 at the final follow-up. The difference between the two groups was statistically not significant. Radiologically, the criteria for solid bony fusion were achieved successfully in all patients of group A, and in 87.5 % of patients in group B. The difference between the two groups was statistically not significant. The fused segment was then evaluated in the sagittal radiographs as regards the height and the lordosis angle. The loss in the height as well as the loss in the lordosis angle was more when posterior instrumentation was not added. However, the difference between the two groups was not statistically significant. Conclusion Stand-alone intersomatic cage fusion is an acceptable line of treatment for four-level cervical disc disease, both clinically and radiologically. Although the addition of posterior instrumentation yields better radiological results, the difference does not reach the statistical significance level.

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“…With the cage implantation all of the donor site complications, and the possibility of late-time bone graft resorption or compression is avoidable 12,14,15,16 . The bony healing throughout the spacer is similar to the iliac crest bone graft procedure 17,18 . Solid fusion between the osteotomized parts can be shown about 12 months after the implantation.…”

Section: Magyar Biomechanikai Kongresszus -A-0047mentioning

confidence: 88%

Minimal invasive surgical techniques for the treatment of pathologic lesions, situated in the midline of the spinal canal

Papp¹,

Vajda²,

Veres³

et al. 2010

Biomech Hung

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Objective: Multilevel laminectomy for exposing the spinal canal to remove spinal cord lesions has been widely used in spine surgery. Destruction of the dorsal structures of the spinal column, detachment of the longitudinal musculature, resection of the vertebral arches, and injury of the joint capsules and ligaments are responsible most of short and late-time complications. Spinal deformities, instability, subluxation, invasion of haematoma and scar tissue into the spinal canal are the most often mentioned complications in the literature. The author main objective was to develop and summarize the novel minimally invasive techniques suitable for exploring and treating different pathologies, located in the midline of the spinal canal with preservation of the stability of the spine.Methods: 38 patients were operated on with intramedullary laesions located from CIII to LI level of the spine with the newly developed multilevel spinous process splitting and distracting laminotomy technique. The dorsal, paraspinal musculature was not detached from the vertebras. With splitting and distracting the spinous processes and the vertebral arches, the vertebral joints, the joint capsules and the ligaments were not injured, these structures remained mostly intact. To achieve a moderate enlargement and decompression of the spinal canal, complementary intervertebral spacer insertion was performed in some cases. The patients were followed with regular MRI, CT scans and neurological examinations.Results: Adequate surgery of the lesions located intramedullary was achieved in all patients using our new procedures. Moderate enlargement and permanent decompression of the spinal canal was achieved with the insertion of homologues tricortical iliac crest bone graft or heterologous PEEK spacer. The numbers of split laminae were 3 to 6. The split spinous processes were closed directly to each other in 24 patients. In 9 cases a tricortical bone graft and in 5 cases a heterologous PEEK spacer was inserted between the facing bony parts.The incidence of postoperative local pain was lower, within acceptable limits, and early mobilization was allowed. The average length of hospital stay was shorter too. The postoperative followup CT scans demonstrated bony healing, with the inserted graft or cage between the osteotomized faces. No compression or dislocation of the spacer was seen. Instability was not detected in any of the patients by fl exion or extension lateral radiographs. MINIMAL INVASIVE SURGICAL TECHNIQUES FOR MAGYAR BIOMECHANIKAI KONGRESSZUS -A-0047Conclusion: The split laminotomy surgical procedure with or without complementary auto-or heterologous grafting method fulfi lls the requirements of other laminotomy techniques. This technique is suitable for removing intramedullary tumors, and the posterior stabilizing structures of the spine, as the vertebral laminae and the longitudinal musculature are completely preserved, nearly anatomical situation can be maintained. Leaving the longitudinal paraspinal musculature innervations i...

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Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

Cited by 78 publications

References 35 publications

A prospective randomized study comparing a cervical carbon fiber cage to the Smith–Robinson technique with allograft and plating: up to 24 months follow-up

A prospective randomized study comparing a cervical carbon fiber cage to the Smith–Robinson technique with allograft and plating: up to 24 months follow-up

Four-level anterior cervical discectomies and cage-augmented fusion with and without fixation

Minimal invasive surgical techniques for the treatment of pathologic lesions, situated in the midline of the spinal canal

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