The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion

Burkhardt, Jan‐Karl; Mannion, Anne F.; Marbacher, Serge; Kleinstück, Frank; Jeszenszky, Dezsö; Porchet, François

doi:10.1007/s00586-014-3456-y

Cited by 20 publications

(16 citation statements)

References 20 publications

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“…We previously reported that ACDF with plating had better radiologic outcome than stand-alone cage groups 13) . In that study, we suggested that anterior plating may play a key role in the support of anterior inter-body height 2) . However, not a few studies have mentioned ACDF with SAC is a clinically/radiologically satisfactory procedure 11 16 17 18) .…”

Section: Introductionmentioning

confidence: 83%

Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages

Kim

Hyun

Choi

et al. 2016

J Korean Neurosurg Soc

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ObjectiveThe purpose of this study was to evaluate long-term follow-up radiologic/clinical outcomes of patients who underwent anterior cervical discectomy and inter-body fusion (ACDF) with stand-alone cages (SAC) in a single academic institution.MethodsTotal 99 patients who underwent ACDF with SAC between February 2004 and December 2012 were evaluated retrospectively. A total of 131 segments were enrolled in this study. Basic demographic information, radiographic [segmental subsidence rate, fusion rate, C2–7 global angle, and segmental angle changes)/clinical outcomes (by Odom's criteria and visual analog score (VAS)] and complications were evaluated to determine the long-term outcomes.ResultsThe majority were males (55 vs. 44) with average age of 53.2. Mean follow-up period was 62.9 months. The segmental subsidence rate was 53.4% and fusion rate was 73.3%. In the subsidence group, anterior intervertebral height (AIH) had more tendency of subsiding than middle or posterior intervertebral height (p=0.01). The segmental angle led kyphotic change related to the subsidence of the AIH. Adjacent segmental disease was occurred in 18 (18.2%) patients. Total 6 (6%) reoperations were performed at the index level. There was no statistical significance between clinical and radiological outcomes. But, overall long-term clinical outcome by Odom's criteria was unsatisfactory (64.64%). The neck and arm VAS score were increased by over time.ConclusionLong-term outcomes of ACDF with SAC group were acceptable but not satisfactory. For optimal decision making, more additional comparative long-term outcome data is needed between ACDF with SAC and ACDF with plating.

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Section: Introductionmentioning

confidence: 83%

Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages

Kim

Hyun

Choi

et al. 2016

J Korean Neurosurg Soc

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“…The relationships between the demographic data and radiologic/clinical outcome had no statistical significance. Previous literature demonstrated that gender, age, level of surgery, cage height and BMD had no significance as outcome factors of the ACDFI surgery [1,2] .…”

Section: Discussionmentioning

confidence: 99%

“…This procedure involved removing the symptomatic disc from an anterior approach without placement of a bone graft. Early studies demonstrated fusion rates with Anterior Cervical Discectomy (ACD) were similar to those of procedures of anterior cervical discectomy and fusion (ACDF) using bone graft [1,2,15] . This extra step has been proposed to promote bony fusion maximizing stability and maintaining 1927 disc space height reducing risk of foraminal stenosis.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study for Cervical Spinal Fusion Using Cervical Cages with and Without Bone Granules

Mohamed

Abdelwahed²

2018

The Medical Journal of Cairo University

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Background: Cervical spinal fusion is a surgical procedure that joins selected bones in the cervical spine.The anterior approach to the cervical spine was developed for treatment of cervical disc, it involves removing the symptomatic disc from an anterior approach without placement of a bone graft. Early studies demonstrated fusion rates with Anterior Cervical Discectomy (ACD) were similar to those of procedures of anterior cervical discectomy and fusion (ACDF) using bone graft.The anterior cervical discectomy and fusion with instrumentation (ACDFI) technique involves the additional stabilization of the cervical spine & graft with instrumentation.Cages were introduced to be used with either autologous or synthetic bone grafts, promoting stability and encouraging fusion. Comparing to graft alternatives, cage interbody implants have better biomechanical properties, designed to maximise biocompatibility and reduced graft dislodgements, increased fusion rates, and decreased foraminal stenosis. However, placement of implants introduces hardware-related complications.Aim of the Study: This prospective study aims to compare the results of ACDFI using cages with & without synthetic bone granules evaluating the outcomes, fusion and associated morbidities.Patients and Methods: Prospective study of 42 patients operated upon between 2012 and 2014 in Cairo University Hospitals & Beni Sueif University Hospital with ACDFI using cervical cages. Patients were divided into two groups: -Group (A) 22 patients operated by ACDFI with placement of cages only -Group (B) 20 patients operated by ACDFI with placement of cages and synthetic bone granules.Both groups underwent postoperative clinical follow-up for an average of 12 months, and results were evaluated according to radiographic evidence of fusion and Fisher exact probability test was used to compare fusion of both groups. We made considerations for patient's age, sex, osteoporosis, and smoking habits. We recorded fusion rates, cervical align-ment, postoperative complications & patient satisfaction using Visual Analogue Score (VAS).Results : 42 patients were included in the study. The mean age was 46, 18 of them were females and 24 were males. 29 patients had single level discs and 13 patients had two levels.One year follow-up fusion rates that were achieved in group (A) were 81.8% while group (B) reached 95%. One year follow up on achievement of alignment of cervical spine was 90.9% of patient's in group (A) and in group (B) was 95% of cases.There were no problems regarding surgical technique or dislodgment in both techniques. Only in one patient in group (A) CSF leak developed and resolved. One patient in group (B) developed a keloid at incision site.Conclusion: Fusion rate is one of several factors that guide surgical decision making for cases requiring ACDFI. Fusion rate is significantly higher in group (B) using cages filled with synthetic bone granules than in group (A) with cages only. Age, sex, osteoporosis and smoking status have not given significantly different results ...

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“…Standalone strut graft has high rate of complications such as graft subsidence, dislodgement, non-union and donor site morbidities. Anterior plating has inherent deficiencies like plate loosening, screw pullout, breakage, trachea-oesophagal irritation has increased operation time [2,3] . Intervertebral cages have been postulated to avoid some of these difficulties due to their selffixing construct, ability to contain graft or graft substitute in it.…”

Section: Introductionmentioning

confidence: 99%

Clinico- radiological evaluation of stand alone cage in degenerative cervical spine

Goregaonkar¹,

Srinivas²,

Shukla³

et al. 2018

Int. J. Orthop. Sci.

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Age-related cervical degeneration is evident in over 50% of the middle-aged population and is the most common cause of neural dysfunction. Cervical spine anteriorly stabilised by use of anterior cervical plate, strut graft, standalone cage or combination to maintain curvature and facilitate arthrodesis. Standalone strut graft has high rate of complications such as graft subsidence, dislodgement, non-union and donor site morbidities. Anterior plating has inherent deficiencies like plate loosening, screw pull out, breakage, trachea-oesophagal irritation has increased operation time. Intervertebral cages avoid some of these difficulties due to their self-fixing construct, ability to contain graft or graft substitute in it. The aim of this study is to compare the clinical and radiological outcome of stand alone cage in single level anterior cervical discectomy and fusion used to treat cervical degenerative disc disease. We performed a prospective study of 30 patients treated with stand alone -cage in single level cervical disc disease. The clinical and radiological outcomes were evaluated which includes visual analogue scale, Japanese orthopaedic association, neck disability index, neurological status, cobbs angle, fusion and subsidence. Through Smith-Robbinson approach ACDF was done. Patients were assessed up. There is a significant improvement of symptoms reflected by VAS score for pain and functional scores like JOA and NDI. Bony fusion was achieved in 29 patients with a rate of 96.7%. Cervical spine alignment was restored in all patients with kyphosis occurring in 23.3% of patients. Cage subsidence rate was 26.7% with majority occurring in C5-6 level. Anterior cervical discectomy and inter body fusion using stand alone cervical cages can be considered a safe and equally efficient alternative to iliac crest auto graft and anterior cervical plating by providing adequate stability. Stand-alone cage can restore physiologic disc height, provide immediate load bearing support to the anterior column and facilitate arthrodesis.

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The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion

Cited by 20 publications

References 20 publications

Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages

Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages

Comparative Study for Cervical Spinal Fusion Using Cervical Cages with and Without Bone Granules

Clinico- radiological evaluation of stand alone cage in degenerative cervical spine

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