Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients

Object The need for interbody fusion or stabilization after anterior cervical microdiscectomy is still debated. The objectives of this prospective randomized study were 1) to examine whether combined interbody fusion and stabilization is more beneficial than microdiscectomy only (MDO) and 2) if fusion is found to be more beneficial than MDO, to determine which is the best method of fusion by comparing the results achieved using autologous bone graft (ABG), polymethylmethacrylate (PMMA) interposition, and threaded titanium cage (TTC). Methods A total of 125 patients with a single-level cervical disc disease were included in this prospective study. All patients were randomized and assigned to one of the four following groups: Group 1 (33 patients), MDO; Group 2 (30 patients), microdiscectomy followed by ABG; Group 3 (26 patients), microdiscectomy followed by injection of PMMA; and Group 4 (36 patients), microdiscectomy followed by placement of a TTC. Clinical outcome according to Odom criteria was summarized as 1) excellent and good or 2) satisfactory and poor. One-year follow-up examination was performed in 123 patients. Patients in the TTC group experienced a significantly better outcome 6 months after surgery (92% excellent and good results) compared with those in the MDO and ABG groups (72.7 and 66.6% excellent and good results, respectively). Twelve months after surgery there was still a significant difference in outcomes between the TTC group (94.4% excellent and good results) and the MDO group (75.5% excellent and good results). Outcome in patients treated with PMMA was comparable with that in those treated with TCC after 6 (91.6%) and 12 months (87.5%), but no segmental fusion was achieved. Differences compared with MDO and ABG were, however, not significant, which may be related to the smaller number of patients in the PMMA group. Conclusions Interbody cage-assisted fusion yields a significantly better short- and intermediate-term outcome than MDO in terms of return to work, radicular pain, Odom criteria, and earlier fusion. In addition, the advantages of interbody cages over ABG fusion included better results in terms of return to work, Odom criteria, and earlier fusion after 6 months. These results suggest that interbody cage–assisted fusion is a promising therapeutic option in patients with single-level disc disease. Polymethylmethacrylate seems to be a good alternative to interbody cage fusion but is hindered by the absence of immediate fusion.

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Use of a polymethylmethacrylate cervical cage in the treatment of single-level cervical disc disease

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.3.1.0024 ◽

2005 ◽

Vol 3 (1) ◽

pp. 24-28 ◽

Cited By ~ 20

Author(s):

Jyi-Feng Chen ◽

Chieh-Tsai Wu ◽

Sai-Cheung Lee ◽

Shih-Tseng Lee

Keyword(s):

Cancellous Bone ◽

Disc Herniation ◽

Interbody Fusion ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Content Type ◽

Single Level ◽

Fine Print

Object. Polymethylmethacrylate (PMMA) bone cement has been used as a spacer in the treatment of patients with cervical disc disease with good long-term outcomes, but solid bone fusion has not been demonstrated in all cases. To achieve cervical interbody fusion, the authors designed a modified PMMA cervical cage that they filled with spongy bone for the treatment of single-level cervical disc herniation. Methods. Sixty-three patients underwent anterior cervical microdiscectomy and implantation of a PMMA cervical cage filled with autograft cancellous bone and were followed for a minimum of 2 years. The fusion rates were 90.5 and 100% at the 6- and 12-month follow-up examinations, respectively. The mean intervertebral disc height gain was 3.4 ± 1.9 mm when preoperative and 24-month postoperative values were compared. Neck pain, measured using the Huskissan visual analog scale (0 mm, no pain; 100 mm, worst possible pain), decreased from 71 ± 13 mm at preoperative baseline to 28 ± 17 at 6, 23 ± 19 at 12, and 31 ± 19 mm at 24 months. Based on the same scale, radicular pain decreased from 83 ± 15 mm at preoperative baseline to 24 ± 11 at 6, 27 ± 13 at 12, and 22 ± 11 mm at 24 months. The self-rated clinical outcome was excellent in 45 (71.4%) and good in 18 (28.6%) of the 63 patients. Conclusions. The autograft cancellous bone—filled PMMA cage is safe and effective for cervical interbody fusion in the treatment of single-level cervical disc herniation and monoradiculopathy.

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Comparison of Subsidence Failure Between a Cervical Cage and a Cortical Allograft in a Human Cadaveric Model

Advances in Bioengineering ◽

10.1115/imece2002-33015 ◽

2002 ◽

Author(s):

Denis J. DiAngelo ◽

Jason W. Sharp ◽

Bobby J. McVay ◽

Scott H. Kitchel ◽

Brian P. Kelly

Keyword(s):

Cervical Spine ◽

Interbody Fusion ◽

Compressive Loading ◽

Disc Height ◽

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Single Level ◽

Cortical Allograft ◽

Cadaveric Model

Interbody fusion (IBF) is an accepted procedure for the treatment of single-level cervical disc disease. The goal of interbody fusion in the cervical spine is to restore disc height and achieve solid arthrodesis; however, a concern with IBF devices is subsidence. The purpose of this study was to biomechanically test and compare subsidence between two cervical interbody fusion techniques, under axial compressive loading in a human cadaveric cervical model.

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A Prospective Randomized Study of Anterior Single-level Cervical Disc Operations with Long-term Follow-up: Surgical Fusion Is Unnecessary

Neurosurgery ◽

10.1097/00006123-199807000-00034 ◽

1998 ◽

Vol 43 (1) ◽

pp. 55-55

Author(s):

Edward C. Benzel

Keyword(s):

Randomized Study ◽

Prospective Randomized Study ◽

Cervical Disc ◽

Single Level ◽

Surgical Fusion ◽

Long Term Follow Up

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Preliminary experience with anterior cervical microdiscectomy and interbody titanium cage fusion (Novus CT-Ti) in patients with cervical disc disease

Surgical Neurology ◽

10.1016/s0090-3019(00)00207-x ◽

2000 ◽

Vol 53 (5) ◽

pp. 417-426 ◽

Cited By ~ 67

Author(s):

Giovanni Profeta ◽

Raffaele de Falco ◽

Giuseppina Ianniciello ◽

Luca Profeta ◽

Alfredo Cigliano ◽

...

Keyword(s):

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Titanium Cage

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Analysis of the three United States Food and Drug Administration investigational device exemption cervical arthroplasty trials

Journal of Neurosurgery Spine ◽

10.3171/2011.6.spine10623 ◽

2012 ◽

Vol 16 (3) ◽

pp. 216-228 ◽

Cited By ~ 99

Author(s):

Cheerag D. Upadhyaya ◽

Jau-Ching Wu ◽

Gregory Trost ◽

Regis W. Haid ◽

Vincent C. Traynelis ◽

...

Keyword(s):

Random Effects ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Adjacent Level ◽

Cervical Disc Disease ◽

Disc Disease ◽

Single Level ◽

Investigational Device Exemption ◽

Time Point

Object There are now 3 randomized, multicenter, US FDA investigational device exemption, industry-sponsored studies comparing arthroplasty with anterior cervical discectomy and fusion (ACDF) for single-level cervical disease with 2 years of follow-up. These 3 studies evaluated the Prestige ST, Bryan, and ProDisc-C artificial discs. The authors analyzed the combined results of these trials. Methods A total of 1213 patients with symptomatic, single-level cervical disc disease were randomized into 2 treatment arms in the 3 randomized trials. Six hundred twenty-one patients received an artificial cervical disc, and 592 patients were treated with ACDF. In the three trials, 94% of the arthroplasty group and 87% of the ACDF group have completed 2 years of follow-up. The authors analyzed the 2-year data from these 3 trials including previously unpublished source data. Statistical analysis was performed with fixed and random effects models. Results The authors' analysis revealed that segmental sagittal motion was preserved with arthroplasty (preoperatively 7.26° and postoperatively 8.14°) at the 2-year time point. The fusion rate for ACDF at 2 years was 95%. The Neck Disability Index, 36-Item Short Form Health Survey Mental, and Physical Component Summaries, neck pain, and arm pain scores were not statistically different between the groups at the 24-month follow-up. The arthroplasty group demonstrated superior results at 24 months in neurological success (RR 0.595, I2 = 0%, p = 0.006). The arthroplasty group had a lower rate of secondary surgeries at the 2-year time point (RR 0.44, I2 = 0%, p = 0.004). At the 2-year time point, the reoperation rate for adjacent-level disease was lower for the arthroplasty group when the authors analyzed the combined data set using a fixed effects model (RR 0.460, I2 = 2.9%, p = 0.030), but this finding was not significant using a random effects model. Adverse event reporting was too heterogeneous between the 3 trials to combine for analysis. Conclusions Both anterior cervical discectomy and fusion as well as arthroplasty demonstrate excellent 2-year surgical results for the treatment of 1-level cervical disc disease with radiculopathy. Arthroplasty is associated with a lower rate of secondary surgery and a higher rate of neurological success at 2 years. Arthroplasty may be associated with a lower rate of adjacent-level disease at 2 years, but further follow-up and analysis are needed to confirm this finding.

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