Use of a bioabsorbable anterior cervical plate in the treatment of cervical degenerative and traumatic disc disruption

2002 ◽  
Vol 97 (4) ◽  
pp. 473-480 ◽  
Author(s):  
Alexander R. Vaccaro ◽  
John A. Carrino ◽  
Benjamin H. Venger ◽  
Todd Albert ◽  
Peter M. Kelleher ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Reaction ◽  
Content Type ◽  
Single Level ◽  
Soft Tissue Reaction ◽  
Solid Fusion ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

Object. Anterior cervical discectomy and fusion (ACDF) is a widely accepted treatment for anterior degenerative or traumatic instability of the cervical spine. To reduce or eliminate complications such as implant migration and failure, imaging degradation, and fusion stress shielding that are occasionally associated with spinal instrumentation, attention has been given to the use of bioresorbable anterior cervical plate (ACP) devices. This paper is a preliminary report of a retrospective series in which a resorbable mesh and screw system was used for graft containment in single-level ACDF. Methods. A review of patient charts and imaging studies was conducted to determine functional outcome, fusion success, and potential soft-tissue reaction to implant resorption. Nine patients with a cervical degenerative disc disease or traumatic disc disruption were treated between October 2001 and March 2002. Follow up averaged 206 days. Eight patients were found to have an excellent result, one patient had a good result, and no patients had a satisfactory or poor result. At the time of follow-up examination, 77% of patients were found to have a radiographically solid fusion. The two patients without a solid fusion were examined only an average 8 months postoperatively and manifested no symptoms related to fusion nonhealing. No significant soft-tissue reaction was noted clinically or radiographically in any of the patients. Conclusions. The results of this preliminary study indicate that bioresorbable ACP systems for single-level ACDF are both safe and effective.

Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 120-127 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Junji Ishihara ◽  
Jie Zhang
Keyword(s):  
Tissue Reaction ◽  
Vascular Lesions ◽  
Thalamic Lesion ◽  
Mr Images ◽  
Unsatisfactory Result ◽  
Content Type ◽  
Rhythmic Discharge ◽  
Latent Interval ◽  
Fine Print

Object. The effects of gamma thalamotomy for parkinsonian and other kinds of tremor were evaluated. Methods. Thirty-six thalamotomies were performed in 31 patients by using a 4-mm collimator. The maximum dose was 150 Gy in the initial six cases, which was reduced to 130 Gy thereafter. The longest follow-up period was 6 years. The target was determined on T2-weighted and proton magnetic resonance (MR) images. The point chosen was in the lateral-most part of the thalamic ventralis intermedius nucleus. This is in keeping with open thalamotomy as practiced at the authors' institution. In 15 cases, gamma thalamotomy was the first surgical procedure. In other cases, previous therapeutic or vascular lesions were visible to facilitate targeting. Two types of tissue reaction were onserved on MR imaging: a simple oval shape and a complex irregular shape. Neither of these changes affected the clinical course. In the majority of cases, the tremor subsided after a latent interval of approximately 1 year after irradiation. The earliest response was demonstrated at 3 months. In five cases the tremor remained. In four of these cases, a second radiation session was administered. One of these four patients as well as another patient with an unsatisfactory result underwent open thalamotomy with microrecording. In both cases, depth recording adjacent to the necrotic area revealed normal neuronal activity, including the rhythmic discharge of tremor. Minor coagulation was performed and resulted in immediate and complete arrest of the remaining tremor. Conclusions. Gamma thalamotomy for Parkinson's disease seems to be an alternative useful method in selected cases.

Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation?

2013 ◽  
Vol 19 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Myles Luszczyk ◽  
Justin S. Smith ◽  
Jeffrey S. Fischgrund ◽  
Steven C. Ludwig ◽  
Rick C. Sasso ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Fusion Rate ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Single Level ◽  
Significant Difference ◽  
Solid Fusion ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Object Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with allograft and plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate. Methods This study is composed of patients from the control groups of 5 separate studies evaluating the use of an anterior cervical disc replacement to treat cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked cervical plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months was required for inclusion in this study. Fusion status was assessed by independent observers using lateral, neutral, and flexion/extension radiographs. Results An overall fusion rate of 91.4% was achieved in all 573 patients. A solid fusion was shown in 382 patients (91.6%) who were nonsmokers. Among patients who were smokers, 142 (91.0%) had radiographic evidence of a solid fusion. A 2-tailed Fisher exact test revealed a p value of 0.867, indicating no difference in the union rates between smokers and nonsmokers. Conclusions The authors found no statistically significant difference in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate. Although the authors do not promote tobacco use, it appears that the use of allograft with a locked cervical plate in single-level ACDF among smokers produces similar fusion rates as it does in their nonsmoking counterparts.

Biomechanical analysis of a newly designed bioabsorbable anterior cervical plate

2005 ◽  
Vol 3 (6) ◽  
pp. 465-470 ◽  
Author(s):  
Christopher P. Ames ◽  
Frank L. Acosta ◽  
Robert H. Chamberlain ◽  
Adolfo Espinoza Larios ◽  
Neil R. Crawford
Keyword(s):  
Axial Rotation ◽  
Metal Plate ◽  
Biomechanical Analysis ◽  
Fibular Graft ◽  
Disc Disease ◽  
Content Type ◽  
Flexion Extension ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

Object. The authors present a biomechanical analysis of a newly designed bioabsorbable anterior cervical plate (ACP) for the treatment of one-level cervical degenerative disc disease. They studied anterior cervical discectomy and fusion (ACDF) in a human cadaveric model, comparing the stability of the cervical spine after placement of the bioabsorbable fusion plate, a bioabsorbable mesh, and a more traditional metallic ACP. Methods. Seven human cadaveric specimens underwent a C6–7 fibular graft—assisted ACDF placement. A one-level resorbable ACP was then placed and secured with bioabsorbable screws. Flexibility testing was performed on both intact and instrumented specimens using a servohydraulic system to create flexion—extension, lateral bending, and axial rotation motions. After data analysis, three parameters were calculated: angular range of motion, lax zone, and stiff zone. The results were compared with those obtained in a previous study of a resorbable fusion mesh and with those acquired using metallic fusion ACPs. For all parameters studied, the resorbable plate consistently conferred greater stability than the resorbable mesh. Moreover, it offered comparable stability with that of metallic fusion ACPs. Conclusions. Bioabsorbable plates provide better stability than resorbable mesh. Although the results of this study do not necessarily indicate that a resorbable plate confers equivalent stability to a metal plate, the resorbable ACP certainly yielded better results than the resorbable mesh. Bioabsorbable fusion ACPs should therefore be considered as alternatives to metal plates when a graft containment device is required.

A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results

2000 ◽  
Vol 93 (2) ◽  
pp. 222-226 ◽  
Author(s):  
Robert J. Hacker
Keyword(s):  
Interbody Fusion ◽  
Donor Site ◽  
Anterior Cervical Fusion ◽  
Cervical Disc ◽  
Control Group ◽  
Cervical Fusion ◽  
Content Type ◽  
Solid Fusion ◽  
Fine Print

Object. Despite variations in technique, inherent problems persist with current approaches to anterior cervical fusion. This study was performed to determine whether anterior cervical fusion performed using an investigational device was safe and effective in the treatment of degenerative cervical disc disorders and whether this device offered advantages over current techniques. Methods. Fifty-four patients with radiculopathy with or without mild myelopathy due to one- or two-level cervical degenerative disc disease were randomized as part of a Food and Drug Administration device study. Following microsurgical discectomy, the control group was treated with iliac crest graft fusion; the experimental study group underwent insertion of an interspace cage and placement of a local autograft. All patients received postoperative follow-up care for at least 2 years. Good or excellent results were found in approximately 97% of the experimental group and 88% of the control group. A solid fusion was achieved in all patients who underwent one-level cage placement, and a solid fusion at one or both levels was achieved in over 90% of both groups. Chronic donor site pain was reported by 31% of the control group. Conclusions. In this study, the use of an interbody fusion cage avoided donor site morbidity and placement of autograft achieved a high rate of good or excellent results. Interbody fusion cages appear safe and effective, and their use helps to avoid some of the inherent problems in performing current anterior cervical fusion techniques.

Acrylic spinal fusion

1980 ◽  
Vol 53 (5) ◽  
pp. 606-612 ◽  
Author(s):  
Robert R. Hansebout ◽  
Gustav A. Blomquist
Keyword(s):  
Excisional Biopsy ◽  
Radical Resection ◽  
Tissue Reaction ◽  
Steel Plates ◽  
Anterior Fusion ◽  
Content Type ◽  
Bone Fusion ◽  
Autopsy Specimens ◽  
Fine Print

✓ Methyl methacrylate (acrylic) was used in fusion techniques in 82 patients, most of whom had metastatic disease, between 1959 and 1979. In all cases the acrylic was used to supplement stabilization with Meurig-Williams stainless steel plates or with wire. In cases involving a decompressive laminectomy and excisional biopsy (radical resection of a tumor mass) that required posterior stabilization, acrylic helped to achieve rapid fusion with excellent results. The series included one anterior fusion with acrylic and nine atlantoaxial fusions in patients without tumors. Strict guidelines for selection of patients are outlined. The advantage of acrylic over bone fusion in selected patients is discussed. Careful follow-up studies including autopsy examinations are included. The technique of the use of acrylic is outlined. There was no case of late instability. There was one instance of infection in a patient who was immunodeficient and in whom a combination acrylic and bone fusion was performed. Tissue reaction to the acrylic in autopsy specimens is discussed.

Clinical and radiological evaluation of the Codman semiconstrained load-sharing anterior cervical plate: prospective multicenter trial and independent blinded evaluation of outcome

2003 ◽  
Vol 99 (3) ◽  
pp. 264-270 ◽  
Author(s):  
Steven Casha ◽  
Michael G. Fehlings
Keyword(s):  
Load Sharing ◽  
Multicenter Trial ◽  
Plate Interface ◽  
Optimal Method ◽  
Content Type ◽  
Neurological Improvement ◽  
Clinical And Radiological Outcome ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

Object. Semiconstrained load-sharing implants for spinal fixation accommodate change in the screw—plate interface as bone grafts shrink. The authors evaluated the clinical and radiological outcome in patients after placement of the Codman anterior cervical plate (ACP) system, which allows change in the screw—plate angle. Methods. The authors undertook a 10-center prospective study with independent blinded evaluation. All patients underwent cervical fusion and placement of ACPs. Clinical and radiological evaluations were performed at 1, 3, 6, 12, and 24 months. Radiographs were examined for screw angles, construct height, fusion, and screw fracture or displacement. One hundred ninety-five patients were enrolled. The mean follow-up period was 17 months. At 24 months neurological improvement was demonstrated in 68.7% and pain improvement in 76.6% of the patients. Fusion was successful in 93.8%. Varying degrees (most minor) of hardware-related failure occurred in 10.4% of cases; however, reoperation was required in only four (2.1%). A significant change in screw angles occurred over time (mean 6.4° in caudal screw angle [p < 0.001] and 2.4° in the rostral screw angle [p = 0.003]). These changes plateaued by 6 months. A change in construct height (mean 3.48 mm) occurred by 6 months (p < 0.05). Conclusions. Based on an independent blinded evaluation, the Codman ACP provides effective fixation with load sharing and is effective in achieving fusion with a 94% success rate. Direct comparison with rigidly locked devices is required to establish definitively the optimal method for anterior cervical fixation.

Failure of a titanium anterior cervical plate implant: microstructural analysis of failure

1995 ◽  
Vol 83 (4) ◽  
pp. 741-743 ◽  
Author(s):  
Nevan G. Baldwin ◽  
Gregg P. Hartman ◽  
Martin W. Weiser ◽  
Edward C. Benzel
Keyword(s):  
Electron Microscopy ◽  
Cervical Spine ◽  
Microstructural Analysis ◽  
Content Type ◽  
Screw Hole ◽  
Plate Fracture ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

✓ The authors present the case of a failed titanium anterior cervical spine plate. The plate was contoured during implantation. Analysis of the failed implant with electron microscopy showed no metallurgical flaw to have caused the plate fracture. A crack was apparently initiated with the contouring of the plate. It was located at the weakest point in the plate (the position of the intermediate screw hole), and with subsequent stress, it propagated and led to fracture. Techniques for avoiding failure of this type are discussed.

Occipitocervical pseudomalignant osseous tumor of the soft tissue (fasciitis ossificans)

2001 ◽  
Vol 95 (1) ◽  
pp. 143-145
Author(s):  
Roberto Tarantino ◽  
Vincenzo Esposito ◽  
Paolo Missori ◽  
Giampaolo Cantore
Keyword(s):  
Soft Tissue ◽  
Content Type ◽  
Fine Print

✓ The authors describe the case of a 12-year-old girl in whom a pseudomalignant osseous tumor of the soft tissue was diagnosed. The lesion was resected, and at 3-year postresection follow-up examination, neuroradiological studies demonstrated no recurrence of the tumor.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

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