A prospective randomized comparison of rectangular titanium cage fusion and iliac crest autograft fusion in patients undergoing anterior cervical discectomy

2006 ◽  
Vol 4 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Claudius Thomé ◽  
Olaf Leheta ◽  
Joachim K. Krauss ◽  
Dimitris Zevgaridis
Keyword(s):  
Clinical Outcome ◽  
Iliac Crest ◽  
Short Form ◽  
Donor Site ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Titanium Cage ◽  
Sf 36 ◽  
Flexion Extension

Object The authors compare clinical outcome and fusion rates after iliac crest autograft (ICAG)– and rectangular titanium cage (RTC)–augmented fusion in patients undergoing anterior cervical discectomy (ACD). Methods One hundred consecutive patients with 127 levels of cervical disc disease refractory to conservative treatment were randomized into one of the two treatment groups (ICAG/RTC fusion). The visual analog scale was used by the patient to rate overall pain and head, neck, arm, and donor site pain separately. Myelopathy was documented according to Japanese Orthopaedic Association and Nurick grading systems. Outcome was analyzed using Odom criteria, the 36-Item Short Form (SF-36), and Patient Satisfaction Index scales. Fusion rates were assessed on standard and flexion–extension radiographs. Follow-up data of at least 12 months' duration were available for 95 patients. More residual overall pain after 12 months was documented in patients who underwent ICAG fusion (3.3 ± 2.5 [ICAG] and 2.2 ± 2.4 [RTC]; p < 0.05). Although arm and head pain were minimal in both groups, neck pain proved to be the predominant symptom (2.7 ± 2.5 [ICAG] and 1.9 ± 2.1 [RTC]), which resolved in only 67 and 48% of RTC-and ICAG-treated patients, respectively (p < 0.05). Myelopathy improved comparably in both groups. Regardless of increased pain in ICAG-treated patients, PSI and SF-36 scores were not significantly different between groups (only four [8%] of 47 ICAG-treated patients and five [10%] of 48 RTC-treated patients were unsatisfied). Good to excellent functional recovery according to Odom criteria was observed in 75 and 79% of ICAG- and RTC-treated patients, respectively. Fusion rates were 81 and 74%, respectively (p = 0.51). Conclusions Fusion rates and clinical outcome at 12 months after ACD were comparable between patients who underwent ICAG and RTC fusion. The use of rectangular cages, however, avoids donor site morbidity and reduces overall pain and, thus, seems to be an advantageous treatment alternative.

scholarly journals Prospective controlled study of rectangular titanium cage fusion compared with iliac crest autograft fusion in anterior cervical discectomy

2002 ◽  
Vol 12 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Dimitris Zevgaridis ◽  
Claudius Thomé ◽  
Joachim K. Krauss
Keyword(s):  
Iliac Crest ◽  
Anterior Cervical Discectomy ◽  
Alternative Methods ◽  
Cervical Disc ◽  
Controlled Study ◽  
Autogenous Bone ◽  
Cervical Discectomy ◽  
Titanium Cage ◽  
Prospective Controlled Study ◽  
Titanium Cages

Object The complications of autogenous bone grafting compel spine surgeons to seek alternative methods for cervical spinal fusion. This prospective study was conducted to evaluate the safety and efficacy of using rectangular titanium cage fusion compared with the widely performed iliac crest autograft fusion. Methods A total of 36 patients with cervical disc disease in whom an anterior approach was indicated for discectomy were included in this prospective controlled study. The first 18 consecutive patients received iliac crest autograft; the next 18 consecutive patients received rectangular titanium cages. The intergroup demographic and clinical data were comparable. All patients attended follow up for 1 year. According to Odom criteria, 15 (83%) of 18 patients in both groups experienced good to excellent functional recovery. According to the Patient Satisfaction Index, 17 (94%) of 18 patients in both groups were satisfied. The evaluation of neck pain and arm pain did not indicate statistically significant differences between either group. Fusion was present after 1 year in 16 (89%) of 18 patients who received iliac crest autografts and in 15 (83%) of 18 patients who received rectangular titanium cages. In the autograft group, a pseudarthrosis was present in one patient and marked hip pain was observed in three patients. In the cage group, there was one case of temporary vocal cord paresis but no implant-related complications. Conclusions The authors conclude that the use of titanium cages in anterior cervical discectomy constitutes a safe and efficient alternative to iliac crest bone autograft.

Anterior Cervical Discectomy with Hydroxylapatite Fusion

Neurosurgery ◽  
1989 ◽  
Vol 25 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Howard J. Senter ◽  
Rick Kortyna ◽  
William R. Kemp
Keyword(s):  
Interbody Fusion ◽  
Iliac Crest ◽  
Donor Site ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Adjacent Level ◽  
Cervical Discectomy ◽  
Bone Plug ◽  
Cervical Disc Surgery

Abstract The outcome of microscopic anterior cervical discectomy with iliac crest interbody fusion in a group of 75 patients was compared with that of microscopic anterior cervical discectomy with synthetic hydroxylapatite fusion in a group of 84 patients. The rate of relief of myelopathy (70%) was similar in both groups, but those who underwent synthetic fusion had better long-term relief of radiculopathy, less need for a second operation at the same or an adjacent level, no resorption of the bone plug, comparable spinal alignment and stability, and the elimination of complications at the iliac crest donor site. The data suggest that hydroxylapatite fusion may be equal or superior to autologous iliac crest interbody fusion for anterior cervical disc surgery.

scholarly journals Anterior cervical discectomy and fusion with polyetheretherketone cages in the management of single and double level cervical spondylotic myelopathy-our experiences of 80 cases

KYAMC Journal ◽  
2018 ◽  
Vol 9 (1) ◽  
pp. 32-34
Author(s):  
Md Anowarul Islam ◽  
Mohd Alamgir Hossain ◽  
Ahmed Asif Iqbal ◽  
Md Qumruzzaman Parvez ◽  
Md Ahsanuzzaman ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Donor Site ◽  
Fusion Rate ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
X Ray ◽  
Arm Pain ◽  
Operative Complications ◽  
Medical University

Background: Anterior cervical discectomy with fusion (ACDF) is challenging with respect to both patient selection and choice of surgical procedure.Objectives: The aim of this study was to evaluate the clinical outcome of anterior cervical discectomy and fusion with an artificial cage made of polyetheretherketoneMaterials & Methods: From January 2012 to January 2017, 80 consecutive patients referred to the Department of spine surgery, Bangabandhu Shekh Mujib Medical University were recruited for the study. Postoperative Clinical outcome assessed with Nurick scale for myelopathy, Odom's criteria for functional outcome and Visual Analogue Scale (VAS) for both neck and arm pain. Radiological fusion was assessed by X-ray. Operative complications were reported.Results: 36 patients were operated for one level discectomy and fusion with PEEK cages and 44 patients for two levels. There were 48 (60%) males and 32 (40%) females. The age of the patients ranged from 30-72 years, a mean ± SD 45 ± 8.34. At the 2 years clinical follow-up, there were significant post operative improvements of Nurick scale, and VAS comparative to preoperative record. According to Odom's criteria, 72/80 patients (90%) were graded excellent-good.Conclusion: Anterior cervical discectomy and fusion with polyetheretherketone (PEEK) cage is an effective treatment of cervical myelopathy having higher fusion rate and lack of donor site morbidity.KYAMC Journal Vol. 9, No.-1, April 2018, Page 32-34

Donor Site Morbidity After Anterior Iliac Crest Bone Harvest for Single-Level Anterior Cervical Discectomy and Fusion

Spine ◽  
2003 ◽  
Vol 28 (2) ◽  
pp. 134-139 ◽  
Author(s):  
Jeff S. Silber ◽  
D. Greg Anderson ◽  
Scott D. Daffner ◽  
Brian T. Brislin ◽  
J. Martin Leland ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Single Level

Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site

2006 ◽  
Vol 4 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Domagoj Coric ◽  
Frederick Finger ◽  
Peggy Boltes
Keyword(s):  
Short Form ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Controlled Study ◽  
Artificial Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Discectomy ◽  
Randomized Controlled ◽  
Bryan Disc

Object The authors report on a prospective randomized controlled multicenter trial in which they compared the clinical outcomes obtained in patients who underwent the placement of a Bryan Cervical Disc System with those obtained in patients who underwent anterior cervical discectomy and fusion (ACDF). In the present study, they evaluated the safety and effectiveness of the artificial disc based on data obtained at a single investigational site. Methods Patients with primary, single-level cervical disc disease producing radiculopathy and/or myelopathy were randomized prospectively to undergo anterior cervical discectomy with either fusion or artificial disc placement. The patients were evaluated with pre- and postoperative serial radiographic studies; the authors also evaluated neck disability indices, visual analog scale scores for pain, 36-Item Short Form Health Survey scores, and neurological status at 1.5, 3, 6, 12, and 24 months. Analysis of the early results obtained in the 33 patients indicated an absence of device-related complications. Preliminary analysis revealed that improvement in all clinical outcome measures was excellent for both treatment groups; however, in patients treated with the artificial cervical disc, motion at the treated level was maintained. Conclusions The preliminary results documented at this investigational site are encouraging. Evaluation of data acquired in the Bryan disc treatment group showed that improvements in the clinical parameters were similar to those in the fusion group. Additionally in the artificial disc–treated group, there was radiographic evidence that motion was maintained. It is theorized that motion preservation may potentially reduce the rate of adjacent-level cervical disc disease that has been documented in patients who undergo ACDF.

scholarly journals Comparing anterior cervical fusion using titanium cage with hydroxyapatite and with autograft

2010 ◽  
Vol 4 (1) ◽  
pp. 147-152
Author(s):  
Prakit Tienboon ◽  
Surapon Atiprayoon
Keyword(s):  
Statistical Significance ◽  
Donor Site ◽  
Anterior Cervical Fusion ◽  
Anterior Cervical Discectomy ◽  
Cervical Fusion ◽  
Cervical Discectomy ◽  
Titanium Cage ◽  
Non Union ◽  
Subsidence Rate ◽  
Donor Site Pain

Abstract Background: Anterior cervical discectomy and fusion using autogenous iliac bone graft may lead to donor site pain. This has led some surgeons to use hydroxyapatite but it has greater rates of complications. Objective: Analyze results of the treatment of cervical spine spondylosis by anterior cervical discectomy, and to compare fusion using titanium cage with hydroxyapatite and with autograft. Methods: We evaluated eighty patients (at 146 cervical levels) that had been treated by anterior cervical discectomy and fusion with hydroxyapatite or autograft. In a prospective study, patients were divided into two groups: 1) 77 levels of anterior cervical fusion from in 40 patients who were treated with cage and hydroxyapatite, and 2) 69 levels of anterior cervical fusions in 40 patients who were treated with cage and autograft. Results were evaluated using the Japanese Orthopedic Association (JOA) scoring system before and after surgery, subsidence, non-union and complication. Results: According to JOA score, the first group (hydroxyapatite) had improved from 9.8 preoperation to 14.5 postoperation. The subsidence rate was 26.0%, the non-union rate was 10.4%, and there was no intra and post-operative complication. In the other group (autograft), the preoperative JOA score had improved from 9.3 to 14.1. The subsidence rate was 11.6%, and there were no non-union and complications. Statistical significance was found in non-union and subsidence aspect between groups, but the clinical outcome of JOA score was not significantly different. Conclusion: Anterior cervical discectomy and fusion in cervical spondylosis patients, titanium cage implantation with hydroxyapatite is a highly useful alternative to autograft.

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