Anterior Cervical Discectomy and Cage-Assisted Fusion
Anterior Cervical Discectomy and Cage-Assisted Fusion
Object. Anterior cervical discectomy (ACD) is an effective and safe treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Cervical interbody fusion allows preservation of the physiological lordosis and stability of the cervical spine. Based on data reported in the literature, fusion rates decrease significantly when more than one level undergoes surgery, and some authors recommend the addition of a plate system to improve results. At the authors' institution cervical carbon fiber cages (CFCs) are routinely used after ACD. They describe their experience in the treatment of 24 patients with two-level disease treated with CFCs alone.
Methods. Twenty-one patients with cervical radiculopathy and three with radiculomyelopathy underwent ACD. Surgery was performed at C5-6 and C6-7 in 18, at C4-5 and C5-6 in four, and at C3-4 and C5-6 in two patients. All the patients underwent magnetic resonance imaging and 15 also underwent computerized tomography (CT) to assess the results of surgery.
Radiculopathy improved after surgery in all the cases, whereas myelopathy resolved in only one patient. At 1 year fusion was achieved in 96% of the surgically treated discs; this was verified on cervical spine x-ray films in all patients and on CT scans in three patients. Cervical lordosis was restored in eight of the nine patients in whom it was lost preoperatively. No complications related to cage extrusion and no cases of symptomatic pseudarthrosis were observed.
Conclusions. Interbody fusion cages have a load-sharing function and stabilize the spine to increase segmental stiffness, thus achieving fusion rates similar to those associated with bone grafts, even in multilevel disease.
Anterior cervical discectomy has proven to be a safe and effective procedure for the treatment of degenerative disc disease. The anterior approach allows direct visualization of the entire interspace and wide decompression of the anterior aspect cervical spinal cord and nerve roots; it may be undertaken in cases of multilevel disease, and interbody fusion may be performed if required.
Cloward first described the anterior approach as an option for cervical disc herniation and cervical spondylosis in cases in which iliac crest bone graft fusion was performed. The Cloward fusion procedure has undergone several technical modifications and there is now no consensus regarding the best technique. The various advantages and the types of morbidity associated with the different procedures are still debated in the literature.
Interbody fusion cages are hollow implants that restore physiological disc height, allowing bone growth within and around them, thus stimulating bone fusion. They have been developed to prevent disc space collapse and its relevant clinicoradiological consequences, as well as the donor-site morbidity reported in conjunction with autologous bone graft procedures. The primary complications related to the implantation of fusion cages are subsidence into the adjacent VBs, cage dislocation, nonunion-related instability, and painful pseudarthrosis.
According to the literature, fusion rates decrease significantly in multilevel surgery and some authors recommend the addition of a plate system to improve the results.
The purpose of this study was to assess the safety and effectiveness of carbon interbody fusion cages for cervical degenerative disc disease and their application in multilevel surgery without the additional use of an anterior plate system.
Abstract
Object. Anterior cervical discectomy (ACD) is an effective and safe treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Cervical interbody fusion allows preservation of the physiological lordosis and stability of the cervical spine. Based on data reported in the literature, fusion rates decrease significantly when more than one level undergoes surgery, and some authors recommend the addition of a plate system to improve results. At the authors' institution cervical carbon fiber cages (CFCs) are routinely used after ACD. They describe their experience in the treatment of 24 patients with two-level disease treated with CFCs alone.
Methods. Twenty-one patients with cervical radiculopathy and three with radiculomyelopathy underwent ACD. Surgery was performed at C5-6 and C6-7 in 18, at C4-5 and C5-6 in four, and at C3-4 and C5-6 in two patients. All the patients underwent magnetic resonance imaging and 15 also underwent computerized tomography (CT) to assess the results of surgery.
Radiculopathy improved after surgery in all the cases, whereas myelopathy resolved in only one patient. At 1 year fusion was achieved in 96% of the surgically treated discs; this was verified on cervical spine x-ray films in all patients and on CT scans in three patients. Cervical lordosis was restored in eight of the nine patients in whom it was lost preoperatively. No complications related to cage extrusion and no cases of symptomatic pseudarthrosis were observed.
Conclusions. Interbody fusion cages have a load-sharing function and stabilize the spine to increase segmental stiffness, thus achieving fusion rates similar to those associated with bone grafts, even in multilevel disease.
Introduction
Anterior cervical discectomy has proven to be a safe and effective procedure for the treatment of degenerative disc disease. The anterior approach allows direct visualization of the entire interspace and wide decompression of the anterior aspect cervical spinal cord and nerve roots; it may be undertaken in cases of multilevel disease, and interbody fusion may be performed if required.
Cloward first described the anterior approach as an option for cervical disc herniation and cervical spondylosis in cases in which iliac crest bone graft fusion was performed. The Cloward fusion procedure has undergone several technical modifications and there is now no consensus regarding the best technique. The various advantages and the types of morbidity associated with the different procedures are still debated in the literature.
Interbody fusion cages are hollow implants that restore physiological disc height, allowing bone growth within and around them, thus stimulating bone fusion. They have been developed to prevent disc space collapse and its relevant clinicoradiological consequences, as well as the donor-site morbidity reported in conjunction with autologous bone graft procedures. The primary complications related to the implantation of fusion cages are subsidence into the adjacent VBs, cage dislocation, nonunion-related instability, and painful pseudarthrosis.
According to the literature, fusion rates decrease significantly in multilevel surgery and some authors recommend the addition of a plate system to improve the results.
The purpose of this study was to assess the safety and effectiveness of carbon interbody fusion cages for cervical degenerative disc disease and their application in multilevel surgery without the additional use of an anterior plate system.
