Artikel
Adjacent level morbidity after Titanium cage fusion : prospective long-term follow-up after two years
Veränderungen der angrenzenden Segmente nach Fusion mittels Titan-Cage : prospektive Erhebung im Verlauf von 2 Jahren
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Autoren
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C. Brenke
- Department of Neurosurgery, Ruhr-University Bochum, Bochum
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M. Wolzik
- Department of Neurorehabilitation, Wittgensteiner Clinic, Hattingen-Holthausen
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M. Scholz
- Department of Neurosurgery, Ruhr-University Bochum, Bochum
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M. Engelhardt
- Department of Neurosurgery, Ruhr-University Bochum, Bochum
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A. Harders
- Department of Neurosurgery, Ruhr-University Bochum, Bochum
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K. Schmieder
- Department of Neurosurgery, Ruhr-University Bochum, Bochum
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Anterior discectomy is a well-established treatment for cervical degenerative disc disease. Currently different methods of fusion are used. After fusion additional stress on the adjacent levels has been demonstrated. The aim of this study was to evaluate the detectable changes in the adjacent levels in patients after titanium cage (WingR) fusion.
Methods
54 patients (26 females, 28 males) with a mean age of 48.3 years were treated with anterior discectomy and fusion. Follow-up examinations were performed at discharge and 24 months postoperatively by an independent investigator. Clinical and radiological findings were evaluated. Lateral spinal plain radiographs were taken using the same technique and compared to the radiographs taken at discharge. Adjacent level morbidity in regard to uncarthrosis and/or retrospondylosis was evaluated and graded. Four categories were used: absent, mild, moderate and severe. Progression was stated if it was present based on the two examinations.
Results
In 54 patients 64 levels were operated due to cervical disc herniations and/or osteochondrosis. C5/6 and C6/7 were the levels most frequently treated. One patient was lost to follow-up. Adjacent level morbidity was present in 9 patients (17%). In five patients uncarthrosis, in three patients retrospondylosis and in one patient both conditions were progressive. 11 levels (18%) were affected. In three levels the alterations were mild, in six levels it was judged to be moderate and in two levels it was severe. 10 of the 11 affected vertebral bodies were located above the fused segment whereas only one was located below. In one patient no information of C7/Th1 was obtainable due to shoulder interference. The observed increase in severity of degeneration was in all cases only one category to the next severe one. Two patients needed surgery for adjacent level morbidity.
Conclusions
The clinical and radiological results at 24 months postoperative showed good preservation of the immediate postoperative improvement of pain and neurological deficits. Radiological findings indicate that in a large number of patients the physiological alignment of the cervical spine is reestablished and preserved. Adjacent level morbidity is detectable and caused additional surgery in 4% of the patients in this study.
