Artikel
Cervical ventral decompression and fusion – Comparison of the intervertebral supply with Plasmapore coated titanium cage, polyetheretherketon cage (PEEK) and tricortical autologous iliac crest onlay
Zervikale ventrale Dekompression und Fusion – Vergleich der intervertebralen Versorgung mit Plasmapore beschichtetem Titan-Cage, Polyetheretherketon-Cage (PEEK) und autologem Beckenkammspan
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Autoren
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F. Kindhaeuser
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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S. Ruetten
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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P. Hahn
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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G. Godolias
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Ventral decompression and fusion is a standard in cervical spinal stenosis and disc herniation. For intervertebral reconstruction, there are implants which replace a bone onlay. Objective of the study was a prospective comparison of 3 intervertebral fusion concepts: 1. osteo-integrative with Plasmapore coated titanium implant (B. Braun Aesculap), 2. PEEK implant (B. Braun Aesculap), 3. tricortical autologous iliac crest onlay.
Methods: 20 patients per group with a max. bi-segmental finding were decompressed and fused in 2003/2004. All the patients were additionally plated dynamically ventrally. In the PEEK cage, implant was filled with bone removed minimally-invasive from the pelvis or during the decompression. Follow-up was 18 months. 56 patients could be followed. Additionally to general parameters validated scores were used.
Results: No intra-operative complications occurred. 12 patients had transient swallowing complaints. A subsidence of up to 3 mm occurred 3 times in Group 1, once in Group 2 and 4 times in Group 3. Major subsidence or dislocations were not established. Group 2 radiologically manifested the signs of the fusion 16 times, Group 3 19 times. It cannot be recorded for Group 1 due to impermeability to X-rays. Here, there were no indications of loosening analogous to joint prostheses. There were no interconnections between clinical result and detectable fusion. 51 patients subjectively reached a satisfactory result. This corresponded to the results of the scores. Significant differences between the groups were not seen. 3 patients in Group 3 stated persisting complaints in the area of the point of removal of the iliac crest onlay.
Conclusions: All three procedure achieved results corresponding to literature. The implant systems can be used as surrogate bone onlays. The Plasmapore titanium cage has the advantage of dispense bone. Clinically, there is sufficient osteo-integration. X-ray impermeability and higher subsidence rates can be disadvantages. Explantation may be hindered by osteointegration. The PEEK cage shows good fusion rates with excellent X-ray permeability and low subsidence. Additional bone can be removed intra-operatively or minimally-invasive. The iliac crest onlay shows good fusion rates with long experience figures at low cost. Persisting complaints in the area of the point of removal can be a disadvantage. The selection of the fusion technique can be made dependent on the pathology or the patients' wishes.
