Artikel
Roentgen stereogrammatic analysis is a useful tool to determine fusion in anterior cervical spine surgery using cages without bone filling
Röntgenstereographische Untersuchungen sind zur Bestimmung der Fusion nach Implantation von zervikalen Cages ohne Knochenfüllung geeignet
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Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
To date, there has been no method devised of determining a mature bony fusion, after anterior cervical discectomy and fusion (ACDF), except through direct surgical inspection. However, roentgen stereophotogrammatic analysis (RSA) has been shown to be highly accurate in both animal testing and lumbar surgery. However, there are no data available for the cervical spine. The objective of the current study was to evaluate this method in ACDF.
Methods
Ten patients were included (7 male, 3 female, mean age 42 years). They all underwent ACDF via a standard anterior approach and segmental decompression by discectomy. Fusion was performed using a fusion cage (Solis, Stryker) without bone transplantation or bone substitute. Anterior plating was performed (Caspar plate with monocortical screws, Aesculap AG + CoKG, Tuttlingen, Germany). A total of 8 tantalum balls were implanted in the adjacent vertebral bodies. RSA was performed on day 7, 90 and 180 after operation. For each of these examinations, the cervical spine of each patient was scanned in a neutral position as well as in extension (30 °) and simultaneous right sided rotation. The difference between the positions of the balls for these two positions was determined by a software program for each examination, and served as a parameter on how much the segment was still in motion. In our lab, the accuracy of this method exceeds 0,3 mm in every motion plane.
Results
Segmental motion was between 1.9 and 0,7 mm - depending on the motion plane - for the early postoperative investigation. After 6 weeks, segmental motion could not be observed in any motion plane using RSA.
Conclusions
RSA seems to be a useful tool for determining segmental fusion within the cervical spine. In view of our results, a bony fusion may be expected 6 weeks after the operation. These results may be of some benefit for the patient with regard to mobilization and professional and leisure activity 6 weeks after operation.