Artikel
Anterior cervical discectomy and fusion in 1 to 3 level procedures without the use of additional anterior plate fixation – Radiologic and clinical analysis
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Autoren
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A. Tomasino
- Klinikum München Bogenhausen, Lehrkrankenhaus der Technischen Universität München, Klinik für Neurochirurgie, München
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C.B. Lumenta
- Klinikum München Bogenhausen, Lehrkrankenhaus der Technischen Universität München, Klinik für Neurochirurgie, München
| Veröffentlicht: | 28. April 2011 |
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Gliederung
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Objective: The use of additional anterior plating for anterior cervical discectomy and fusion (ACDF) procedures is still controversial. Possible higher fusion rates with additional plate but longer OR time and higher perioperative and postoperative complications.
The aim of this study was to determine the clinical and radiologic outcome of patients underwent ACDF without additional anterior plate fixation in one, two and three-level procedures.
Methods: 98 patients were enrolled in a retrospective single centre analysis including 52 male and 46 female with age from 29 to 88. 56 patients were considered smokers and 62 non-smoker. Regular anterior procedures were performed using stand-alone cages in PEEK or titanium. By surgeons selection angulated or straight cages were implanted. Postoperative no cervical collar was used.
Mean follow-up time was 22.1 moths (11–36 months). 55 one-level procedures, 33 two-level and 10 three-level procedures respectively were performed. Clinical outcome was determined using VAS score for arm and neck pain, NDI score pre- and postoperatively and Odom's criteria at most recent follow-up. Perioperative and postoperative complications were recorded. Radiologic outcome was measured by using segmental disc height (subsidence), Cobb-angle 1 day postoperative compare to most recent follow-up lat. x-ray.
A fusion was defined as constant distance of spinous process in flexion extension lat. x-ray.
Results: Overall favourable clinical outcome with statistical significant reduction of VAS in arm and neck pain, as well as significant improvement of NDI score. Radiologic findings show a subsidence and Cobb-angle reduction of 1.56mm/2.19° in one-level, 3.8 mm/3.02° in 2-level and 2.9 mm/3.22° in 3-level procedures respectively. Fusion rate was 86% overall, 87% for 1-level, 90.91% for 2-level and 70% for 3-level procedures. Peri- and postoperative complication rate was 9.8%. Smoking habits had no negative impact concerning subsidence or fusion rates.
Conclusions: There was no statistical difference in clinical outcome for 1-, 2- or 3-level procedures. Cage material had no impact in case of subsidence, reduction of Cobb-angle or fusion rates. Angulated cages had no higher reduction of Cobb-angle compare to straight cages. Fusion rates for 1- and 2-level procedures are comparable with existing literature. 3-level procedures had significant lower fusion rates, although subsidence and kyphosis were similar.
