Artikel
Radiographic assessment and outcome after ventral discectomy and implantation of cage or PMMA
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Autoren
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J.H. Klingler
- Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
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M.T. Krüger
- Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
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R. Sircar
- Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
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E. Kogias
- Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
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C. Scheiwe
- Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
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U. Hubbe
- Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: To assess fusion rates and quality of life in patients with cervical degenerative disc disease (DDD) after ventral discectomy with different disc substitutes.
Methods: 126 of 175 patients with cervical DDD operated in a single center between 01/2005 and 02/2009 agreed to participate in the study. Of these, 19 patients were excluded due to previous cervical surgery, cervical DDD of level C7/Th1, or ventral discectomy of more than two cervical levels. 39 patients (50 levels) with cervical cage, 38 patients (49 levels) with Sulfix® PMMA dowel, and 32 patients (43 levels) with Palacos® PMMA dowel were analyzed retrospectively. We determined bony fusion of the operated level, graft subsidence, segmental Cobb angle, absolute rotation angle and alignment of the cervical spine in X-rays and CT scans with a follow-up not less than nine months. Clinical outcome was determined with NRS pain, NDI and SF-36 at follow-up.
Results: After a mean follow-up of 2.5 years, fusion was achieved in 65% (cage = C), 57% (Sulfix = S), and 45% (Palacos = P) with statistically significant difference between the cage and Palacos group (p < 0.05). Subsidence and loss of segmental Cobb angle was highest in the cage group. NDI was 27 ± 16% (C), 35 ± 17% (S), and 27 ± 19% (P) with statistically significant difference between the cage and Sulfix group (p < 0.05). NRS pain with 3.1 ± 2.0 (C), 3.6 ± 2.2 (S), and 3.0 ± 2.8 (P), and SF-36 Component Summaries did not reveal any statistically significant differences. Physical Function (SF-36) of 68 ± 24 (C), 50 ± 28 (S), and 61 ± 25 (P) showed statistically significant difference between the cage and Sulfix group (p < 0.05). Revision surgery for dislocated implants was necessary in 1/39 (C), 0/38 (S), and 2/32 (P) patients.
Conclusions: Highest fusion rates but also highest subsidence rates were observed after cage implantation. For clinical outcome, no clear advantageous disc substitute could be specified; however, the cage group appeared to present better function in comparison to the Sulfix group.
