gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Article

Send article

A prospective randomized comparison of rectangular titanium cage fusion and iliac crest autograft fusion in anterior cervical discectomy

Ein prospektiver, randomisierter Vergleich von rechteckigen Titancages und autologem Beckenkammspan bei der ventralen zervikalen Diskektomie

Meeting Abstract

Search Medline for

  • corresponding author C. Thomé - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • O. Leheta - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • J. K. Krauss - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • D. Zevgaridis - Neurochirurgische Klinik, Universitätsklinikum Mannheim

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-10.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0042.shtml

Published: May 4, 2005

© 2005 Thomé et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

To compare clinical outcome and fusion rates of iliac crest autografts (IC) and rectangular titanium cages (RTC) in anterior cervical discectomy (ACD).

Methods

100 consecutive patients with mono- or bisegmental cervical disc disease refractory to adequate conservative treatment were randomized to the two treatment arms (IC/RTC). Pain was self-assessed overall and separately for head, neck, arm and donor site (VAS). Myelopathy was documented according to JOAS and Nurick Score. Outcome was analyzed using Odom criteria, SF-36 and patient satisfaction. Fusion rates were assessed using standard and flexion/extension radiographs. Follow-up of 12 months was available for 95 patients.

Results

Donor site morbidity at the IC graft site interfered with patient expectations in the first postoperative weeks, but did not significantly affect clinical outcome at 12 months. Residual overall pain was rated higher by IC patients (3.3±2.5) compared to RTC patients (2.2±2.4; p<0.05) after 12 months. While arm and head pain were minimal in both groups, neck pain proved to be the predominant postoperative symptom (2.7±2.5 (IC) vs. 1.9±2.1 (RTC)), that resolved completely in only 67% (RTC) and 48% (IC) of patients (p<0.05). Myelopathy improved comparably in both groups. Regardless of the higher rate of residual pain in IC patients, patient satisfaction and SF-36 did not reveal significant differences between groups leaving only 4 of 47 IC patients (8%) and 5 of 48 RTC patients (10%) unsatisfied. 75% (IC) and 79% (RTC) of patients experienced good to excellent functional recovery according to Odom criteria. Fusion rates were 81% (IC) and 74% (RTC; p>0.05).

Conclusions

Neck pain proved to be the predominant postoperative symptom in both groups. Fusion rates and functional outcome 12 months after ACD are comparable between IC and RTC. The use of rectangular cages, however, avoids donor site morbidity and reduces overall pain and thus seems to be an advantageous treatment alternative.