Artikel
Clinical and radiological outcome of 67 patients with cervical myelopathy following anterior cervical discectomy and fusion with stand-alone PEEK cages without osteogenic filling substance
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Autoren
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E. Shiban
- Neurochirurgische Klinik und Poliklinik, Technische Universität München
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H. Pape
- Neurochirurgische Klinik und Poliklinik, Technische Universität München
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B. Meyer
- Neurochirurgische Klinik und Poliklinik, Technische Universität München
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J. Lehmberg
- Neurochirurgische Klinik und Poliklinik, Technische Universität München
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: To evaluate long-term results after anterior cervical discectomy and fusion (ACDF) with stand-alone PEEK cages without osteogenic filling substance in patients with cervical myelopathy.
Methods: We performed a retrospective review of patients presenting with spondylotic cervical myelopathy und underwent anterior cervical discectomy and fusion (ACDF) with stand-alone PEEK cages without Osteogenic Filling Substance between 2007 and 2010 and had a minimum follow-up of 12 months. Radiographic follow-up included static and flexion/extension radiographs. Changes in the operated segments were measured and compared to radiographs directly after surgery. Clinical outcome was evaluated by a physical exam, pain VAS and the EuroQOL questionnaire (EQ-5D).
Results: 67 patients were found. The mean age at presentation was 68 years, 30 patients were male (44%). 31, 27 and 9 patients had one- two- and three-level surgeries, respectively. 46 (68%) patients presented with pain. Mild, moderate and severe myelopathy was observed in 49 (73%), 11 (12%) and 7 (10%), respectively. Fusion was achieved in 30/31 (97%), 52/54 (96%), and 100% levels in one-, two-, and three-level surgeries, respectively. Subsidence into the vertebral bodies of > 3 mm in one-, > 5 mm in two-, and > 7 mm in three-level surgery was observed in 22%, 18% and 14%, respectively. The alignment of the whole cervical spine worsened in 6 (18%), 6 (22%) and 4 (57%) in one two and three level surgeries, respectively (according to the Katsuura and Laing methods). From the 46 patients presenting with pain, pain resolved or improved in 39 (84%) cases. Mean VAS declined from 5.6 to 2, 5.2 to 2.4 and 5 to 1.25 in one-, two-, and three-level surgeries, respectively. Myelopathy improved in 43 patients (64%). Improvement or stability was observed in all dimensions of the EQ-5D in all surgery groups except for the dimension "Mobility" in the three level surgery group.
Conclusions: One and two level ACDF with stand-alone PEEK cages without plates or the use of osteogenic filling substance achieved high fusion rates, high rate of alignment stability, and rare segmental instability. The rate of clinical improvement is satisfying. For three or more level ACDF the use of ventral plating is recommended to avoid cervical misalignment.
