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
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Published: | May 4, 2005 |
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Outline
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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.