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Anterior Cervical Discectomy and Fusion Using a Double Cylindrical Cage versus an Anterior Cervical Plating System with Iliac Crest Autografts for the Treatment of Cervical Degenerative Disc Disease.

Kim SJ, Kim SD - J Korean Neurosurg Soc (2014)

Bottom Line: There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups.However, there was no significant difference in this distance between the two groups at the 12-month follow-up.A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea.

ABSTRACT

Objective: Anterior cervical discectomy and fusion (ACDF) is often complicated by subsidence, pseudoarthrosis, kyphosis, and graft donor site morbidities. To decrease the occurrence of these complications, various types of cages have been developed. We designed this retrospective study to analyze and compare the efficacy and outcomes of ACDF using double cylindrical cages (DCC) (BK Medical, Seoul, Korea) versus an anterior cervical plating system with autogenous iliac crest grafts.

Methods: Forty-eight patients were treated with autograft and plating (plate group), and 48 with DCC group from October 2007 to October 2011. We analyzed construct length, cervical lordotic curvarture, the thickness of the prevertebral soft tissue, segmental instability, and clinical outcomes.

Results: There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups. The prevertebral soft tissue was thinner in the DCC group than the plate group immediately after surgery and at the 3-, 6-, and 12-month follow-ups. The difference in interspinous distance on flexion-extension was shorter in the plate group than the DCC group at the 3- and 6-month follow-ups. However, there was no significant difference in this distance between the two groups at the 12-month follow-up.

Conclusion: A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

No MeSH data available.


Related in: MedlinePlus

A : Double cylindrical cage (DCC). B : Intraoperative picture after cage placement. C and D : Anteroposterior and lateral radiographs following anterior cervical discectomy and fusion using DCC.
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Figure 1: A : Double cylindrical cage (DCC). B : Intraoperative picture after cage placement. C and D : Anteroposterior and lateral radiographs following anterior cervical discectomy and fusion using DCC.

Mentions: This procedure is used to decompress the spinal cord and nerve roots, stabilize the affected segments, and provide solid arthrodesis. Several technical modifications of this procedure have been developed, but there is currently no consensus regarding the optimal technique7). Unfortunately, this procedure is often complicated by collapse of the graft bone, pseudoarthrosis, kyphotic deformity, and especially, graft donor site morbidities1,4,7) such as prolonged donor site pain, hematomas, infection, nerve injury, and iliac crest fracture or deformity12,19,20). In addition, plate fixation has the drawbacks of high cost, a long operative time, and risk to adjacent structures because of the retraction required for plate insertion21). To decrease the occurrence of these complications, various types of cages have been developed and are currently being used10,12,22). However, among those cages, cylindrical cages are underused because they are thought to have a tendency to subside, though this has not been conclusively shown8,19). We designed this retrospective study to analyze and compare the efficacy and outcomes of anterior cervical fusion using a double cylindrical cage (DCC) (BK Medical, Seoul, Korea) (Fig. 1) or autogenous iliac crest grafts and an anterior cervical plating system.


Anterior Cervical Discectomy and Fusion Using a Double Cylindrical Cage versus an Anterior Cervical Plating System with Iliac Crest Autografts for the Treatment of Cervical Degenerative Disc Disease.

Kim SJ, Kim SD - J Korean Neurosurg Soc (2014)

A : Double cylindrical cage (DCC). B : Intraoperative picture after cage placement. C and D : Anteroposterior and lateral radiographs following anterior cervical discectomy and fusion using DCC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928342&req=5

Figure 1: A : Double cylindrical cage (DCC). B : Intraoperative picture after cage placement. C and D : Anteroposterior and lateral radiographs following anterior cervical discectomy and fusion using DCC.
Mentions: This procedure is used to decompress the spinal cord and nerve roots, stabilize the affected segments, and provide solid arthrodesis. Several technical modifications of this procedure have been developed, but there is currently no consensus regarding the optimal technique7). Unfortunately, this procedure is often complicated by collapse of the graft bone, pseudoarthrosis, kyphotic deformity, and especially, graft donor site morbidities1,4,7) such as prolonged donor site pain, hematomas, infection, nerve injury, and iliac crest fracture or deformity12,19,20). In addition, plate fixation has the drawbacks of high cost, a long operative time, and risk to adjacent structures because of the retraction required for plate insertion21). To decrease the occurrence of these complications, various types of cages have been developed and are currently being used10,12,22). However, among those cages, cylindrical cages are underused because they are thought to have a tendency to subside, though this has not been conclusively shown8,19). We designed this retrospective study to analyze and compare the efficacy and outcomes of anterior cervical fusion using a double cylindrical cage (DCC) (BK Medical, Seoul, Korea) (Fig. 1) or autogenous iliac crest grafts and an anterior cervical plating system.

Bottom Line: There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups.However, there was no significant difference in this distance between the two groups at the 12-month follow-up.A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea.

ABSTRACT

Objective: Anterior cervical discectomy and fusion (ACDF) is often complicated by subsidence, pseudoarthrosis, kyphosis, and graft donor site morbidities. To decrease the occurrence of these complications, various types of cages have been developed. We designed this retrospective study to analyze and compare the efficacy and outcomes of ACDF using double cylindrical cages (DCC) (BK Medical, Seoul, Korea) versus an anterior cervical plating system with autogenous iliac crest grafts.

Methods: Forty-eight patients were treated with autograft and plating (plate group), and 48 with DCC group from October 2007 to October 2011. We analyzed construct length, cervical lordotic curvarture, the thickness of the prevertebral soft tissue, segmental instability, and clinical outcomes.

Results: There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups. The prevertebral soft tissue was thinner in the DCC group than the plate group immediately after surgery and at the 3-, 6-, and 12-month follow-ups. The difference in interspinous distance on flexion-extension was shorter in the plate group than the DCC group at the 3- and 6-month follow-ups. However, there was no significant difference in this distance between the two groups at the 12-month follow-up.

Conclusion: A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

No MeSH data available.


Related in: MedlinePlus