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Current concepts of anterior cervical discectomy and fusion: a review of literature.

Song KJ, Choi BY - Asian Spine J (2014)

Bottom Line: Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported.To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established.Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Biomedical Science Institute, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT
Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported. To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established. Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

No MeSH data available.


Related in: MedlinePlus

Synthetic cages with various design and material. (A) PEEK (Solis, adapted from http://www.stryker.com/emea/Products/Spine/Cervical/SolisPEEK/index.htm, with permission of Stryker). (B) Metal thread (BAK/C, adapted from http://www.zimmer.com/, with permission of Zimmer Inc.). (C) Metal mesh (Ti Surgical mesh, adapted from http://www.synthes.com/, with permission of Depuy Synthes). (D) Tricalcium phosphate (Cervios ChronOs, adapted from http://www.synthes.com/, with permission of Depuy Synthes).
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Figure 2: Synthetic cages with various design and material. (A) PEEK (Solis, adapted from http://www.stryker.com/emea/Products/Spine/Cervical/SolisPEEK/index.htm, with permission of Stryker). (B) Metal thread (BAK/C, adapted from http://www.zimmer.com/, with permission of Zimmer Inc.). (C) Metal mesh (Ti Surgical mesh, adapted from http://www.synthes.com/, with permission of Depuy Synthes). (D) Tricalcium phosphate (Cervios ChronOs, adapted from http://www.synthes.com/, with permission of Depuy Synthes).

Mentions: A various synthetic materials have been introduced which can substitute autograft (Fig. 2). The use of cage has advantages of shorter operation time, maintenance of intervertebral disc height and lordotic angle and when it is used with cancellous autobone that is packed into the cage, it can reduce the donor site complications and obtain comparable fusion rate to autogenous tricortical iliac bone [22,23]. On the other hand, some reports indicated that the cage itself appeared to have stress shielding onto inserted bone graft so that it reduced the fusion rate, and caused delay in fusion, nonunion and kyphosis due to the cage migration, subsidence and loss of lordosis [24]. Although cortical allograft can be manufactured as a cage, the materials generally used for cage are plastic and metal. Polyetheretherketone cage which is a kind of plastic cage is popularized due to its physical property that has similar rigidity to the normal bone, and it is feasible in radiological fusion analysis [22,25,26]. Usually it is made in a box type which cancellous autobone, DBM or ceramics can be packed. Stainless steel, Ti (titanium), Ta (tantalum) are used for metal cage, and mainly Ti is used. Titanium cage is generally packed with autogenous bone from iliac crest, and there are provided as a variety of form such as mesh type, thread type, box type, etc, and it showed low donor site morbidity, high fusion rates [27,28], but in case of mesh cage, the combination with anterior cervical plate was recommended due to the risk of subsidence [27]. The cage with carbon fiber showed satisfactory results [29], but this device is currently not available in the United States.


Current concepts of anterior cervical discectomy and fusion: a review of literature.

Song KJ, Choi BY - Asian Spine J (2014)

Synthetic cages with various design and material. (A) PEEK (Solis, adapted from http://www.stryker.com/emea/Products/Spine/Cervical/SolisPEEK/index.htm, with permission of Stryker). (B) Metal thread (BAK/C, adapted from http://www.zimmer.com/, with permission of Zimmer Inc.). (C) Metal mesh (Ti Surgical mesh, adapted from http://www.synthes.com/, with permission of Depuy Synthes). (D) Tricalcium phosphate (Cervios ChronOs, adapted from http://www.synthes.com/, with permission of Depuy Synthes).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150000&req=5

Figure 2: Synthetic cages with various design and material. (A) PEEK (Solis, adapted from http://www.stryker.com/emea/Products/Spine/Cervical/SolisPEEK/index.htm, with permission of Stryker). (B) Metal thread (BAK/C, adapted from http://www.zimmer.com/, with permission of Zimmer Inc.). (C) Metal mesh (Ti Surgical mesh, adapted from http://www.synthes.com/, with permission of Depuy Synthes). (D) Tricalcium phosphate (Cervios ChronOs, adapted from http://www.synthes.com/, with permission of Depuy Synthes).
Mentions: A various synthetic materials have been introduced which can substitute autograft (Fig. 2). The use of cage has advantages of shorter operation time, maintenance of intervertebral disc height and lordotic angle and when it is used with cancellous autobone that is packed into the cage, it can reduce the donor site complications and obtain comparable fusion rate to autogenous tricortical iliac bone [22,23]. On the other hand, some reports indicated that the cage itself appeared to have stress shielding onto inserted bone graft so that it reduced the fusion rate, and caused delay in fusion, nonunion and kyphosis due to the cage migration, subsidence and loss of lordosis [24]. Although cortical allograft can be manufactured as a cage, the materials generally used for cage are plastic and metal. Polyetheretherketone cage which is a kind of plastic cage is popularized due to its physical property that has similar rigidity to the normal bone, and it is feasible in radiological fusion analysis [22,25,26]. Usually it is made in a box type which cancellous autobone, DBM or ceramics can be packed. Stainless steel, Ti (titanium), Ta (tantalum) are used for metal cage, and mainly Ti is used. Titanium cage is generally packed with autogenous bone from iliac crest, and there are provided as a variety of form such as mesh type, thread type, box type, etc, and it showed low donor site morbidity, high fusion rates [27,28], but in case of mesh cage, the combination with anterior cervical plate was recommended due to the risk of subsidence [27]. The cage with carbon fiber showed satisfactory results [29], but this device is currently not available in the United States.

Bottom Line: Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported.To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established.Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Biomedical Science Institute, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT
Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported. To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established. Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

No MeSH data available.


Related in: MedlinePlus