Multilevel cage-assisted anterior decompression and fusion for cervical spondylosis: long-term outcomes in 20 cases

doi:10.3969/j.issn.2095-4344.2014.48.007

Abstract

Abstract:

BACKGROUND: Ideal method for spinal fusion is interbody fusion, which was firstly applied by Robinson and Smith in 1955 on the removal of herniated intervertebral discs through the anterior cervical approach, followed by interbody grafting. Subsequently the presumption of interbody contents emerges to promote spinal fusion. The spinal interbody fusion has achieved significant developments and is considered one of standard treatments for spinal degeneration.
OBJECTIVE: To investigate the long-term efficacy of multilevel anterior cervical decompression and cage-assisted fusion for cervical spondylosis.
METHODS: From October 2000 to October 2002, twenty cases with cervical spondylosis underwent three-level cage-assisted anterior cervical depression and fusion in the 306 Hospital of Chinese PLA (including 15 males and 5 females). The involved patients aged 48-65 years, with mean 56.4 years. The affected lesions were observed at the C4-7 level in 12 cases and at the C3-6 level in 8 cases. JOA scores were recorded before treatment and at final follow-up to evaluate the improvement rate. Clinical results were graded using the Odom criteria. Radiological results at the anterioposterior and lateral film positions were observed before and after treatment, as well as at final follow-up. Cervical spine curvature (Cobb angle) was measured before and after treatment. Adjacent segment degeneration and graft fusion rate were observed upon final follow-up.
RESULTS AND CONCLUSION: All 20 patients were successfully operated. No neurological and fixation-related complications occurred. The follow-up period was arranged from 10 to 132 months. The JOA score was (9.85 ± 0.81) preoperatively and (14.40 ± 0.94) postoperatively, showing significant difference. The average JOA improvement rate was 81%. Odom grading at final follow-ups included 14 excellent cases, 4 good cases, and 2 fair cases. No adjacent segment lesions were observed, Cage sedimentation was visible in two cases, and cervical curve maintained good. Graft fusion rate was 100% at final follow-up. Radiograph analysis indicated that, Cobb angle of cervical lordosis was significantly higher at postoperative 1 year and at final follow-up compared with preoperative measurement (P < 0.01), and no difference was significant between postoperative 1 year and final follow-up (P > 0.05). Multilevel cage-assisted anterior cervical decompression and fusion is an effective and safe way for multilevel cervical spondylosis and the long-term outcomes are good.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: internal fixators, cervical vertebrae, spinal fusion, follow-up studies

CLC Number:

R318

Chen Xiao-ming, Ma Hua-song, Tan Rong, Tian Tian, Liu Tao, Cui Kai, Zhang Ye. Multilevel cage-assisted anterior decompression and fusion for cervical spondylosis: long-term outcomes in 20 cases[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(48): 7745-7750.

Figures/Tables 1

References

[1] Femyhough JC,White JI, LaRocca H. Fusion rates in multilevel cervicalspondylosis comparing allograft fibula with autograft fibula in 126 patients.Spine.1991;16(10 Suppl):561-564．
[2] Smith GW,Robinson RA.The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion.J Bone Joint Surg Am. 1958;40(3)：607-624．
[3] 孙宇,刘忠军,党耕町.颈椎病外科治疗的回顾[J].北京大学学报(医学版),2002,34(5):627-629.
[4] Odom GL,Finney W,Woodhall B.Cervical disk lesions.J Am Med Assoc. 1958;166:23-28.
[5] Barsa P,Suchomel P.Factors affecting sagittal malaligament due to Cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J. 2007;16(7):1395-1400.
[6] 贾连顺.颈椎病的手术时机与手术方案选择[J].中国脊柱脊髓杂志,2007,17(2):90．
[7] Wang JC,McDonough PW,Kanim LE,et al.Increased fusion rates with cervical palting for fhree-level anterior cervical discectomy and fusion.Spine. 2001;26:643-647．
[8] Hilibrand AS,Fye MA,Emery SE,et al.Increased rate of arthrodesis with strut Grafting after multilevel anterior cervical decompression.Spine. 2002;27:146-151.
[9] Nirala AP,Husain M,Vatsal DK.A retrospective study of multiple interbody grafting and long segment strut grafting following multilevel anterior cervical Decompression.Br J Neurosurg. 2004;18:227-232.
[10] 鲍达,马远征,袁文,等.前路融合内固定方式对颈椎曲度的影响[J].中华骨科杂志,2004,24(12):705-708.
[11] Hilibrand AS,Carlson GD,Palumbo MA,et al.Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical Arthrodesis.J Bone Joint Surg Am. 1999;81 (4):519-528.
[12] Goto S,Kita T.Long-term follow-up evaluation of surgery for ossification of the posterior longitudinal ligament.Spine. 1995; 20(20):2247-2256.
[13] Katsuura A,Hukuda S,Sarahashi Y,et al.Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels.Eur Spine J.2001;10:320-324．
[14] Matge G.Cervical cage fusion with 5 different implants:250 cases. Acta Neurochir(Wien). 2002;144(6):539-550.
[15] Montgomery DM,Brower RS.Cervical spondylotic myelopathy.Clinical syndrome And natural history.Orthop Clin North Am. 1992;23(3):487-493.
[16] 贾连顺,史建刚.重视脊髓型颈椎病的诊断与严格手术指征[J].中华骨科杂志,2002,22(1):58-60.
[17] 孙宇.颈椎病手术治疗中值得关注的几个问题[J].中国脊柱脊髓杂志,2007,17(2):95-96.
[18] Barsa P, Suchomel P. Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J. 2007;16(9):1395-1400.
[19] Vamvanij V, Ruangchainikom M, Thanapipatsiri S, et al. The outcomes of combined posterior instrumentation and anterior radical debridement with fusion for multilevel spinal tuberculosis. J Med Assoc Thai. 2014;97 Suppl 9:S50-55.
[20] Moon MS, Kim SS, Yoon MG, et al. Radiographic Assessment of Effect of Congenital Monosegment Synostosis of Lower Cervical Spine between C2-C6 on Adjacent Mobile Segments. Asian Spine J. 2014;8(5):615-623.
[21] Ament JD,Yang Z, Nunley P, et al. Cost-effectiveness of Cervical Total Disc Replacement vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease. JAMA Surg. 2014. doi: 10.1001/jamasurg.2014.716.
[22] Caruso R, Pesce A, Marrocco L, et al. Anterior approach to the cervical spine for treatment of spondylosis or disc herniation: Long-term results. Comparison between ACD, ACDF, TDR. Clin Ter. 2014;165(4):e263-270.
[23] Kao TH, Wu CH, Chou YC, et al. Risk factors for subsidence in anterior cervical fusion with stand-alone polyetheretherketone (PEEK) cages: a review of 82 cases and 182 levels. Arch Orthop Trauma Surg. 2014;134(10): 1343-1351.
[24] Gologorsky Y, Skovrlj B, Steinberger J, et al. Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis. J Neurosurg Spine. 2014;21(4):601-607.
[25] Rampersaud YR, Fisher C, Yee A, et al. Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study. Can J Surg. 2014;57(4): E126-133.
[26] Huang ZY, Wu AM, Li QL, et al. Comparison of two anterior fusion methods in two-level cervical spondylosis myelopathy: a meta-analysis. BMJ Open. 2014;4(7):e004581.
[27] Schairer WW, Carrer A, Lu M, et al. The Increased Prevalence of Cervical Spondylosis in Patients with Adult Thoracolumbar Spinal Deformity. J Spinal Disord Tech. 2014. [Epub ahead of print]