All Title Author
Keywords Abstract


Four Levels Anterior Cervical Discectomy and Fusion by Stand Alone PEEK Cages

DOI: 10.4236/ojmn.2018.82014, PP. 162-173

Keywords: Four Levels Cervical Disc, Peek Cage Fusion, Cervical Spondylotic Myelopathy

Full-Text   Cite this paper   Add to My Lib

Abstract:

Background: cervical spondylotic myelopathy is a common health problem that neurosurgeons face in Egypt. The aim of this study is to evaluate the efficacy of PEEK cage only in 4 levels anterior cervical discectomy as one of surgical option other than anterior cervical corpectomy, fixation by plat or posterior approach for cervical laminectomy, and assessment of post spinal surgery pain. Methods: this prospective study on 28 patients with cervical spondylotic myelopathy (CSM) over a period of 3 years (between April 2012 and April 2015) with mean period of follow up 30 months. We have done anterior cervical discectomy with fixation by cage only for all cases with perioperative assessment and scoring clinically and radiologically (Japanese Orthopaedic Association [JOA] scores, Visual Analogue Scale [VAS] scores for assessment of neck and arm pain, perioperative parameters (hospital stay, blood loss, operative time), the European Myelopathy Scoring (EMS) and Odom’s criteria, and the incidence of complication,post spinal surgery pain assessment). Results: clinical outcome was excellent (28.55), good (50%) and fair (21.5) according to Odom criteria. The European Myelopathy Scoring (EMS), improved from 10 to 16. The mean JOA score improved from 10.1 ± 2.1 to 14.2 ± 2.3. Fusion failure had been seen in 4 patients in one level for each secondary to anterior displacement of the cage with no other major complications. Conclusion: 4 levels anterior cervical discectomy with PEEK cage only is an effective, save and less costly with less post operative complication and hospital stay and less post spinal surgery pain.

References

[1]  Yalamanchili, P.K., Vives, M.J. and Chaudhary, S.B. (2012) Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach. Advances in Orthopedics, 2012, Article ID: 783762.
https://doi.org/10.1155/2012/783762
[2]  Ding, F., Jia, Z., Wu, Y., et al. (2014) Fusion-Nonfusion Hybrid Construct versus Anterior Cervical Hybrid Decompression and Fusion: A Comparative Study for 3-Level Cervical Degenerative Disc Diseases. Spine (Phila Pa 1976), 39, 1934-1942.
https://doi.org/10.1097/BRS.0000000000000588
[3]  Burkus, J.K., Traynelis, V.C., Haid, R.W., et al. (2014) Clinical and Radiographic Analysis of an Artificial Cervical Disc: 7-Year Follow-Up from the Prestige Prospective Randomized Controlled Clinical Trial. Journal of Neurosurgery: Spine, 21, 516-528.
https://doi.org/10.3171/2014.6.SPINE13996
[4]  Cloward, R.B. (2007) The Anterior Approach for Removal of Ruptured Cervical Disks. Journal of Neurosurgery, 6, 496-511.
https://doi.org/10.3171/spi.2007.6.5.496
[5]  Gao, R., Yang, L., Chen, H., et al. (2012) Long Term Results of Anterior Corpectomy and Fusion for Cervical Spondylotic Myelopathy. PLoS One, 7, e34811.
[6]  Wen, Z.Q., Du, J.Y., Ling, Z.H., et al. (2015) Anterior Cervical Discectomy and Fusion versus Anterior Cervical Corpectomy and Fusion in the Treatment of Multilevel Cervical Spondylotic Myelopathy: Systematic Review and a Meta-Analysis. Therapeutics and Clinical Risk Management, 11, 161-170.
[7]  Nirala, A.P., Husain, M. and Vatsal, D.K. (2004) A Retrospective Study of Multiple Interbody Grafting and Long Segment Strut Grafting Following Multilevel Anterior Cervical Decompression. British Journal of Neurosurgery, 18, 227-232.
https://doi.org/10.1080/02688690410001732643
[8]  Chang, S.W., Kakarla, U.K., Maughan, P.H., et al. (2010) Four-Level Anterior Cervical Discectomy and Fusion with Plate Fixation: Radiographic and Clinical Results. Neurosurgery, 66, 639-646.
https://doi.org/10.1227/01.NEU.0000367449.60796.94
[9]  Liu, Y., Qi, M., Chen, H., et al. (2012) Comparative Analysis of Complications of Different Reconstructive Techniques Following Anterior Decompression for Multilevel Cervical Spondylotic Myelopathy. European Spine Journal, 21, 2428-2435.
https://doi.org/10.1007/s00586-012-2323-y
[10]  Wang, L.F., Zhang, Y.Z., Shen, Y., et al. (2010) Using the T2-Weighted Magnetic Resonance Imaging Signal Intensity Ratio and Clinical Manifestations to Assess the Prognosis of Patients with Cervical Ossification of the Posterior Longitudinal Ligament. Journal of Neurosurgery: Spine, 13, 319-323.
https://doi.org/10.3171/2010.3.SPINE09887
[11]  Zhu, B., Xu, Y., Liu, X., Liu, Z. and Dang, G. (2013) Anterior Approach versus Posterior Approach for the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Systemic Review and Meta-Analysis. European Spine Journal, 22, 1583-1593.
https://doi.org/10.1007/s00586-013-2817-2
[12]  Han, Y.C., Liu, Z.Q., Wang, S.J., Li, L.J. and Tan, J. (2014) Is Anterior Cervical Discectomy and Fusion Superior to Corpectomy and Fusion for Treatment of Multilevel Cervical Spondylotic Myelopathy? A Systemic Review and Meta-Analysis. PloS One, 9, e87191.
[13]  Song, K.J., Yoon, S.J. and Lee, K.B. (2012) Three- and Four-Level Anterior Cervical Discectomy and Fusion with a PEEK Cage and Plate Construct. European Spine Journal, 21, 2492-2497.
https://doi.org/10.1007/s00586-012-2447-0
[14]  Verma, K., Gandhi, S.D., Maltenfort, M., Albert, T.J., Hilibrand, A.S., Vaccaro, A.R., et al. (2013) Rate of Adjacent Segment Disease in Cervical Disc Arthroplasty versus Single-Level Fusion: Meta-Analysis of Prospective Studies. Spine (Phila Pa 1976), 38, 2253-2257.
https://doi.org/10.1097/BRS.0000000000000052
[15]  Park, J.I., Cho, D.C., Kim, K.T. and Sung, J.K. (2013) Anterior Cervical Discectomy and Fusion Using a Stand-Alone Polyetheretherketone Cage Packed with Local Autobone: Assessment of Bone Fusion and Subsidence. Journal of Korean Neurosurgical Society, 54, 189-193.
https://doi.org/10.3340/jkns.2013.54.3.189
[16]  Barbagallo, G.M., Assietti, R., Corbino, L., Olindo, G., Foti, P.V., Russo, V., et al. (2009) Early Results and Review of the Literature of a Novel Hybrid Surgical Technique Combining Cervical Arthrodesis and Disc Arthroplasty for Treating Multilevel Degenerative Disc Disease: Opposite or Complementary Techniques? European Spine Journal, 18, 29-39.
[17]  Wilson, H.D., Mayer, T.G. and Gatchel, R.J. (2011) The Lack of Association between Changes in Functional Outcomes and Work Retention in a Chronic Disabling Occupational Spinal Disorder Population: Implications for the Minimum Clinical Important Difference. Spine, 36, 474-480.
https://doi.org/10.1097/BRS.0b013e3181d41632
[18]  Hey, H.W., Hong, C.C., Long, A.S. and Hee, H.T. (2013) Is Hybrid Surgery of the Cervical Spine a Good Balance between Fusion and Arthroplasty? Pilot Results from a Single Surgeon Series. European Spine Journal, 22, 116-122.
https://doi.org/10.1007/s00586-012-2486-6
[19]  Liu, Y., Hou, Y., Yang, L., et al. (2012) Comparison of 3 Reconstructive Techniques in the Surgical Management of Multilevel Cervical Spondylotic Myelopathy. Spine, 37, E1450-E1458.
[20]  Sakaura, H., Hosono, N., Mukai, Y., et al. (2003) C5 Palsy after Decompression Surgery for Cervical Myelopathy: Review of the Literature. Spine, 28, 2447-2451.
[21]  Hwang, S.L., Lin, C.L. and lieu, A.S. (2004) Three-Level and 4 Level Anterior Cervical Discectomy and Titanium Cage Augmented Fusion with and without Plate Fixation. Journal of Neurosurgery: Spine, 1, 160-167.
[22]  Bucciero, A., Zorzi, T. and Piscopo, G.A. (2008) PEEK Cage Assisted Anterior Cervical Discectomy and Fusion at 4 Levels: Clinical and Radiographic Results. Journal of Neurosurgical Sciences, 52, 37-40.
[23]  Chiles, B.W., Leonard, M.A., Chourdi, H.F. and Cooper, P.R. (1999) Cervical Spondylotic Myelopathy: Pattern of Neurological Deficit and Recovery after Anterior Cervical Decompression. Neurosurgery, 44, 762-770.
[24]  Rigoard, P., Blond, S., David, R. and Mertens, P. (2015) Pathophysiological Characterisation of Back Pain Generators in Failed Back Surgery Syndrome (Part B). Neurochirurgie, 61, S35-S44.
[25]  Thomson, S. and Jacques, L. (2009) Demographic Characteristics of Patients with Severe Neuropathic Pain Secondary to Failed Back Surgery Syndrome. Pain Practice, 9, 206-215.
https://doi.org/10.1111/j.1533-2500.2009.00276.x
[26]  Liu, Y., Qi, M., Chen, H., et al. (2012) Comparative Analysis of Complications of Different Reconstructive Techniques Following Anterior Decompression for Multilevel Cervical Spondylotic Myelopathy. European Spine Journal, 21, 2428-2435.
[27]  Saarinen, T., Niemela, M., Kivisaari, R., Pitkaniemi, J., Pohjola, J. and Hernesniemi, J. (2013) Early and Late Re-Operations after Anterior Cervical Decompression and Fusion during an 11-Year Follow-Up. Acta Neurochirurgica, 155, 285-291.
https://doi.org/10.1007/s00701-012-1563-2
[28]  Song, K.J., Lee, K.B. and Song, J.H. (2012) Efficacy of Multilevel Anterior Cervical Discectomy and Fusion versus Corpectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy: A Minimum 5-Year Follow-Up Study. European Spine Journal, 21, 1551-1557.
https://doi.org/10.1007/s00586-012-2296-x
[29]  Lau, D., Chou, D. and Mummaneni, P.V. (2015) Two-Level Corpectomy versus Three-Level Discectomy for Cervical Spondylotic Myelopathy: A Comparison of Perioperative, Radiographic, and Clinical Outcomes. Journal of Neurosurgery: Spine, 23, 280-289.
https://doi.org/10.3171/2014.12.SPINE14545
[30]  Chang, S.W., Kakarla, U.K., Maughan, P.H., et al. (2010) Four-Level Anterior Cervical Discectomy and Fusion with Plate Fixation: Radiographic and Clinical Results. Neurosurgery, 66, 639-646.

Full-Text

comments powered by Disqus