Is the radiographic subsidence of stand-alone cages associated with adverse clinical outcomes after cervical spine fusion? An observational cohort study with 2-year follow-up outcome scoring

Patient Safety in Surgery

Christoph-Eckhard Heyde¹  Jens Gulow¹  Michael Moche²  Anna Voelker¹  Nicolas von der Höh¹  Anne-Catherine Franke¹  Dirk Zajonz¹ 

[1] Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany;Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany

关键词: Cervical spine;    Stand-alone cervical cages;    ACDF;    Cervical cage subsidence;   

Others  :  1171509
DOI  :  10.1186/s13037-014-0043-4

 received in 2014-07-13, accepted in 2014-10-14,  发布年份 2014

【 摘 要 】

Background

The stand-alone treatment of degenerative cervical spine pathologies is a proven method in clinical practice. However, its impact on subsidence, the resulting changes to the profile of the cervical spine and the possible influence of clinical results compared to treatment with additive plate osteosynthesis remain under discussion until present.

Methods

This study was designed as a retrospective observational cohort study to test the hypothesis that radiographic subsidence of cervical cages is not associated with adverse clinical outcomes. 33 cervical segments were treated surgically by ACDF with stand-alone cage in 17 patients (11 female, 6 male), mean age 56 years (33¿82 years), and re-examined after eight and twenty-six months (mean) by means of radiology and score assessment (Medical Outcomes Study Short Form (MOS-SF 36), Oswestry Neck Disability Index (ONDI), painDETECT questionnaire and the visual analogue scale (VAS)).

Results

Subsidence was observed in 50.5% of segments (18/33) and 70.6% of patients (12/17). 36.3% of cases of subsidence (12/33) were observed after eight months during mean time of follow-up 1. After 26 months during mean time of follow-up 2, full radiographic fusion was seen in 100%. MOS-SF 36, ONDI and VAS did not show any significant difference between cases with and without subsidence in the two-sample t-test. Only in one type of scoring (painDETECT questionnaire) did a statistically significant difference in t-Test emerge between the two groups (p = 0.03; ? = 0.05). However, preoperative painDETECT score differ significantly between patients with subsidence (13.3 falling to 12.6) and patients without subsidence (7.8 dropped to 6.3).

Conclusions

The radiological findings indicated 100% healing after stand-alone treatment with ACDF. Subsidence occurred in 50% of the segments treated. No impact on the clinical results was detected in the medium-term study period.

【 授权许可】

   
2014 Zajonz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Badley EM, Tennant A: Changing profile of joint disorders with age: findings from a postal survey of the population of Calderdale, West Yorkshire, United Kingdom. Ann Rheum Dis 1992, 51:366-371.
• [2]March LM, Brnabic AJ, Skinner JC, Schwarz JM, Finnegan T, Druce J, Brooks PM: Musculoskeletal disability among elderly people in the community. Med J Aust 1998, 168:439-442.
• [3]Fejer R, Kyvik KO, Hartvigsen J: The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 2006, 15:834-848.
• [4]Reyes-Llerena GA, Guibert-Toledano M, Hernandez-Martinez AA, Gonzalez-Otero ZA, Alcocer-Varela J, Cardiel MH: Prevalence of musculoskeletal complaints and disability in Cuba. A community-based study using the COPCORD core questionnaire. Clin Exp Rheumatol 2000, 18:739-742.
• [5]Makela M, Heliovaara M, Sievers K, Impivaara O, Knekt P, Aromaa A: Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol 1991, 134:1356-1367.
• [6]Statistisches Bundesamt:Krankheitskosten 2002. Wiesbaden; 2004
• [7]Grob D: Surgery in the degenerative cervical spine. Spine 1998, 23:2674-2683.
• [8]Cloward R: The anterior approach for removal of ruptured cervical discs. Neurosurg 1958, 15:602-617.
• [9]Hukuda S, Li FX, Imai S: Large vertebral body, in addition to narrow spinal canal, are risk factors for cervical myelopathy. J Spinal Disord 1996, 9:177-186.
• [10]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 1958, 40:607-623.
• [11]Aebi M, Zuber K, Marchesi D: Treatment of cervical spine injuries with anterior plating. Indications, techniques, and results. Spine 1991, 16:38-45.
• [12]Bailey RW, Bagdley CE: Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg 1960, 42:565-594.
• [13]Blauth M, Schmidt U, Dienst M, Knop C, Lobenhoffer P, Tscherne H: Longterm outcome of 57 patients after ventral interbody spondylodesis of the lower cervical spine. Unfallchirurg 1996, 99:925-939.
• [14]Hee HT, Majd ME, Holt RT, Whitecloud TS 3rd, Pienkowski D: Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech 2003, 16:1-9.
• [15]Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr: Anterior cervical discectomy and fusion associated complications. Spine 2007, 32:2310-2317.
• [16]Zilkens G, Röllinghoff M, Sobottke R, Eysel P, Delank KS: Cage assisted fusion operation of the spine. Z Orthop Unfall 2009, 147:751-760.
• [17]Kaden B, Swamy S, Schmitz HJ: Das titan- implantat als alternative fusionsmöglichkeit im HWS-Bereich ¿ erste klinische Erfahrungen. Zentralbl Neurochir 1993, 54:166-170.
• [18]Profeta G, de Falco R, Ianniciello G: Preliminary experience with anterior cervical microdiscectomy and interbody titanium cage fusion (novis ct-ti) in patients with cervical disc disease. Surg Neurol 2000, 53:417-426.
• [19]Schröder J, Wassmann H: Polymethylmethacrylat (PMMA) in der Halsbandscheibenchirurgie - gegenwärtige Situation in Deutschland. Zentralbl Neurochir 2002, 63:33-36.
• [20]Assietti R, Beretta F, Arienta C: Two ¿ level anterior cervical discectomy and cage - assisted fusion without plates. Neurosurg Focus 2002, 12:1-7.
• [21]Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S: Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 2012, 14:13.
• [22]Coric D, Kim PK, Clemente JD, Boltes MO, Nussbaum M, James S: Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site. J Neurosurg Spine 2013, 18:36-42.
• [23]Hahn R, Hoffmann B, Jasper M, Sepehrnia A: Microsurgical anterior discectomy with cage fusion for treatment of cervical radiculopathy: follow - up of 80 patients concerning subsidence and clinical outcome after three months. In Abstract 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). 1st edition. Deutschen Gesellschaft für Neurochirurgie e.V, Strasbourg; 2005:41.
• [24]Pechlivanis I, Thuring T, Brenke C, Seiz M, Thome C, Barth M, Harders A, Schmieder K: Non-fusion rates in anterior cervical discectomy and implantation of empty polyetheretherketone cages. Spine 2011, 36:15-20.
• [25]Moran C, Bolger C: Operative techniques for cervical radiculopathy and myelopathy. Adv Orthop 2012, 916149:1-5.
• [26]Ernstberger T, Buchhorn G, Heidrich G: Artifacts in spine magnetic resonance imaging due to different intervertebral test spacers: an in vitro evaluation of magnesium versus titanium and carbon-fiber-reinforced polymers as biomaterials. Neuroradiology 2009, 51:525-529.
• [27]Biederer J, Hutzelmann A, Rama B, Heller M: The x-ray follow-up study of the cervical spine after anterior fusion with titanium disk implants. RöFo 1999, 171:95-99.
• [28]Zevgarides D, Thomé L, Krauss JK: Prospective controlled study of rectangular titanium cage fusion compared with iliac crest autograft fusion in anterior cervical discectomy. Neurosurg Focus 2002, 12:1-8.
• [29]Mannion AF, Junge A, Fairbank JC, Dvorak J, Grob D: Development of a German version of the Oswestry disability index. part 1: cross-cultural adaptation, reliability, and validity. Eur Spine J 2006, 15:55-65.
• [30]MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH: Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther 2009, 39:400-417.
• [31]Vernon H: The neck disability index: state-of-the-art, 1991¿2008. J Manipulative Physiol Ther 2008, 31:491-502.
• [32]Freynhagen R, Baron R, Gockel U, Tölle TR: painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006, 22:1911-1920.
• [33]Patel AA, Donegan D, Albert T: The 36-item short form. J Am Acad Orthop Surg 2007, 15:126-134.
• [34]Freyd M: The graphic rating scale. J Educ Psychol 1923, 14:83-102.
• [35]Mastronardi L, Ducati A, Ferrante L: Anterior cervical fusion with polyetheretherketone (PEEK) cages in treatment of degenerative disc disease. Preliminary observations of consecutive cases with a minimum 12 - month follow - up. Acta Neurochir 2006, 148:307-312.
• [36]Salame K, Quaknine GER, Razon N, Rochkind S: The use of carbon fibre cages in anterior cervical interbody fusion - Report of 100 cases. Neurosurg Focus 2005, 12:1-5.
• [37]Barsa P, Suchomel P: Factors affecting sagittal malalignment due to cage ubsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 2007, 16:1395-1400.
• [38]Bartels R, Donk R, Feuth T: Subsidence of stand - alone cervical carbon fiber cages. Clinical studies. Neurosurgery 2006, 58:502-508.
• [39]Gercek E, Arlet V, Delisle J, Marchesi D: Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 2003, 12:513-516.
• [40]Hwang SL, Hwang YE, Lieu AS: Outcome analyses of interbody titanium cage fusion used in the anterior discectomy for cervical degeneratice disc disease. J Spinal Disord Tech 2005, 18:36-331.
• [41]Lemcke J, Menz H, Al-Zain F, Meier U: Outcome after cervical anterior fusion-a clinical study of 368 patients. Z Orthop Unfall 2007, 145:744-752.
• [42]Lin CN, Wu YC, Wang NP, Howng SL: Preliminary experience with anterior interbody titanium cage fusion for treatment of cervical disc disease. Kaohsiung J Med Sci 2003, 19:208-215.
• [43]Meier U, Kemmesies D: Experiences with six different intervertebral disc spacers for spondylodesis of the cervical spine. Orthopäde 2004, 33:1290-1299.
• [44]Moreland DB, Asch HL, Clabaux DE: Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft. Spine J 2004, 4:184-191.
• [45]Schmiederer K, Wolzik - Grossmann M, Pechlivanis I: Subsidence of the Wing titanium cage after anterior cervical interbody fusion: 2 - year follow - up study. J Neurosurg Spine 2006, 4:447-453.
• [46]Kwon B, Kim DH, Marvin A, Jenis LG: Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. J Spinal Disord Tech 2005, 18:304-308.
• [47]Fürderer S, Schöllhuber F, Rompe JD, Eysel P: Effect of design and implantation technique on risk of progressive sintering of various cervical vertebrae cages. Orthopade 2002, 31:466-471.
• [48]Lim TH, Kwon H, Jeon CH: Effect of endplate conditions and bone mineral density on the compressive strength of the graft - endplate interface in anterior cervical spine fusion. Spine 2001, 26:951-956.
• [49]Meier U, Kemmesis D: Erfahrungen mit 6 verschiedenen Intervertebrodiskalen Spacern zur Spondylodese der Halswirbelsäule. Orthopäde 1999, 33:1290-1299.