CLINICAL COMPARATIVE STUDY OF TWO OPERATIVE WAYS IN TREATING MULTI-LEVEL CERVICAL DEGENERATIVE DISEASE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FENGShuo ,  ZHANGWei , SHENYong , DINGWenyuan , SUNYapeng , MALei , ZHANGDi

Department of Spinal Surgery, Hebei Province Key Laboratory of Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P. R. China;

Corresponding?author：

ZHANGWei, Email: zhangweisurgeon@sina.com

Keywords：

Multi-level cervical degenerative disease; Anterior cervical discectomy and fusion with Cage; Fused segment height; Global cervical lordosis

DOI：

10.7507/1002-1892.20140104

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Objective To assesse the effectiveness of anterior cervical discectomy and fusion with Cage alone in treating multi-level cervical degenerative disease. Methods Between August 2010 and August 2012, 62 eligible patients with multi-level cervical degenerative disease were treated, and the clinical data were reviewed. Of 62 patients, 32 underwent anterior cervical discectomy and fusion with Cage alone (group A), and 30 underwent anterior cervical discectomy and fusion with plate fixation (group B). Both groups showed no significant difference in gender, age, disease duration, lesion types, and affected segments (P>0.05), it had comparability. Clinical outcomes were assessed using Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score; the fused segment height, subsidence rates of Cages, global cervical lordosis, and fusion rates were also compared. Results The operation time of group B[(109.7±11.2) minutes] was significantly more than group A[(87.8±6.9) minutes] (t=-2.259, P=0.037). Primary healing of incisions was obtained in all patients of 2 groups. All patients were followed up; the follow-up period ranged from 8 to 27 months (mean, 15.8 months) in group A, and from 9 to 28 months (mean, 16.4 months) in group B. There was no complication and internal fixation failure. The JOA score and VAS score were significantly improved at last follow-up when compared with preoperative scores in 2 groups (P<0.05). According to Robinson standard for axial symptom severity, the results were excellent in 20 cases, good in 9, fair in 2, and poor in 1, with an excellent and good rate of 90.63% in group A; the results were excellent in 19 cases, good in 7, fair in 3, and poor in 1, with an excellent and good rate of 86.67% in group B; and no significant difference was found between 2 groups (χ²=0.765, P=0.382). The fused segment height at immediate after operation and at last follow-up and global cervical lordosis at last follow-up were significantly improved when compared with preoperative ones in 2 groups (P<0.05). There was no significant difference (P>0.05) between groups A and B in the Cage subsidence height[(1.4±0.9) mm vs. (1.2±1.6) mm], Cage subsidence rate[9.52% (8/84) vs. 7.59% (6/79)], and fusion rate[95.24% (80/84) vs. 96.20% (76/79)]. Conclusion Anterior cervical discectomy and fusion with Cage alone can obtain good clinical results and radiologic indexes, avoid plate-related complications and reduce operation time. It is a safe and effective surgical option in the treatment of multi-level cervical degenerative disease.

Citation： FENGShuo, ZHANGWei, SHENYong, DINGWenyuan, SUNYapeng, MALei, ZHANGDi. CLINICAL COMPARATIVE STUDY OF TWO OPERATIVE WAYS IN TREATING MULTI-LEVEL CERVICAL DEGENERATIVE DISEASE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 457-462. doi: 10.7507/1002-1892.20140104 Copy

1.	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-A(3):607-624.
2.	Zdeblick TA, Phillips FM. Interbody cage devices. Spine (Phila Pa 1976), 2003, 28(15 Suppl):S2-7.
3.	Moreland SB, Asch HL, Clabeaux DE, et al. Anterior cervical discectomy and fusion with implantable titanium cage:initial impressions, patient outcomes and comparison to fusion with allograft. Spine J, 2004, 4(2):184-191.
4.	Song KJ, Taghavi CE, Lee KB, et al. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976), 2009, 34(26):2886-2892.
5.	Varruch L, Hedlund R, Javid D, et al. A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine:a clinical and radiologic study. Spine (Phila Pa 1976), 2002, 27(16):1694-1701.
6.	Chou YC, Chen DC, Hsieh WA, et al. Efficacy of anterior cervical fusion:comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci, 2008, 15(11):1240-1245.
7.	Hirabayashi K, Watanabe K, Wakano K, et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976), 1983, 8(7):693-699.
8.	Robinson RA, Walker AE, Ferlic DC, et al. The results of anterior interbody fusion of cervical spine. J Bone Joint Surg (Am), 1962, 44(8):1569-1587.
9.	Ha SK, Park JY, Kim SH, et al. Radiologic assessment of subsidence in stand-alone cervical polyetheretherketone (PEEK) cage. J Korean Neurosurg Soc, 2008, 44(6):370-374.
10.	van Jonbergen HP, Spruit M, Anderson PG, et al. Anterior cervical interbody fusion with a titanium box cage:early radiological assessment of fusion and subsidence. Spine J, 2005, 5(6):645-649.
11.	Cannada LK, Scherping SC, Yoo JU, et al. Pseudoarthrosis of the cervical spine:a comparison of radiographic diagnostic measures. Spine (Phila Pa 1976), 2003, 28(1):46-51.
12.	Kim MK, Kim SM, Jeon JM, et al. Radiographic comparison of four anterior fusion methods in two level cervical disc diseases:autograft plate fixation versus cage plate fixation versus stand-alone cage fusion versus corpectomy and plate fixation. J Korean Neurosurg Soc, 2012, 51(3):135-140.
13.	Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation:a prospective randomized study. Neurosurgery, 2007, 61(1):107-117.
14.	Joo JY, Lee JW, Kwon KY, et al. Comparison of fusion with cage alone and Plate instrumentation in two-level cervical degenerative disease. J Korean Neurosurg Soc, 2010, 48(4):342-346.
15.	Tye GW, Graham RS, Broaddus WC, et al. Graft subsidence after instnanent-assisted anterior cervical fusion. J Neurosurg, 2002, 97(2 Suppl):186-192.
16.	夏磊, 王義生, 王利民, 等. 頸椎前路不同融合方式維持椎間高度的對照研究. 中華外科雜志, 2006, 44(16):1094-1097.
17.	郭永飛, 陳德玉, 王良意, 等. 頸椎椎體終板傾斜角的影像學測量. 中國臨床康復, 2003, 7(14):2006-2007.
18.	朱希田, 田野, 王以朋, 等. 三種植骨融合方法在頸前路椎體次全切除術后維持椎間高度的影像學結果分析. 中華外科雜志, 2012, 50(11):981-986.
19.	Kast E, Derakhshani S, Bothmann M, et al. Subsidence after anterior cervical interbody fusion. A randomized prospective clinical trial. Neurosurg Rev, 2009, 32(2):207-214.
20.	譚俊銘, 葉曉健, 袁文, 等. 三種頸前路融合術后頸椎前柱高度和Cobb角比較. 中國修復重建外科雜志, 2006, 20(4):367-371.
21.	Schmieder K, Wolzik-Grossmann M, Pechlivanis I, et al. Subsidence of the wing titanium cage after anterior cervical interbody fusion:2-year follow-up study. J Neurosurg Spine, 2006, 4(6):447-453.
22.	Türeyen K. Disc height loss after anterior cervical Microdiscectomy with titanium intervertebral cage fusion. Acta Neuorchir (Wien), 2003, 145(7):565-570.
23.	Gercek E, Arlet V, Delisle J, et al. Subsidence of stand-alone cervical cages in anterior interbody fusion:warning. Eur Spine J, 2003, 12(5):513-516.
24.	張為, 李鵬飛, 申勇, 等. 頸后路三種手術方法對頸椎曲度及軸性癥狀的長期影響. 中國矯形外科雜志, 2011, 19(9):709-712.
25.	潘勝發, 孫宇, 朱振軍, 等. 單開門頸椎管擴大椎板成形術后軸性癥狀與頸椎穩定性的相關觀察. 中國脊柱脊髓雜志, 2003, 13(10):604-607.

1. 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-A(3):607-624.
2. Zdeblick TA, Phillips FM. Interbody cage devices. Spine (Phila Pa 1976), 2003, 28(15 Suppl):S2-7.
3. Moreland SB, Asch HL, Clabeaux DE, et al. Anterior cervical discectomy and fusion with implantable titanium cage:initial impressions, patient outcomes and comparison to fusion with allograft. Spine J, 2004, 4(2):184-191.
4. Song KJ, Taghavi CE, Lee KB, et al. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976), 2009, 34(26):2886-2892.
5. Varruch L, Hedlund R, Javid D, et al. A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine:a clinical and radiologic study. Spine (Phila Pa 1976), 2002, 27(16):1694-1701.
6. Chou YC, Chen DC, Hsieh WA, et al. Efficacy of anterior cervical fusion:comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci, 2008, 15(11):1240-1245.
7. Hirabayashi K, Watanabe K, Wakano K, et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976), 1983, 8(7):693-699.
8. Robinson RA, Walker AE, Ferlic DC, et al. The results of anterior interbody fusion of cervical spine. J Bone Joint Surg (Am), 1962, 44(8):1569-1587.
9. Ha SK, Park JY, Kim SH, et al. Radiologic assessment of subsidence in stand-alone cervical polyetheretherketone (PEEK) cage. J Korean Neurosurg Soc, 2008, 44(6):370-374.
10. van Jonbergen HP, Spruit M, Anderson PG, et al. Anterior cervical interbody fusion with a titanium box cage:early radiological assessment of fusion and subsidence. Spine J, 2005, 5(6):645-649.
11. Cannada LK, Scherping SC, Yoo JU, et al. Pseudoarthrosis of the cervical spine:a comparison of radiographic diagnostic measures. Spine (Phila Pa 1976), 2003, 28(1):46-51.
12. Kim MK, Kim SM, Jeon JM, et al. Radiographic comparison of four anterior fusion methods in two level cervical disc diseases:autograft plate fixation versus cage plate fixation versus stand-alone cage fusion versus corpectomy and plate fixation. J Korean Neurosurg Soc, 2012, 51(3):135-140.
13. Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation:a prospective randomized study. Neurosurgery, 2007, 61(1):107-117.
14. Joo JY, Lee JW, Kwon KY, et al. Comparison of fusion with cage alone and Plate instrumentation in two-level cervical degenerative disease. J Korean Neurosurg Soc, 2010, 48(4):342-346.
15. Tye GW, Graham RS, Broaddus WC, et al. Graft subsidence after instnanent-assisted anterior cervical fusion. J Neurosurg, 2002, 97(2 Suppl):186-192.
16. 夏磊, 王義生, 王利民, 等. 頸椎前路不同融合方式維持椎間高度的對照研究. 中華外科雜志, 2006, 44(16):1094-1097.
17. 郭永飛, 陳德玉, 王良意, 等. 頸椎椎體終板傾斜角的影像學測量. 中國臨床康復, 2003, 7(14):2006-2007.
18. 朱希田, 田野, 王以朋, 等. 三種植骨融合方法在頸前路椎體次全切除術后維持椎間高度的影像學結果分析. 中華外科雜志, 2012, 50(11):981-986.
19. Kast E, Derakhshani S, Bothmann M, et al. Subsidence after anterior cervical interbody fusion. A randomized prospective clinical trial. Neurosurg Rev, 2009, 32(2):207-214.
20. 譚俊銘, 葉曉健, 袁文, 等. 三種頸前路融合術后頸椎前柱高度和Cobb角比較. 中國修復重建外科雜志, 2006, 20(4):367-371.
21. Schmieder K, Wolzik-Grossmann M, Pechlivanis I, et al. Subsidence of the wing titanium cage after anterior cervical interbody fusion:2-year follow-up study. J Neurosurg Spine, 2006, 4(6):447-453.
22. Türeyen K. Disc height loss after anterior cervical Microdiscectomy with titanium intervertebral cage fusion. Acta Neuorchir (Wien), 2003, 145(7):565-570.
23. Gercek E, Arlet V, Delisle J, et al. Subsidence of stand-alone cervical cages in anterior interbody fusion:warning. Eur Spine J, 2003, 12(5):513-516.
24. 張為, 李鵬飛, 申勇, 等. 頸后路三種手術方法對頸椎曲度及軸性癥狀的長期影響. 中國矯形外科雜志, 2011, 19(9):709-712.
25. 潘勝發, 孫宇, 朱振軍, 等. 單開門頸椎管擴大椎板成形術后軸性癥狀與頸椎穩定性的相關觀察. 中國脊柱脊髓雜志, 2003, 13(10):604-607.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL COMPARATIVE STUDY OF TWO OPERATIVE WAYS IN TREATING MULTI-LEVEL CERVICAL DEGENERATIVE DISEASE

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