Cent Eur Neurosurg 2009; 70(4): 180-186
DOI: 10.1055/s-0029-1220940
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Anterior Cervical Discectomy and Titanium Cage Fusion – 7-year Follow-up

7-jährige Langzeitergebnisse nach anteriorer cervikaler Diskektomie und Fusion mittels Titan-ImplantatS. M. Rohe1 , M. Engelhardt1 , A. Harders1 , K. Schmieder2
  • 1Ruhr-University, Department of Neurosurgery, Bochum, Germany
  • 2Medical Faculty Mannheim, University of Heidelberg, Neurosurgery, Mannheim, Germany
Further Information

Publication History

Publication Date:
31 August 2009 (online)

Abstract

Background and study aims: The purpose of this study was to prospectively evaluate long-term results after anterior cervical discectomy and titanium cage fusion (ACDF) and titanium cage fusion. Special focus was on the adjacent levels.

Methods: 54 patients (age: 48±10 years; one level operation in 44 patients and two level operation in 10 patients) entered the study. Re-evaluation consisted of a clinical out patient investigation and was possible in 33 patients. VAS, PROLO and Oswestry scores were used. Lateral radiographs were taken and changes in the operated and adjacent segments were measured and compared to radiographs directly after surgery. Clinical patient data was compared with the data prior to surgery.

Results: The mean follow-up time of the 33 patients was 7.26 ± 0.22 years. One patient needed re-surgery of the cervical spine above the fused segment. PROLO results showed a significant improvement (PROLO F 1.52±0.67 to 3.79±1.17 p<0.01; PROLO E 1.52±0.5 to 3.55±1.42 p<0.01). Mean VAS at the time of investigation was 3.2±2.5. Oswestry score was 16.4±9.5. The alignment of the whole cervical spine was stable lordotic (Katsuura 10.9±9.0° to 11.5±7.8°; p=0.76). Total segmental height had reduced from 36.6±4.6 mm to 34.6±3.9 mm (p=0.04). No significant reduction of disc space height of adjacent levels was detectable (superior: 5.8±1.6 mm to 5.2±1.6 mm; inferior: 6.0±1.7 mm to 5.3±1.9 mm). One adjacent superior level showed spontaneous fusion. Ventral and dorsal osteophytes in the superior and inferior adjacent levels increased in number and increased significantly in degree. Patients with bi-segmental fusion (n=7) showed similar results.

Conclusion: ACDF with titanium cages has good clinical long-term results. A significant progression of degenerative changes can be observed on radiographs without clinical consequences for the patients. A comparison with patients without surgery and conservative therapy is needed to allow a better interpretation of the radiological results.

Zusammenfassung

Hintergrund und Zielsetzung: Das Ziel dieser Studie war die prospektive Evaluation anteriorer cervikaler Diskektomie und Fusion (ACDF) mittels „Wing” Titancage-Implantation.

Methoden: 54 Patienten (48±10 Jahre), die eine ACDF mit Titancage (eine Höhe bei 44 Patienten und zwei Höhen bei 10 Patienten) erhielten, wurden in die Studie aufgenommen. 33 Patienten (56±9 Jahre) konnten klinisch und radiologisch (nativ HWS-Röntgen) nachuntersucht werden. In der Untersuchung wurden VAS, PROLO und Oswestry erhoben und mit den präoperativ sowie postoperativ erhobenen Daten verglichen. Die lateralen Röntgenaufnahmen 7 Jahre nach Operation wurden mit den unmittelbar postoperativen HWS-Röntgenaufnahmen verglichen.

Ergebnisse: Nach im Mittel 7,26±0,22 Jahren zeigte sich eine hochsignifikante Verbesserung der aktivitätseinschränkenden Schmerzen (PROLO F 1,52±0,67 auf 3,79±1,17 p<0,01; PROLO E 1,52±0,5 auf 3,55±1,42 p<0,01). Ein Patient musste im superioren Nachbarsegment operiert werden. Der mittlere Wert auf der VAS lag bei 3,2±2,5. Der Oswestry Score war 16,4±9,5. Die Stellung der gesamten zervikalen Wirbelsäule blieb lordotisch (Katsuura 10,9±9,0° to 11,5±7,8°; p=0,76). Die Gesamthöhe des operierten Segmentes verringerte sich von 36,6±4,6 mm auf 34,6±3,9 mm (p=0,04). Es war keine signifikante Höhenminderung in den angrenzenden Bandscheibenfächern nachweisbar (superior: 5,8±1,6 mm auf 5,2±1,6 mm; inferior: 6,0±1,7 mm to 5,3±1,9 mm). Ein benachbartes superiores Bandscheibenfach fusionierte spontan. Ventrale and dorsale Osteophyten in den angrenzenden superioren and inferioren Segmenten nahmen in Anzahl und signifikant im Schweregrad zu. Patienten mit bi-segmentaler Fusionsoperation (n=7) zeigten vergleichbare Ergebnisse.

Schlußfolgerung: ACDF mit Titancages zeigt in unserer Langzeitstudie gute Ergebnisse. Es zeigt sich eine signifikante radiologische Progredienz der degenerativen Veränderungen der HWS ohne klinisches Korrelat. Eine Vergleichsstudie mit einer konservativ therapierten Patientenkohorte ist zur optimalen Interpretation der radiologischen Veränderungen erforderlich.

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Correspondence

Simone M. Rohe

Department of Neurosurgery

Ruhr-University Bochum

Germany

In der Schornau 23-25

44892 Bochum

Germany

Phone: +49/234/299 802 56

Fax: +49/234/299 36 09

Email: simone.rohe@web.de

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