Download PDF
J Neurol Surg A Cent Eur Neurosurg 2015; 76(01): 13-19
DOI: 10.1055/s-0034-1368092
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Use of a Stand-Alone Interbody Fusion Cage in Subaxial Cervical Spine Trauma: A Preliminary Report

Carlo Brembilla
1   Department of Neurosurgery, Ospedali Riuniti, Bergamo, Italy
,
Luigi Andrea Lanterna
1   Department of Neurosurgery, Ospedali Riuniti, Bergamo, Italy
,
Paolo Gritti
2   Department of Anaesthesia and Intensive Care IV, Ospedali Riuniti, Bergamo, Italy
,
Antonio Signorelli
1   Department of Neurosurgery, Ospedali Riuniti, Bergamo, Italy
,
Francesco Biroli
1   Department of Neurosurgery, Ospedali Riuniti, Bergamo, Italy
› Author Affiliations
Further Information

Publication History

26 October 2012

10 December 2013

Publication Date:
28 March 2014 (online)

    Permissions and Reprints

Abstract

Background Anterior spinal surgery has a predominant role in the treatment of traumatic lesions of the subaxial cervical spine. Plating is considered indispensable to achieve stability but may cause dysphagia, dysphonia, and adjacent-level ossification. Zero-P (Synthes GmbH, Oberdorf, Switzerland), an anchored interdisc spacer, can be used without an associated plate. The present study aimed to test if this new implant would be associated with a low rate of dysphagia and other short-term complications compared with the standard for anterior spinal fusion surgery and would be able to achieve a solid fusion and maintain correct metamere alignment.

Material and Methods This is a preliminary presentation of a clinical case series of patients with subaxial cervical injuries who underwent anterior interbody fusion. From July 2009 until September 2011, 12 patients were treated with a Zero-P cage. The data for analysis included operating time compared with the standard for spinal fusion surgery with a cage plus plate construct, intraoperative blood loss, clinical and radiographic results, and complications.

Results In the postoperative period no patient had neurologic worsening. One patient experienced transient dysphonia and moderate dysphagia. All the patients were followed up for a minimum of 6 months (mean: 13 months; range: 6–27 months). Stability and fusion were obtained in all patients together with correct metamere alignment.

Conclusion We presented the preliminary results of a clinical case series. Our results support the initiation of prospective randomized trials with more patients and longer follow-up.

Keywords

cervical spine - cervical injuries - anterior cervical fusion - stand alone - biomechanical evaluation
 

  • References

  • 1 Aebi M, Arlet V, Webb J. AO spine manual. Vol 1 and 2. New York, NY: Thieme; 2007
    Google Scholar
  • 2 Rea G. Sub-axial injuries of the cervical spine. In: Menezes AH, Sonntag VKH, , eds. Principles of Spinal Surgery. New York, NY: McGraw-Hill; 1996: 885-898
    Google Scholar
  • 3 Fountas KN, Kapsalaki EZ, Nikolakakos LG , et al. Anterior cervical discectomy and fusion associated complications. Spine 2007; 32 (21) 2310-2317
    Google Scholar
  • 4 Kasimatis GB, Panagiotopoulos E, Gliatis J, Tyllianakis M, Zouboulis P, Lambiris E. Complications of anterior surgery in cervical spine trauma: an overview. Clin Neurol Neurosurg 2009; 111 (1) 18-27
    CrossrefPubMedGoogle Scholar
  • 5 Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am 2005; 87 (3) 558-563
    PubMedGoogle Scholar
  • 6 Schleicher P, Gerlach R, Schär B , et al. Biomechanical comparison of two different concepts for stand alone anterior lumbar interbody fusion. Eur Spine J 2008; 17 (12) 1757-1765
    CrossrefPubMedGoogle Scholar
  • 7 Scholz M, Reyes PM, Schleicher P , et al. A new stand-alone cervical anterior interbody fusion device: biomechanical comparison with established anterior cervical fixation devices. Spine 2009; 34 (2) 156-160
    CrossrefPubMedGoogle Scholar
  • 8 Scholz M, Schnake KJ, Pingel A, Hoffmann R, Kandziora F. A new zero-profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res 2011; 469 (3) 666-673
    CrossrefPubMedGoogle Scholar
  • 9 Patel AA, Hurlbert RJ, Bono CM, Bessey JT, Yang N, Vaccaro AR. Classification and surgical decision making in acute subaxial cervical spine trauma. Spine 2010; 35 (21, Suppl): S228-S234
    CrossrefPubMedGoogle Scholar
  • 10 Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 1970; 52 (8) 1534-1551
    PubMedGoogle Scholar
  • 11 Allen Jr BL, Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 1982; 7 (1) 1-27
    CrossrefPubMedGoogle Scholar
  • 12 Harris Jr JH, Edeiken-Monroe B, Kopaniky DR. A practical classification of acute cervical spine injuries. Orthop Clin North Am 1986; 17 (1) 15-30
    PubMedGoogle Scholar
  • 13 Pitzen TR, Chrobok J, Stulik J , et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multi-centric, randomized, controlled study. Spine 2009; 34 (7) 641-646
    CrossrefPubMedGoogle Scholar
  • 14 Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001; 8 (12) 1153-1157
    CrossrefPubMedGoogle Scholar
  • 15 Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983; 16 (1) 87-101
    CrossrefPubMedGoogle Scholar
  • 16 Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine 2002; 27 (22) 2453-2458
    Google Scholar
  • 17 Aebi M, Mohler J, Zäch GA, Morscher E. Indication, surgical technique, and results of 100 surgically-treated fractures and fracture-dislocations of the cervical spine. Clin Orthop Relat Res 1986; 203 (203) 244-257
    PubMedGoogle Scholar
  • 18 Glaser JA, Jaworski BA, Cuddy BG , et al. Variation in surgical opinion regarding management of selected cervical spine injuries. A preliminary study. Spine 1998; 23 (9) 975-982; discussion 983
    CrossrefPubMedGoogle Scholar
  • 19 Aebi M. Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J 2010; 19 (Suppl. 01) S33-S39
    CrossrefPubMedGoogle Scholar
  • 20 O'Dowd JK. Basic principles of management for cervical spine trauma. Eur Spine J 2010; 19 (Suppl. 01) S18-S22
    CrossrefPubMedGoogle Scholar
  • 21 Tortolani PJ, Cunningham BW, Vigna F, Hu N, Zorn CM, McAfee PC. A comparison of retraction pressure during anterior cervical plate surgery and cervical disc replacement: a cadaveric study. J Spinal Disord Tech 2006; 19 (5) 312-317
    CrossrefPubMedGoogle Scholar
  • 22 Smith-Hammond CA, New KC, Pietrobon R, Curtis DJ, Scharver CH, Turner DA. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine 2004; 29 (13) 1441-1446
    CrossrefPubMedGoogle Scholar
  • 23 Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study. Eur Spine J 2005; 14 (7) 677-682
    CrossrefPubMedGoogle Scholar
  • 24 Lee MJ, Bazaz R, Furey CG, Yoo J. Influence of anterior cervical plate design on dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech 2005; 18 (5) 406-409
    CrossrefPubMedGoogle Scholar
  • 25 Yang JY, Song HS, Lee M, Bohlman HH, Riew KD. Adjacent level ossification development after anterior cervical fusion without plate fixation. Spine 2009; 34 (1) 30-33
    CrossrefPubMedGoogle Scholar
  • 26 Cain CM, Schleicher P, Gerlach R, Pflugmacher R, Scholz M, Kandziora F. A new stand-alone anterior lumbar interbody fusion device: biomechanical comparison with established fixation techniques. Spine 2005; 30 (23) 2631-2636
    CrossrefPubMedGoogle Scholar