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, 王义生, 王利民, 等. 颈椎前路不同融合方式维持椎间高度的对照研究. 中华外科杂志, 2006, 44(16):1094-1097.
17.	郭永飞, 陈德玉, 王良意, 等. 颈椎椎体终板倾斜角的影像学测量. 中国临床康复, 2003, 7(14):2006-2007.
18.	朱希田, 田野, 王以朋, 等. 三种植骨融合方法在颈前路椎体次全切除术后维持椎间高度的影像学结果分析. 中华外科杂志, 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.	谭俊铭, 叶晓健, 袁文, 等. 三种颈前路融合术后颈椎前柱高度和Cobb角比较. 中国修复重建外科杂志, 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.	张为, 李鹏飞, 申勇, 等. 颈后路三种手术方法对颈椎曲度及轴性症状的长期影响. 中国矫形外科杂志, 2011, 19(9):709-712.
25.	潘胜发, 孙宇, 朱振军, 等. 单开门颈椎管扩大椎板成形术后轴性症状与颈椎稳定性的相关观察. 中国脊柱脊髓杂志, 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, 王义生, 王利民, 等. 颈椎前路不同融合方式维持椎间高度的对照研究. 中华外科杂志, 2006, 44(16):1094-1097.
17. 郭永飞, 陈德玉, 王良意, 等. 颈椎椎体终板倾斜角的影像学测量. 中国临床康复, 2003, 7(14):2006-2007.
18. 朱希田, 田野, 王以朋, 等. 三种植骨融合方法在颈前路椎体次全切除术后维持椎间高度的影像学结果分析. 中华外科杂志, 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. 谭俊铭, 叶晓健, 袁文, 等. 三种颈前路融合术后颈椎前柱高度和Cobb角比较. 中国修复重建外科杂志, 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. 张为, 李鹏飞, 申勇, 等. 颈后路三种手术方法对颈椎曲度及轴性症状的长期影响. 中国矫形外科杂志, 2011, 19(9):709-712.
25. 潘胜发, 孙宇, 朱振军, 等. 单开门颈椎管扩大椎板成形术后轴性症状与颈椎稳定性的相关观察. 中国脊柱脊髓杂志, 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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