Study Design. Prospective single-center study. Objectives. To assess the clinical and radiological outcomes after ACDF with 3D printed cellular titanium cages filled with bone marrow and to compare the clinical and radiological results with the current scientific literature. Methods. ACDF was performed monosegmentally under standardized conditions. X-rays were analyzed to determine the range of motion, fusion rates, and subsidence preoperatively and 3 and 12 months postoperatively. Clinical outcome measurements included neck disability index (NDI), visual analogue scale (VAS) for brachialgia and cervicalgia, and patient satisfaction. Results. 18 patients were included in the study. The mean RoM decreased from 7.7 ° ± 2.6 preoperatively to 1.7 ° ± 1.1 ° after 3 months and 1.8 ° ± 1.2 ° 12 months after surgery. The fusion rates were at 94.4% after 3 and 12 months. The mean subsidence was 0.9 mm ± 0.5 mm 3 months postoperatively and 1.1 mm ± 0.5 mm 12 months after surgery. The mean NDI improved significantly from preoperatively to 12 months postoperatively ( 34.6 ± 6.2 and 3.4 ± 4.1 , respectively). The VAS-neck also showed a large improvement from 5.8 ± 2.2 before and 1.3 ± 1.4 12 months after surgery, as did the VAS-arm ( 6.4 ± 1.5 and 0.9 ± 1.6 , respectively). Patient satisfaction was high throughout the follow-up period. Conclusion. ACDF with a 3D printed titanium cage resulted in fast fusion without pathological subsidence. In comparison to other cage materials such as PEEK, the 3D printed titanium cage was noninferior in regard to its fusion rate and clinical results.
Minimally invasive techniques are currently applied in large variety of spinal surgical procedures. Surgical invasiveness has been minimized mainly for surgical accesses but in some procedures (e.g. decompression surgery) also for the 'target surgery'. Despite different techniques, there are general principles which have to be considered. Only with combination of preoperative planning, the (educational) elaboration of a surgical strategy, the thorough knowledge of the patient's individual anatomy, the respect for the anatomy, properties and function of tissues, the well-trained surgeon, and the use of modern surgical high-tech -equipment will lead to an improvement of peri-and postoperative morbidity and clinical result for our patients. Minimally invasive spine surgery is a 'moving target' so it must be accepted that evidence Level I data in a scientific sense are still missing for some of these procedures. However, empirical data all suggest that minimally invasive spine surgery can significantly improve early post-op outcomes and decrease perioperative morbidity. It is thus the task of every spine surgeon to apply his experiencebased expertise in a responsible way for the safety of our patients. Minimally invasive spine surgery is nothing but a 'natural evolution' of surgical technique to further decrease tissue trauma for certain operations.
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