A Prospective Randomized Multicenter Clinical Evaluation of an Anterior Cervical Fusion Cage

Hacker, Robert J.; Cauthen, Joseph C.; Gilbert, Thomas; Griffith, Steven L.

doi:10.1097/00007632-200010150-00017

Cited by 314 publications

(232 citation statements)

References 20 publications

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“…In a multicenter study [11] comparing the cylindrical cage with non-instrumented boneonly fusion, similar success rates were shown for the two techniques. Overall complication rate for the cage is lower.…”

Section: Discussionmentioning

confidence: 67%

Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study

et al. 2011

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Objective Clinical outcomes of the stand-alone cage have been encouraging when used in anterior cervical discectomy and fusion (ACDF), but concerns remain regarding its complications, especially cage subsidence. This retrospective study was undertaken to investigate the long-term radiological and clinical outcomes of the stand-alone titanium cage and to evaluate the incidence of cage subsidence in relation to the clinical outcome in the surgical treatment of degenerative cervical disc disease. Methods A total of 57 consecutive patients (68 levels) who underwent ACDF using a titanium box cage for the treatment of cervical radiculopathy and/or myelopathy were reviewed for the radiological and clinical outcomes. They were followed for at least 5 years. Radiographs were obtained before and after surgery, 3 months postoperatively, and at the final follow-up to determine the presence of fusion and cage subsidence. The Cobb angle of C2-C7 and the vertebral bodies adjacent to the treated disc were measured to evaluate the cervical sagittal alignment and local lordosis. The disc height was measured as well. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for cervical myelopathy, before and after surgery, and at the final follow-up.The recovery rate of JOA score was also calculated. The Visual Analogue Scale (VAS) score of neck and radicular pain were evaluated as well. The fusion rate was 95.6% (65/68) 3 months after surgery. ResultsSuccessful bone fusion was achieved in all patients at the final follow-up. Cage subsidence occurred in 13 cages (19.1%) at 3-month follow-up; however, there was no relation between fusion and cage subsidence. Cervical and local lordosis improved after surgery, with the improvement preserved at the final follow-up. The preoperative disc height of both subsidence and non-subsidence patients was similar; however, postoperative posterior disc height (PDH) of subsidence group was significantly greater than of non-subsidence group. Significant improvement of the JOA score was noted immediately after surgery and at the final follow-up. There was no significant difference of the recovery rate of JOA score between subsidence and non-subsidence groups. The recovery rate of JOA score was significantly related to the improvement of the C2-C7 Cobb angle. The VAS score regarding neck and radicular pain was significantly improved after surgery and at the final follow-up. There was no significant difference of the neck and radicular pain between both subsidence and non-subsidence groups. ConclusionsThe results suggest that the clinical and radiological outcomes of the stand-alone titanium box cage for the surgical treatment of one-or two-level degenerative cervical disc disease are satisfactory. Cage subsidence does not exert significant impact upon the long-term clinical outcome although it is common for the stand-alone cages. The cervical lordosis may be more important for the longterm clinical outcome than cage subsidence

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Section: Discussionmentioning

confidence: 67%

Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study

et al. 2011

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“…Therefore, graft material as soft as cancellous bone can be used. Cancellous bone can be obtained with less morbidity and incorporates more quickly than allograft [14]. This may account for the findings that a higher percentage of levels were found fused in the cervical cage group at 3 months, though this difference was not detectable at later follow-ups.…”

Section: Rationale For Carbon Fiber Cagesmentioning

confidence: 97%

“…To avoid donor site complications altogether, empty carbon fiber osteoconductive polymer cages were placed by Payer et al [18], who reported segmental stability in all 25 patients and bone fusion in 24. Hacker et al [14] reported nearly 100% fusion rates with threaded carbon fiber cages and autograft versus 90% for non-instrumented bone graft alone. Salame et al [19] reported 98% fusion in 100 patients with the I/ F carbon cage.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

A prospective randomized study comparing a cervical carbon fiber cage to the Smith–Robinson technique with allograft and plating: up to 24 months follow-up

2005

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IntroductionSymptomatic cervical disc herniation and degeneration are routinely treated by anterior decompression; however, the options for subsequent fusion and stabilization are numerous and ever increasing. The original anterior discectomy and fusion by Cloward [11] described interbody fusion with an autograft bone dowel. This was followed by the technique of Smith-Robinson describing the harvest of a rectangular tricortical iliac bone Abstract Introduction: Intervertebral carbon fiber cages may reduce graft collapse and promote bony fusion. Their safety and efficacy in the cervical spine have been investigated; however, no study has compared the outcomes of anterior cervical decompression and placement of a carbon fiber cage with placement of allograft and plate. Methods: Forty consecutive patients who met inclusion criteria were enrolled and randomized to anterior cervical discectomy with carbon fiber cage alone (n=20) or with allograft with plating (n=20). Clinical and radiographic evaluations were performed at baseline and at 6 weeks, 3, 6, 12 and 24 months. Neck and arm pain as well as neck disability index (NDI) were assessed at every visit. The Short Form (SF)-36 was completed prior to operation and at 12-month intervals. Cervical radiographs were evaluated pre-op and at every follow-up for evidence of fusion and instability. Results: No significant difference was found between the two randomized groups with respect to pre-operative age (mean 50 years), sex, employment status, duration of pain or cervical levels affected. The mean followup period was 14 months (range, 6-26 months). The clinical pain and disability improvements were similar for both treatments. Post-operative donor site pain was only present in the cage group, but not of significant long-term disability. At up to 24 months, NDI scores were significantly improved in both groups when compared with baseline. At 12 and 24 months, all SF-36 questionnaire responses were also improved in both the treatment groups. However, there was no statistically significant difference in outcomes between the two groups at any time. The fusion rate was 100% in both groups by 12 and 24 months, without evidence of instability. There were no differences in complications between both groups. Conclusions: The outcomes after cervical decompression and placement of a carbon fiber cage appear to be similar to cervical decompression with allograft and plating by the Smith-Robinson technique.

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“…Anterior cervical spine surgery-associated complications in a retrospective case-control study an overstatement that anterior cervical approach constitutes one of the most rewarding spinal procedures (4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Review Articlementioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

114

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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A Prospective Randomized Multicenter Clinical Evaluation of an Anterior Cervical Fusion Cage

Abstract: These results demonstrate that outcomes after a cervical fusion procedure with a threaded cage are the same as those of a conventional uninstrumented bone-only anterior discectomy and fusion with a low risk of complications and rare need for autogenous bone graft harvest.

Cited by 314 publications

References 20 publications

Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study

Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study

A prospective randomized study comparing a cervical carbon fiber cage to the Smith–Robinson technique with allograft and plating: up to 24 months follow-up

Anterior cervical spine surgery-associated complications in a retrospective case-control study

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