Anterior Cervical Plating Enhances Arthrodesis after Discectomy and Fusion with Cortical Allograft

Kaiser, Michael G.; Haid, Regis W.; Subach, Brian R.; Barnes, Brian R.; Rodts, Gerald E.

doi:10.1097/00006123-200202000-00001

Cited by 160 publications

(105 citation statements)

References 51 publications

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“…None of the patients had severe disability with a score [50%. The NDI average improvement rate is 65%, which is similar to literature data [4,8,10,11,13,19,24,29,33]. Radiographic outcome demonstrates correction of the kyphotic deformation with improvement of the lordotic overall and segmental alignment after surgery (except one patient with a smaller cage).…”

Section: Discussionsupporting

confidence: 86%

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Anterior cervical fusion with a bio-resorbable composite cage (beta TCP–PLLA): clinical and radiological results from a prospective study on 20 patients

et al. 2009

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A resorbable composite material (40% PLLA and 60% beta TCP) with a high breaking strength and capacity to withstand plastic and elastic strain has been developed for cervical interbody fusion. This is a prospective study to evaluate clinical and radiological results of 20 patients implanted with 27 cages (mean follow-up, 27 months). Clinical (neck disability index, VAS, neurological evaluation) and radiological (anteroposterior, lateral, bending X-rays) data were assessed before and after surgery. At the end of the study, CT scan was performed to evaluate fusion, resorption of the cage and density of the new tissue substituting the cage. The mean patient age was 50.3 years (range, 18-79 years). The average improvement was 55% for neck pain, 83% for arm pain and 65% for NDI, with 85% good or excellent results at final outcomes. Radiologically, lordosis was significantly improved (mean gain of 5.4°and 3.7°for overall and segmental lordosis, respectively). This correction was conserved in 95% of cases. Fusion was obtained in 96% (CT evaluation). Resorption was started in all cases and completed in an average of 36 months after surgery. The mean density of tissue substituting the cage was 659 UH with a range, of 455-911 UH (compatible with bone nature). Over time, the amount of bony tissue increased and the graft remodelled with an increase in density value. This demonstrates a biological activity and changing bone mineral content of this tissue. The new composite cage under investigation provides long-term fusion without loss of correction or inflammatory reaction. The ceramic block guarantees the maintenance of the disc height and its slow resorption allows long-term fusion and stability with good and reliable clinical and radiological outcomes.

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Section: Discussionsupporting

confidence: 86%

“…Autograft is the most commonly used fusion material with good or excellent results in literature [4,8,10,11,19,24,29,33]. However, the use of autologous grafts induces a second operation, generally on the iliac crest, and may be associated with an important morbidity.…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical fusion with a bio-resorbable composite cage (beta TCP–PLLA): clinical and radiological results from a prospective study on 20 patients

et al. 2009

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“…During this procedure, an anterior cervical plate is usually applied to enhance the cervical stability, increase the interbody fusion rate and prevent graft dislocation or subsidence[3, 29]. However, several postoperative complications are closely associated with the anterior plate, as the plate can lead to the compression or stimulation of vital structures[27].…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis Comparing Zero-Profile Spacer and Anterior Plate in Anterior Cervical Fusion

et al. 2015

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BackgroundAnterior plate fusion is an effective procedure for the treatment of cervical spinal diseases but is accompanied by a high incidence of postoperative dysphagia. A zero profile (Zero-P) spacer is increasingly being used to reduce postoperative dysphagia and other potential complications associated with surgical intervention. Studies comparing the Zero-P spacer and anterior plate have reported conflicting results.MethodologyA meta-analysis was conducted to compare the safety, efficacy, radiological outcomes and complications associated with the use of a Zero-P spacer versus an anterior plate in anterior cervical spine fusion for the treatment of cervical spinal disease. We comprehensively searched PubMed, Embase, the Cochrane Library and other databases and performed a meta-analysis of all randomized controlled trials (RCTs) and prospective or retrospective comparative studies assessing the two techniques.ResultsTen studies enrolling 719 cervical spondylosis patients were included. The pooled data showed significant differences in the operation time [SMD = –0.58 (95% CI = −0.77 to 0.40, p < 0.01)] and blood loss [SMD = −0.40, 95% CI (−0.59 to –0.21), p < 0.01] between the two groups. Compared to the anterior plate group, the Zero-P group exhibited a significantly improved JOA score and reduced NDI and VAS. However, anterior plate fusion had greater postoperative segmental and cervical Cobb’s angles than the Zero-P group at the last follow-up. The fusion rate in the two groups was similar. More importantly, the Zero-P group had a lower incidence of earlier and later postoperative dysphagia.ConclusionsCompared to anterior plate fusion, Zero-P is a safer and effective procedure, with a similar fusion rate and lower incidence of earlier and later postoperative dysphagia. However, the results of this meta-analysis should be accepted with caution due to the limitations of the study. Further evaluation and large-sample RCTs are required to confirm and update the results of this study.

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“…'s study, the fusion rate for single-level fixed-plated ACDF (Orion and Atlantis Plates [Medtronic, Memphis, TN, USA] and Codman Plates [Codman and Shurtleff, Inc., Raynham, MA, USA]) was 96% compared with a lesser 90% fusion rate for nonplated 1-ACDF. [7] In the Samartzis et al . series, the fusion rate was 100% for patients undergoing 1-ACDF using fixed plates (Orion; Medtronic) with allograft compared with a 90.3% fusion rate for fixed plate/autograft (note that the difference in fusion rates was not considered significant).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and outcomes of dynamic-plated single-level anterior diskectomy/fusion with additional analysis of comparative costs

Epstein

2011

Surg Neurol Int

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Background:Few studies focus on the fusion rates and outcomes for single-level anterior cervical diskectomy/fusion (1-ACDF) utilizing iliac autograft and dynamic plates.Methods:Fusion rates and outcomes were prospectively evaluated in 60 consecutive patients undergoing 1-ACDF utilizing iliac autograft and dynamic plates (ABC; Aesculap, Tuttlingen, Germany). Eighteen patients had radiculopathy, while 42 were myelopathic (average Nurick Score 3.3). Pathology included single-level disc disease/spondylosis (38 patients) and/or ossification of the posterior longitudinal ligament (OPLL, 22 patients). Fusion was assessed at 3, 6, and up to 12 months postoperatively utilizing dynamic X-rays and 2D-CT scans. Outcomes were evaluated up to 24 months postoperatively utilizing Odom's Criteria, Nurick Grades, and Short-Form 36 (SF-36) outcome questionnaires. Patients were followed for an average of 4.8 postoperative years (minimum 2 years).Results:Although dynamic X-rays/2D-CT studies documented 100% fusion an average of 3.8 months (range 2.5-8 months] postoperatively, 5 heavy smokers exhibited delayed fusions [6-8 months postoperatively]. Two years postoperatively, the average Nurick Score was 0.3 (mild radiculopathy), while Odom's Criteria revealed 52 excellent, 6 good, and 2 fair outcomes [the latter 8 patients were heavy smokers]). Utilizing SF-36 outcome questionnaires, patients markedly improved (>10.0 point gain) on 5 of 8 Health Scales within 6 months, 7 of 8 within 1 year, and all 8 within 2 postoperative years.Conclusions:For 60 patients undergoing 1-ACDF utilizing dynamic plates, ultimately a 100% fusion rate was achieved (5 heavy smokers exhibited delayed fusions). Two years postoperatively, Nurick Grades, Odom's Criteria, and SF-36 questionnaires revealed adequate outcomes.

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Anterior Cervical Plating Enhances Arthrodesis after Discectomy and Fusion with Cortical Allograft

Cited by 160 publications

References 51 publications

Anterior cervical fusion with a bio-resorbable composite cage (beta TCP–PLLA): clinical and radiological results from a prospective study on 20 patients

Anterior cervical fusion with a bio-resorbable composite cage (beta TCP–PLLA): clinical and radiological results from a prospective study on 20 patients

Meta-Analysis Comparing Zero-Profile Spacer and Anterior Plate in Anterior Cervical Fusion

Efficacy and outcomes of dynamic-plated single-level anterior diskectomy/fusion with additional analysis of comparative costs

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