Anterior Techniques in Managing Cervical Disc Disease

Kim, Lily H.; D’Souza, Marissa; Ho, Allen L.; Pendharkar, Arjun V; Sussman, Eric S; Rezaii, Paymon; Desai, Atman

doi:10.7759/cureus.3146

Cited by 18 publications

(22 citation statements)

References 50 publications

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“…The clinical bene ts of autogenous vertebrae mainly include: (1) No additional iliac bone extraction was performed during the operation, the operative time was signi cantly shortened; (2) The intraoperative blood loss was signi cantly fewer because no additional incision was needed; (3) Postoperative complications on donor site can be fully avoided; (4) The vertebral extracted from the body is convenient and cheap compared to the allogeneic bone; (5) At the 12-months follow-up, the bone fusion rate and functional outcomes were excellent, indicating that the autologous vertebrate lled PEEK Cage can achieve a satisfying clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Anterior cervical discectomy and fusion with instrumentation (ACDFI) have been widely used in the treatment of degenerative disease or traumatic instability of the cervical spine [1,2]. In the past, the autologous iliac crest (AIC) was considered to be the best material for intervertebral support and bone graft fusion, however, the absorption and displacement of the grafted bone is one of the long-term complications.…”

Section: Introductionmentioning

confidence: 99%

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Clinical efficacy of autogenous vertebrae-filled polyetheretherketone cage in anterior cervical discectomy and fusion with instrumentation

Liu

Zhan

Chang

et al. 2021

Preprint

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Background. Anterior cervical discectomy and fusion with instrumentation (ACDFI) have been widely used in the treatment of the degenerative disease or traumatic instability of the cervical spine. This study aimed to investigate the clinical efficacy of the autologous vertebral-filled polyetheretherketone (PEEK) cage in anterior cervical discectomy and fusion with instrumentation (ACDFI).Material and Methods. The clinical data of 368 patients who received ACDFI from September 2015 to September 2020 were retrospectively analyzed. According to the material that filled PEEK cage during the surgery, the patients were divided into two groups, the autologous vertebrate group (n = 185) and the autologous iliac group (n = 183). The operative time, operative blood loss, postoperative complications in two groups were recorded and analyzed. The bone graft fusion and postoperative functional outcomes, including scores of modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and visual analog scale (VAS) were compared.Results. Patients were followed-up for 14.04 ± 0.98 months. At a 6-months follow-up, the rate of spinal fusion was 96.29% (178/185) in the vertebral group and 95.94% (176/183) in the iliac group, there was no statistically significant difference between the two groups (P>0.05). The postoperative VAS, mJOA, and NDI scores were not significantly different between two groups during the follow-up (P>0.05). The operative time and blood loss in the vertebral group were significantly less than that of the iliac group (P<0.01). In the iliac group, all patients suffered pain in the iliac donor site, 65 patients suffered numbness, 12 patients had fat liquefaction in donor incision, while all patients in the vertebral group had no postoperative complications. Conclusion. The autologous vertebrae-filled PEEK cage can achieve the same clinical outcome as the autologous iliac, but the autologous vertebrae filled PEEK cage have the advantage of shorter operative time, less intraoperative blood loss, and postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of autogenous vertebrae-filled polyetheretherketone cage in anterior cervical discectomy and fusion with instrumentation

Liu

Zhan

Chang

et al. 2021

Preprint

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“…According to the static structure analysis results, the optimized cloud map is shown in Fig.11. The original volume of the cage was 766.44mm 3 , while the volume of the optimized structure was 306.58 mm 3 . The porosity was 40%, and the pore structure was Octet, mainly concentrated in the front of the cage.…”

Section: Lattice Optimization According To the Biomechanical Loadmentioning

confidence: 99%

“…Surgical treatment is available for patients with cervical spondylosis who have failed conservative treatment and whose daily life has been signi cantly affected by cervical spondylosis. Anterior cervical disc removal and bone graft fusion (ACDF) were rstly proposed by Cloward [1] in the 1950s, which have the advantages of less trauma, thorough decompression, and effective restoration of the cervical spine's physiological curvature [2,3].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of cervical interbody fusion cages with ZK60 and Ti-6Al-4V materials: A finite element analysis and lattice topology optimization

Sun¹,

Wang²,

Cai³

et al. 2020

Preprint

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Background In current clinical practice, the most commonly used fusion cage materials are titanium (Ti) alloys. However, titanium alloys are non-degradable and may cause stress shielding. ZK60 is a bio-absorbable implant that can effectively avoid long-term complications, such as stress shielding effects, implant displacement, and foreign body reactions. In this study, we aimed at investigating the biomechanical behavior of the cervical spine after implanting different interbody fusion cages.Methods The finite element (FE) models of anterior cervical disc removal and bone graft fusion (ACDF) with a ZK60 cage and a Ti cage were constructed, respectively. Simulations were performed to evaluate their properties of flexion, extension, lateral bending, and axial rotation of the cervical spine. Moreover, a side-by-side comparison was conducted on the range of motion (ROM), the deformation of cages, the stress in the cages, bone grafts, and cage-end plate interface. Simultaneously, according to the results of biomechanical analysis, the microporous structure of the ZK60 cage was improved by the lattice topology optimization technology and validation using static structure.Results The ROMs in the current study were comparable with the results reported in the literature. There was no significant difference in the deformation of the two cages under various conditions. Moreover, the maximum stress occurred at the rear of the cage in all cases. The cage's and endplate-cage interface's stress of the ZK60 group was reduced compared with the Ti cage, while the bone graft stress in the ZK60 fusion cage was significantly greater than that in the Ti fusion cage (average 27.70%). We further optimized the cage by filling with lattice structures, the volume was decreased by 40%, and validation showed more significant biomechanical properties than ZK60 and Ti cages.Conclusion The application of the ZK60 cage can significantly increase the stress stimulation to the bone graft by reducing the stress shielding effect between the two instrumented bodies. We also observed that the stress of the endplate-cage interface decreased as the reduction of the cage's stiffness, indicating that subsidence is less likely to occur in the cage with lower stiffness. Moreover, we successfully designed a porous cage on the basis of the biomechanical load by lattice optimization.

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“…Radicular pain, myelopathy and spinal joint instability are among the main clinical manifestations secondary to degenerative changes in the cervical spine. After failure of first-line conservative therapies such as physiotherapy, oral drugs or injections of epidural cortisone, or in presence of myelopathy, surgical approaches are indicated [2].…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of complications in anterior cervical discectomy and fusion using cage

Mahieu¹,

Vuylsteke²

2020

Med Clin Sci

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Introduction: Anterior cervical discectomy and fusion (ACDF) is often performed surgery for single and multi-level cervical disc pathology. The purpose of the present study was to evaluate retrospectively the performance of TiPEEK cages, by assessing fusion rate and intra-operative and post-operative complications in patients who underwent ACDF with Mecta-C cervical cage. Materials and methods: Seventy-eight patients who underwent ACDF using Mecta-C cervical cage alone or combined with plates were reviewed retrospectively for clinical and radiological outcomes. Bone substitute was used in all the cases. Results: At the time of surgery the mean age of the patients was 48.2±10.1 years (range 26.7 -75.5). After one year 76 patients underwent a CT scan which proved a complete fusion. At the follow up of 46.5 months±13.7 (range 29 -70) the clinical outcome was reported to be "excellent", "very good" or "good" in 47.4%, 29.5% or 14.1% of patients, respectively. Only 7% of the patients reported a "poor" outcome. No adverse effects, neither intra-operative nor post-operative, were observed. Conclusions: ACDF using Mecta-C cervical cage filled with a bone substitute as a stand-alone device or combined with the Mecta-C cervical plate leads to a complete fusion in all patients one year after surgery. Furthermore, 75% of patients reported satisfying clinical outcomes without any complications or adverse events.

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Anterior Techniques in Managing Cervical Disc Disease

Cited by 18 publications

References 50 publications

Clinical efficacy of autogenous vertebrae-filled polyetheretherketone cage in anterior cervical discectomy and fusion with instrumentation

Clinical efficacy of autogenous vertebrae-filled polyetheretherketone cage in anterior cervical discectomy and fusion with instrumentation

Biomechanical comparison of cervical interbody fusion cages with ZK60 and Ti-6Al-4V materials: A finite element analysis and lattice topology optimization

Retrospective analysis of complications in anterior cervical discectomy and fusion using cage

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