Outcome Analysis of Noninstrumented Anterior Cervical Discectomy and Interbody Fusion in 348 Patients

Cauthen, Joseph C.; Kinard, Richard E.; Vogler, James B.; Jackson, Donald E.; DePaz, Oscar B.; Hunter, Oregon L.; Wasserburger, Lori B.; Williams, Virginia M.

doi:10.1097/00007632-199801150-00008

Cited by 214 publications

(96 citation statements)

References 7 publications

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“…Vavruch et al [27] found the clinical outcome for both treatment groups was the same. Their study and the above results are also comparable with other studies reviewing anterior cervical fusion procedures reporting symptomatic relief and patient satisfaction approaching 90% [10,22,25].…”

Section: Clinical Evaluationsupporting

confidence: 89%

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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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Section: Clinical Evaluationsupporting

confidence: 89%

“…This general technique has only undergone minor refinements over four decades with satisfactory clinical results from many trials at about 90% [10].…”

mentioning

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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“…Anterior corpectomy and resection of OPLL is a radical surgical option due to direct decompression, and provides satisfactory results. The overall fusion rate in a large number of patients evaluated in a comprehensive literature review was 92% [20]. In this study, we observed that the surgical approach was closely related with postoperative JOA score and IR.…”

Section: Discussionmentioning

confidence: 60%

Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?

et al. 2011

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Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on magnetic resonance imaging (MRI) on surgical opportunity and approach for cervical myelopathy due to OPLL. This was a prospective randomized controlled study. Fifty-six patients with cervical myelopathy due to OPLL were enrolled and assigned to either group A (receiving anterior decompression and fusion, n = 27) or group P (receiving posterior laminectomy, n = 29). All the patients were followed up for an average 20.3 months (12-34 months). The clinical outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA) score, improvement rate (IR) and complication. To determine the relevant statistics, we made two factorial designs and regrouped the data of all patients to group H (with hyperintensity on MRI, n = 31), group L (with hypointensity on MRI, n = 19) and group N (no signal on MRI, n = 25), and then to further six subgroups as well: AH (with hyperintensity on MRI from group A, n = 15), PH (with hyperintensity on MRI from group P, n = 16), AL (with hypointensity on MRI from group A, n = 10), PL (with hypointensity on MRI from group P, n = 9), AN (no signal intensity on MRI from group A, n = 12) and PN (no signal intensity on MRI from group P, n = 13). Both hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging had a close relationship with the JOA score and IR. The pre-and postoperative JOA score and postoperative IR of either group H or group L was significantly lower than that of group N (P \ 0.05), regardless of whether the patients had received anterior or posterior surgery. On the other hand, both the JOA score and IR of subgroup AH were higher than those of subgroup PH at 1 week, 6 and 12 months postoperatively (P \ 0.05), as well as between subgroup AL and PL; but in group N, there was no difference between the subgroup AN and PN (P [ 0.05). In conclusion, regardless of hyperintensity on T2-weighted imaging or hypointensity on T1-weighted imaging in patients with OPLL, severe damage to the spinal cord is indicated. Surgical treatment should be provided before the advent of intramedullary spinal cord changes in signal intensity on MRI. The anterior approach is more effective than posterior approach for treating cervical myelopathy due to OPLL characterized by intramedullary spinal cord changes in signal intensity on MRI.

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“…The kyphotic alignment of the cervical spine and of the fused vertebrae is a commonly reported complication after the Cloward procedure. In a review of the extensive literature on the Cloward procedure, Chauten et al [8] reported a rate of kyphotic alignment of 20%. Vavruch et al [51] reported an increase of SSA at 1-year followup after the Cloward procedure.…”

Section: Discussionmentioning

confidence: 99%

“…1). This technique is reportedly associated with overall rates of satisfaction ranging from 70% to 99% depending on type of grading scale [8,12,34,36,41,46]. When one cervical segment is fused, the adjacent cervical levels provide compensatory motion, thus increasing the mechanical stress of these sites [9,18,20,25,33,39].…”

Section: Introductionmentioning

confidence: 99%

Sagittal Segmental Alignment as Predictor of Adjacent-Level Degeneration After a Cloward Procedure

Faldini

Pagkrati

Leonetti

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background The Cloward anterior interbody fusion is commonly performed for cervical disc herniation or spondylosis. In followup studies, various authors have noted clinically relevant adjacent-level degeneration. However, factors associated with adjacent-level degeneration are not well known. Questions/purposes We asked whether the postoperative sagittal segmental alignment of the fused vertebrae could be used as a predictor of adjacent-level degeneration. Methods We retrospectively studied 107 patients, aged 35 to 55 years, with one-level cervical disc disease between C4 and C7 operated on from 1985 to 1995 by discectomy and one-level anterior cervical fusion according to the Cloward procedure. In standard radiographs of the cervical spine in lateral view, the alignment of the involved intervertebral space (sagittal segmental alignment) and the sagittal alignment of the cervical spine were measured and the adjacent-level degeneration was assessed using the Kellgren and Lawrence criteria. The minimum followup was 10 years (mean, 16 years; range, 10-23 years).

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Outcome Analysis of Noninstrumented Anterior Cervical Discectomy and Interbody Fusion in 348 Patients

Cited by 214 publications

References 7 publications

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

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

Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?

Sagittal Segmental Alignment as Predictor of Adjacent-Level Degeneration After a Cloward Procedure

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