Three- and Four-Level Anterior Cervical Discectomy and Fusion With Plate Fixation

Bolesta, Michael J.; Rechtine, Glenn R.; Chrin, Ann Marie

doi:10.1097/00007632-200008150-00007

Cited by 202 publications

(130 citation statements)

References 33 publications

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“…Wang et al [30] found that 18 % (7 of 40) of the patients had pseudarthrosis after three-level plated ACDF, and they observed no difference in fusion rates between plated and nonplated subgroups. Bolesta et al [3] reported a nonunion rate of 53 % (8/15 patients) for plated ACDF, the highest in the literature. This wide range of reported values can be explained by multiple factors, including differences in surgical technique, the number of levels grafted, the criteria used for pseudarthrosis, the length of brace use, and the length of follow-up.…”

Section: Discussionmentioning

confidence: 95%

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Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

2012

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Introduction Three-or four-level anterior cervical discectomy and fusion with autograft and plate fixation have demonstrated relatively good fusion rates and outcomes, but donor site morbidity and the limitations of autograft harvest remain problematic. The purpose of this study is to assess the radiographic and clinical outcomes of three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Methods This retrospective review included 43 consecutive patients who underwent three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct (three level: 39 cases, four level: 4 cases). The fusion rate, time to fusion, Cobb angle and disc height were assessed radiographically. Clinical outcomes were evaluated with the VAS, NDI, and SF36 scores. Complications were also recorded. Results Solid fusion was achieved in all the patients, and mean time to fusion was 13.7 ± 5.1 weeks. The postoperative Cobb angle, lordotic angle, and disc height (5.6°, 10.5°a nd 3.15 mm, respectively) increased significantly compared to preoperative values (p = 0.038, p = 0.032, and p = 0.0004, respectively), and these improvements were maintained through final follow-up. The postoperative NDI (17.2), VAS (2.8), and SF36 (13.1) scores increased significantly compared to the preoperative scores (p = 0.026, p = 0.0007 and p = 0.041, respectively). Complications included three cases of respiratory difficulty, four cases of dysphagia and one case of hoarseness. There were no cases of donor site morbidity. Conclusions Three-or four-level anterior cervical discectomy and fusion with a PEEK cage, and plate construct provide good clinical and radiographic outcomes including high fusion rates, low complication rates, low donor site morbidity, and good maintenance of the lordotic angle and disc height in the treatment of multilevel cervical spondylosis.

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Section: Discussionmentioning

confidence: 95%

“…This technique allows direct decompression of neural structures, restoration of disc height, and stabilization of the affected motion segments [2,3]. The success of the procedure relies on the development of a solid arthrodesis, although pseudarthrosis is not always associated with inferior outcome [4,5].…”

Section: Introductionmentioning

confidence: 99%

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

2012

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“…Thus it was desirable, and infact, using instrumentations gained an increase in lordotic curvature, as well as an increased primary stability with higher fusion rates [12,22,37,49,57,76,96,98]. However, it was scrutinized that with the advantage of anterior cervical spine instrumentations came their own shortcomings, such as implant related complications [12,20,37,115,117]. We could not confirm this observation in general, yet to be proven with a thorough evaluation of our clinical and radiographical results.…”

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confidence: 99%

“…The literature offers some hints that reconstruction of cervical lordosis might be favourable concerning clinical outcome and neurologic recovery [32,70,72,113]. However, the question of any influence of a distinct amount of lordotic realignement following the reconstruction of the multilevel decompressed cervical spine demands further investigation [12].…”

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confidence: 99%

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

et al. 2007

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In the future, there will be an increased number of cervical revision surgeries, including 4-and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4-and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5°in average, which measured a mean of 15.6°at last follow-up. Postoperative lordosis at fusion block was 14.4°in average, and 13.6°at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4-and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360°instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions.

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“…However, this method has been associated with complications such as pseudoarthrosis or loss of solid fixation. Many of these complications are probably attributable to the inherent instability associated with these techniques [5,8,9,10,32,42,55]. Decompression via laminectomy is a commonly employed surgical intervention, although many clinicians have reported that the longitudinal results can be less than ideal.…”

mentioning

confidence: 99%

Biomechanics of cervical laminoplasty: kinetic studies comparing different surgical techniques, temporal effects and the degree of level involvement

Puttlitz

Deviren

Smith

et al. 2004

European Spine Journal

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Laminoplasty is a common surgical technique used to treat cervical myelopathy. Both voids and contradictory information exist in the literature with regard to the initial and long-term biomechanical consequences of cervical laminoplasty. In order to clarify the existing literature, as well as provide clinically useful information, we identified three specific aims: (1) to measure the long-term differences in kinetics between the open door laminoplasty (ODL) and French door laminoplasty (FDL) techniques; (2) to delineate differences in primary and long-term cervical motion after laminoplasty; and (3) to determine whether inclusion of additional levels in the laminoplasty procedure results in a change in immediate cervical biomechanics. The study design involved both an animal (caprine) model and in vitro surgical simulation. We kinematically evaluated the cervical spine specimens (C2-C7) by applying pure bending moment loads to the cephalad vertebra (C2), while constraining the caudal vertebra (C7). Resultant intervertebral rotations (C3-C6) were determined via stereophotogrammetry. Overall, the data indicate that both FDL and ODL significantly reduce range of motion 6 months postoperatively, compared with the un-operated spine. There were no significant differences between the two techniques after 6 months. We also showed that ODL produces a significant reduction in motion 6 months postoperatively compared with the immediate postoperative condition. Finally, the data indicated that extending the laminoplasty from two to four levels did not significantly change range of motion. The choice of technique should be based upon the surgeon's experience with these technically demanding procedures. In addition, initial stability considerations should not affect the decision to extend the laminoplasty to adjacent levels. Finally, the data also suggest that early changes in biomechanics should not be a major factor when considering whether immobilization of the cervical spine is necessary after laminoplasty. In fact, our temporal study, as well as previously reported clinical data, indicates that one should expect significantly decreased intervertebral motion 6 months after laminoplasty. Therefore, early physical therapy should be considered to preserve a more physiologic pattern of cervical range of motion.

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Three- and Four-Level Anterior Cervical Discectomy and Fusion With Plate Fixation

Abstract: Three- and four-level modified Robinson cervical discectomy and fusion results in an unacceptably high rate of pseudarthrosis. The Cervical Spine Locking Plate alone does not appear to improve the arthrodesis rate.

Cited by 202 publications

References 33 publications

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

Biomechanics of cervical laminoplasty: kinetic studies comparing different surgical techniques, temporal effects and the degree of level involvement

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