Clinical results of cervical discectomy and fusion with anchored cage – prospective study with a 24-month follow-up

Česká verze

Authors: R. Opšenák; B. Kolarovszki; M. Benčo; R. Richterová; P. Snopko; M. Hanko; K. Varga
Authors place of work: Neurochirurgická klinika JLF UK a UN Martin
Published in the journal: Cesk Slov Neurol N 2018; 81(6): 669-677
Category: Původní práce
doi: https://doi.org/10.14735/amcsnn2018669

Summary

Introduction:

Anterior cervical discectomy and fusion (ACDF) using an anchored intervertebral cage represents an alternative to the use of a cage fixed by a conventional plate.

Patients and methods:

Prospective single-center study with a 24-month follow-up. Sixty-one patients who underwent a 1- or 2-level anterior cervical discectomy with implantation of an anchored cage Zero Profile Variable Angle® (DePuy Synthes, Oberdorf, Switzerland) from May 2013 to April 2015 were included in this study. The results of the surgical treatment were evaluated using a visual analogue scale, Odom‘s criteria and neck disability index. Incidence of the intersomatic fusion and complications related to the surgical approach and implant type were assessed postoperatively.

Results:

After the ACDF, there was a decrease in neck and upper-limb pain intensity and an improvement of the patients‘ life quality. Female gender and age below 55 years were identified as risk factors for inadequate effect of the operative treatment. The incidence of intersomatic fusion after 12 months was at 93%. The incidence of complications related to the surgical approach did not differ from other studies. The implant’s zero profile did not act as a preventive factor against postoperative dysphagia. A presence of preexisting dysphagia was a risk factor for incidence of postoperative dysphagia. Neither dislocation nor breakdown of the impant was recorded. The preventive effect against cage subsidence using its stabilisation by two fixating screws was not confirmed. Osteoporosis posed a risk factor for subsidence of the cage. The cage subsidence did not have a significant influence on the efficiency of the surgical treatment or on the incidence of intersomatic fusion.

Conclusion:

The Zero Profile Variable Angle® anchored cage is a safe implant providing favourable results of surgical treatment. The implant’s zero profile does not reduce the incidence of postoperative dysphagia. Stabilisation of the cage in the intervertebral space has no preventive influence against its subsidence which, however, has no influence on the efficiency of the surgical treatment.

Key words:

anterior cervical discectomy – complications – dysphagia – intersomatic fusion – cage subsidence

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Chinese summary - 摘要

颈椎间盘切除术与锚固融合术的临床结果 - 前瞻性研究，随访24个月

介绍：

使用锚定椎间笼的前颈椎间盘切除术和融合术（ACDF）代表了使用由常规板固定的笼子的替代方案。

患者和方法：

前瞻性单中心研究，随访24个月。 2013年5月至2015年4月，61名接受1或2级颈椎前路椎间盘切除术并植入锚定笼

Zero Profile VariableAngle®（DePuy Synthes，Oberdorf，Switzerland）的患者纳入本研究。使用视觉模拟评分，Odom标准和颈部残疾指数评估手术治疗的结果。术后评估了椎间融合的发生率以及与手术入路和种植体类型相关的并发症。

结果：

ACDF后，颈部和上肢疼痛强度下降，患者生活质量得到改善。女性和55岁以下的年龄被确定为手术治疗效果不佳的风险因素。 12个月后椎间融合的发生率为93％。与手术方法相关的并发症发生率与其他研究没有差异。植入物的零曲线并不是预防术后吞咽困难的预防因素。先前存在的吞咽困难是导致术后吞咽困难的一个危险因素。没有植入物的脱位或破裂被记录。使用两个固定螺钉稳定对笼子下沉的预防作用没有被证实。骨质疏松症是笼子下沉的危险因素。笼下沉对手术治疗效率或椎间融合发生率没有显著影响。

结论：

Zero ProfileVariableAngle®锚固笼是一种安全的植入物，可提供有利的手术治疗效果。植入物的零曲线不会降低术后吞咽困难的发生率。椎间隙内椎间盘的稳定对其下沉没有预防性影响，但是对于手术治疗的效率没有影响。

关键词：

颈椎前路椎间盘切除术 - 并发症 - 吞咽困难 - 椎间融合术 - 下陷

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