#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

The Effects of Mono- and Bi-Segmental Cervical Discectomy with Interbody Replacement: A Prospective One-Year´s Study


Authors: M. Häckel 1;  I. Štětkářová 2;  J. Chrobok J 3;  D. Hořínek 1;  L. Stejskal 1;  S. Ostrý 1
Authors‘ workplace: Neurochirurgická klinika 1. LF UK a IPVZ Ústřední vojenská nemocnice, Praha 1;  Neurologické oddělení Nemocnice Na Homolce 2;  Neurochirurgické oddělení Nemocnice Na Homolce 3
Published in: Cesk Slov Neurol N 2007; 70/103(3): 253-258
Category: Original Paper

Práce byla podpořena grantem IGA MZ ČR NR 7773-3

Overview

The Aim:
To compare mono- and bi-segmental decompressions of neural structures by means of discectomy with interbody replacement in patients with radiculopathy at a degenerative disease of the cervical spine using two types of subjective scales, clinical and electrophysiological investigations.

Material and Methods:
Surgical interventions were used in 78 patients (38 men, 40 women). The fixation after mono-segmental (52 patients) and bi-segmental (26 patients) operations was carried out using three different methods of mediating the bone fusion, i.e. by an autologous graft, autologous graft fixed with a splint, and a titanium cage filled with spongious bone without the splint fixation. Patients were followed up prospectively before an intervention, 3, 6, and 12 months after an operation. Results were evaluated together and separately after mono-segmental (group 1) and bi-segmental (group 2) interventions irrespective of the type of post-operative fixation. There were processed statistically the subjective assessment using NDI (neck disability index) and 5 items of perceived intensity of pain (head, neck, between scapulae, shoulder and arms of the affected extremity) of visual analogue scale (VAS).

The results obtained from the two scales used have shown statistically significant improvement after the intervention carried out in both groups of patients in all the post-operative check-ups. The comparison of electrophysiological findings in patients before and after surgery has shown no significant difference. The differences between the therapeutical results after mono-segmental and bi-segmental interventions were not singificant in the selected items of VAS, however, the assessment with NDI provided significant difference to disadvantage of bi-segmental surgery during check-ups carried out 6 months and one year after operation.

Conclusion:
The results obtained by means of chosen subjective scales have demonstrated statistically significant improvement of patients’ health conditions checked up after the intervention – discectomy with interbody replacement – in all the post-operative investigations, i.e. they support both mono- and bi-segmental discectomies with interbody replacement as a method of choice of surgical therapy for neurological complications of degenerative disorders of the cervical spine. The results obtained with NDI 6 and 12 months after surgery are significantly worse after bi-segmental interventions if compared with mono-segmental surgery, i.e. the value of intermediate results of NDI is negatively affected by the extent of the cervical spine desis.

Key words degenerative disorders of cervical spine – anterior cervical discectomy with fusion – VAS – NDI


Sources

1. Brodsky AE, Khalil MA, Sassard WR, Newman BP. Repair of symptomatic pseudoartrosis of anterior cervical fusion. Posterior versus anterior repair. Spine 1992; 17: 1137–1143.

2. Farey ID, McAfee PC, Davis RF, Long DM. Pseudoartrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve root decompression, stabilization and arthrodesis. J Bone Joint Surg Am 1990; 72: 1171–1177.

3. Sameš M, Urbánková E, Häckel M, Mohapl M, Beneš V jr. Chirurgické řešení degenerativních onemocnění krční páteře předním přístupem. Cesk Slov Neurol N 1996; 59(92): 326–31.

4. Suchomel P. Update in cervical spine surgery. Principal topic. Eur Spine J. v tisku.

5. Suchomel P, Barsa P, Buchvald P, Svobodník A, Vaničková E. Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respekt to a bone union pattern. Eur Spine J 2004; 13: 510 –515.

6. Häckel M, Stejskal L, Kramář F. Přední krční somatektomie při řešení víceetážových degenerativních stenóz se spondylogenní myelopatií. Výsledky prospektivní studie 1999–2001. Cesk Slov Neurol N 2004; 67/100: 251–259.

7. Suchomel P, Barsa P. Náhrada krční meziobratlové ploténky vložkou Cespace bez použití kosti či její náhrady. Prospektivní studie. Acta Spondylologica 2004; 1: 5–9.

8. Wang JC, McDonough PW, Endow KK, Delamerter RB, Emery SE. Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. J Spinal Disord 2001; 14: 222–225.

9. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Psychologic Therapeutics 1991 14(7): 409–415

10. Kadaňka Z, Bednařík J, Voháňka S. Praktická elektromyografie. Brno: Institut pro další vzdělávání pracovníků ve zdravotnictví v Brně 1994: 33–36.

11. Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 1972; 95: 87–100.

12. Alexander JT. Natural history and nonoperative management of cervical spondylosis. In: Menezes AH, Sonntag VKH (eds). Principle of Spinal Surgery. New York: McGraw-Hill 1996: 547–558.

13. Netuka D, Beneš V, Mikulík R, Kuba R. Bow hunter’s stroke – case report and review of the literature. Zentralbl Neurochir 2005; 66: 217–222.

14. Barsa P, Suchomel P. Organické materiály v přední krční diskektomii a fúzi. Acta Spondylologica 2002; 2: 123–129.

15. Barsa P, Suchomel P. Cervikocervikální přechod v přední krční operativě. Acta Spondylologica 2004; 1: 38–41.

16. Arun R, Rajasekaran S. Radiological and functional outcome of cervical fusion without instrumentation. Eur Spine J 2005; 14 (Suppl. 1): S2/5.

17. Carlsson AM. Assessment of chronic pain: I. Aspects of the realiability and validity of the visual analoque scale. Pain 1983; 16: 87–101.

18. Zoëga B, Kärrholm J, Lind B. Outcome scores in cervical degenerative disc surgery. Eur Spine J 2004; 9: 137–143.

19. Bednařík J, Kadaňka Z, Voháňka S. Median nerve mononeuropathy in spondylotic cervical myelopathy: double crush syndrome? J Neurol 1999; 246: 544–551.

20. Filip M, Veselský T, Paleček T, Wolný E. Sklokeramická náhrada meziobratlové ploténky u degenerativních onemocnění krční páteře – první zkušenosti. Cesk Slov Neurol N 2000; 63/96: 31–36.

21. Häckel M, Stejskal L, Beneš V ml. Přední mikrodiskektomie a somatektomie při degenerativním onemocnění krční páteře. Zkušenosti z uplynulé dekády a vývoj v letech 1998–2001. Cesk Slov Neurol N 2001; 64/97: 401–409.

22. Chrobok J, Prokop L, Kučera R. Náhrada krční ploténky titanovou klíckou. Onemocnění páteře. Kongres České a Slovenské Spondylochirurgické společnosti s mezinárodní účastí. Hrádek nad Moravicí 2002; Prog. Abs. str. 56.

23. Barsa P, Suchomel P, Buchvald P, Kolářová E, Svobodník A. Je víceetážová instrumentovaná přední krční fúze rizikovým faktorem vzniku kostního spojení? (prospektivní studie s minimální délkou sledování 3 roky) Acta Chir OrthopTraumatol Cech 2004; 71(3): 137–141.

24. Azmi H, Schlenk RP. Surgery for postarthrodesis adjacent-cervical segment degeneration. Neurosurg Focus 2003; 15 (3): E6.

25. Iseda T, Goya T, Nakano S, Kodama T, Moriyama T, Wakisaka S. Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis: anterior interbody fusion versus expansive laminoplasty. Acta Neurochir 2001; 143: 707–710.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2007 Issue 3

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#