Interbody Spacers in the Treatment of Cervical Spine Disorders
Authors:
F. Pataky; M. Gajdoš; V. Kaťuch
Authors‘ workplace:
Neurochirurgická klinika LF UPJŠ, Fakultná nemocnica L. Pasteura Košice, Slovenská republika
prim. MUDr. Vladimír Kaťuch / doc. MUDr. Miroslav Gajdoš, CSc., mim. prof.
Published in:
Rozhl. Chir., 2010, roč. 89, č. 6, s. 336-343.
Category:
Monothematic special - Original
Overview
Degenerative conditions of the spine represent a group of most common lifestyle associated diseases with significant medical and important social impact.
Clinical symptoms and syndromes of surgically considerable degenerative diseases of the spine mostly result from nerve root or spinal cord compression caused by a herniated intervertebral disc or a dorsal osteophyte. Therefore, the main goal of the surgical treatment is decompression of the neural structures by complete removal of the intervertebral disc and the osteophytes followed by insertion of an artificial disc spacer into the remaining space.
The most frequently used procedure for treating such findings is called anterior cervical discectomy. Since its first introduction in 1950, several modifications of the original technique have been introduced. Their common feature is that removal of the degenerated intervertebral disc or the osteophytes requires stabilization of the adjacent segments by fusion. Thus, implantation of an interbody spacer results not only in intervertebral space reconstruction, but by immobilizing the adjacent vertebral bodies also in forming a firm bony bridging between them – and ultimately a solid bony block.
Our paper provides a review of cervical interbody spacers in the order of their evolution from auto- and allografts, through compact materials, cages and dynamic artificial disks. Furthermore, different types of cage filling materials used for fusion augmentation are also discussed.
Key words:
anterior cervical discectomy – interbody spacer – fusion
Sources
1. Casey, A. T., Hayward, R. D., Harkness, W. F., et al. The use of autologous skull bone grafts for posterior fusion of the upper cervical spine in children. Spine, 1995; 20: 2217–2220.
2. Sawin, P. D., Traynelis, V. C., Menezes, A. H. A comparative analysis of fusion rates and donor-site morbidity for autogenic rib and iliac crest bone grafts in posterior cervical fusions. J. Neurosurg., 1998; 88: 255–265.
3. Marchesi, D. G. Spinal fusion: bone and bone substitutes. Eur. Spine J., 2000; 9: 372–378.
4. Smith, G. W., Robinson, R. A. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J. Bone Joint Surg. Am., 1958 Jun; 40-A(3): 607–624.
5. Robinson, R. A., Walker, A. E., Ferlic, D. C., et al. The results of anterior interbody fusion of the cervical spine. J. Bone Joint Surg., 1962; 44A: 1569–1587.
6. Dowd, G., Wirth, F. Anterior cervical dissectomy: Is fusion necessary? J. Neurosurg., 1999; 90: 8–12.
7. Whitecloud, T. S. III. Cervical spondylosis: The anterior approach. In: Frymoyer, et al.: The adult spine. New York, Raven Press, 1991: 1165–1186.
8. Banwart, J. C., Asher, M. A., Hassanein, R. S. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine, 1995; 20: 1055–1060.
9. Summers, B. N., Eisenstein, S. M. Donor site pain from the ilium: a complication of lumbar spine fusion. J. Bone Joint Surg., 1989; 71: 677–680.
10. Younger, E. M., Chapman, M. W. Morbidity at bone graft donor site. J. Orthop. Trauma., 1989; 3: 192–195.
11. Cloward, R. B. Gas-sterilised cadaver bone grafts for spinal fusion operations. A simplified bone bank. Spine, 1980; 5(1): 4–10.
12. Bishop, R. C., Moore, K. A., Hadley, M. N. Anterior cervical interbody fusion using autogenic and allogenic bone graft substrate: a prospective comparative analysis. J. Neurosurg., 1996; 85: 206–210.
13. Barsa, P., Suchomel, P. Organické materiály v prednej krčnej diskektomii a fúzii (souborný referát). Acta Spondylologica, 2002; 2: 123–129.
14. Suchomel, P., Barsa, P., Buchvald, P. Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern. Eur. Spine J., 2004 Oct; 13(6): 510–515. Epub 2004 Mar 20.
15. Zdeblick, T. A., Ducker, T. B. The use of freeze-dried allograft bone for anterior cervical fusion. Spine, 1991; 16: 726–729.
16. Murphy, M. A., Trimble, M. B., Piedmonte, M. R., et al. Changes in the cervical foraminal area after anterior discectomy with and without a graft. Neurosurgery, 1994; 34: 93–96.
17. Martin, G. J., Haid, R. W., MacMillan, M., et al. Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review. Spine, 1999; 24: 852–859.
18. Grote, W., Rottgen, P. The ventral fusion in cervical osteochondrosis and its treatment results. Acta Neurochir. (Wien), 1967; 16(3): 218–240.
19. Kalff, R., Rauhut, F., Roosen, K., et al. Complications of ventral fusion operations in degenerative intervertebral disc diseases. Neurochirurgia, 1990, Nov; 33(6): 184–189.
20. Hamburger, C., Festenberg, F. V., Uhl, E. Ventral discectomy with pmma interbody fusion for cervical disc disease: long-term results in 249 patients. Spine, 2001, Feb 1; 26(3): 249–255.
21. Schroder, J., Wassmann, H. Polymethylmethacrylate (PMMA) in anterior cervical spine surgery – current situation in Germany. Zentralbl. Neurochir., 2001; 62(2): 33–36.
22. Schroder, J., Palkovic, S. Anterior surgery for degenerative disorders of the cervical spine – techniques and innovations. In: Rudinský, B.: Spinálna chirurgia. Bratislava, Slovak Academic Press, 2006: 109–114.
23. Barlocher, C. B., Barth, A., Krauss, J. K., et al. Comparative evaluation of microdiscectomy only, autograft fusion,polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg. Focus, 2002, Jan 15; 12(1): E4.
24. Bent, M. J., Oosting, J., Wouda, E. J. Anterior cervical discectomy with or without fusion with acrylate. A randomized trial. Spine, 1996, Apr 1; 21(7): 834–839; discussion 840.
25. Levkuš, P., Šulla, I., Novotný, V., et al. Naše skúsenosti s prednou krčnou mikrodiskektómiou s fúziou pomocou akrylátu. Acta Spondylologica, 2003; 1: 24–27.
26. Horowitz, S. M., Doty, S. B., Lane, J. M. Studies of the mechanism by which the mechanical failure of polymethylmethacrylate leads to bone resorption. J. Bone Joint Surg. Am., 1993, Jun; 75(6): 802–813.
27. Rudinský, B., Hill, R., Koleják, K. Anterior cervical interbody fusion with bioceramic cages: initial experience. In: Kaech, D. L., Jinkins, J. R.: Spinal restabilization procedures. Elsevier, 2002: 249–255.
28. Kim, P., Wakai, S., Matsuo, S. Bisegmental cervical interbody fusion using hydroxyapatite implants: surgical results and long-term observation in 70 cases. J. Neurosurg., 1998, Jan; 88(1): 21–27.
29. Hill, R. Chirurgická liečba degeneratívnych ochorení krčnej chrbtice. In: Rudinský, B.: Spinálna chirurgia. Bratislava, Slovak Academic Press, 2006: 115–138.
30. Brooke, N. S., Rorke, A. W., King, A. T. Preliminary experience of carbon fibre cage prosthesis for treatment of cervical spine disorders. Br. J. Neurosurg., 1997, Jun; 11(3): 221–227.
31. Suchomel, P., Barsa, P. Náhrada krční meziobratlové ploténky vložkou Cespace bez použití kosti či její náhrady. Prospektivní studie. Acta Spondylologica, 2004; 1: 5–9.
32. Daculsi, G., LeGeros, R., Nery, E., et al. Transformation of biphasic calcium phosphate ceramics in vivo: ultrastructural and physicochemical characterisation. J. Biomed. Mater Res., 1989; 23: 883–894.
33. Urist, M. R. Bone formation by autoinduction. Science, 1965; 150: 893–899.
34. Boakye, M., Mummaneni, P. V., Garrett, M. Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein. J. Neurosurg. Spine, 2005, May; 2(5): 521–525.
35. Burkus, J. K., Transfeldt, E. E., Kitchel, S. H. Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2. Spine, 2002, Nov 1; 27(21): 2396–2408.
36. Assieti, R., Beretta, F., Arienta, C. Two-level anterior discectomy and cage-assisted fusion without plates. Neurosurg. Focus, 2002; 12(1): 1–5.
37. Cho, D. Y., Liau, W. R., Lee, W. Y., et al. Preliminary experience using a polyetheretherletone (PEEK) cage in the treatment of cervocal disc disease. Neurosurgery, 2002, December; 51(6): 1343–1350.
38. Brantigan, J. W., Steffee, A. D. A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine, 1993, Oct 15; 18(14): 2106–2107.
39. Wenz, L. M., Merritt, K., Brown, S. A., et al. In vitro biocompatibility of polyetheretherketone and polysulfone composites. J. Biomed. Mater Res., 1990; 24: 207–215.
40. Bartels, R., Donk, R., Azn, R. Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage. J. Neurosurg., 2001; 95 (1 Suppl): 40–42.
41. Frederic, S., Benedict, R., Payer, M. Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for singlelevel disc herniation: a prospective comparative study. J. Neurosurg. Spine, 2006; 4: 292–299.
42. Mastronardi, L., Ducati, A., Ferrante, L. Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir., 2006; 148: 307–312.
43. Parsons, J. R., Bhayani, S., Alexander, H., et al. Carbon fiber debris within the synovial joint: A time-dependent mechanical and histologic study. Clin. Orthop., 1985; 196: 69–76.
44. Kandziora, F., Pflugmacher, R., Scholz, M. Bioabsorbable interbody cages in a sheep cervical spine fusion model. Spine, 2004, Sep 1; 29(17): 1845–1855; discussion 1856.
45. Pflugmacher, R., Schleicher, P., Gumnior, S., et al. Biomechanical comparison of bioabsorbable cervical spine interbody fusion cages. Spine, 2004, Aug 15; 29(16): 1717–1722.
46. Goffin, J., van Loon, J., van Calenbergh, F., et al. Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J. Spinal Disord., 1995; 8: 499–508.
47. Hilibrand, A. S., Yoo, J. U., Carlson, G. D., et al. The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine, 1997; 22: 1574–1579.
48. Phillips, F. M., Garfin, S. R. Cervical disc replacement. Spine, 2005; 30: S27–33.
49. Bryan, V. E. Cervical motion segment replacement. Europ. Spine J., 2002; 11: 92–97.
50. Wigfield, C. C., Gill, S. S., Nelson, R. J., et al. The new Frenchay Artificial Cervical Joint: results from a two-year pilot study. Spine, 2002; 27: 2446–2452.
51. Goffin, J., Casey, A., Kehr, P., et al. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery, 2002; 51: 840–847.
52. Goffin, J., van Calenbergh, F., van Loon, J., et al. Intermediate follow-up after treatment of degenerative disc disease by the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine, 2003; 28: 2673–2678.
53. Sekhon, L. Cervical arthroplasty in the management of spondylotic myelopathy. J. Spinal Disord. Tech., 2003; 16: 307–313.
54. Rudinský, B., Koleják, K. Totálna artroplastika – arteficiálny disk cervikálnej chrbtice. In: Rudinský, B.: Spinálna chirurgia. Bratislava, Slovak Academic Press, 2006: 139–147.
55. Sawin, P. D., Ceola, W., Mummaneni Praveen, V., et al. Cervical disc arthroplasty with the Prestige ST cervical disc: preliminary results from a multicenter randomized controlled trial. Neurosurgery, 2005 August; 57(2): 421–422.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
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