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Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages

  • Clinical Article
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Abstract

Background

Anterior cervical discectomy and fusion (ACDF) is widely performed for the treatment of cervical spinal degenerative disease. Autogenic or allogenic bone grafts are used for interbody fusion with satisfactory long term outcomes. However, harvest of the autograft causes donor site complications and allograft is associated with low fusion rate. Threaded titanium cages (TC) have recently been introduced to cope with these disadvantages, but there is little evidence of long term results.

Methods

The long term outcome was studied after ACDF using TC. Clinical and imaging follow up was performed in 41 patients for at least 5 years (range 5–8.3 years). New computer-assisted measurement methods for radiographs are proposed.

Findings

ACDF with TC achieved 80% excellent or good outcome by Odom’s criteria, 95% fusion rate, and few minor complications. Asymptomatic adjacent disc degeneration was detected in 50% of the patients by our measurement methods. However, symptomatic adjacent disc degeneration occurred in 5% of the patients and only 2% required additional surgery.

Conclusions

These results are comparable or better than those after ACDF with autograft or allograft. ACDF with TC can achieve rigid fixation and provide good long term results.

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Authors and Affiliations

  1. Department of Neurosurgery, School of Medicine, Akita University, Akita, Japan

    Taku Sugawara, Yasunobu Itoh, Yoshitaka Hirano, Naoki Higashiyama & Kazuo Mizoi

  2. Department of Neurosurgery, Akita University Hospital, 1-1-1 Hondo, Akita City, 010-8543, Japan

    Taku Sugawara

Authors
  1. Taku Sugawara
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  2. Yasunobu Itoh
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  3. Yoshitaka Hirano
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  4. Naoki Higashiyama
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  5. Kazuo Mizoi
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Corresponding author

Correspondence to Taku Sugawara.

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Comments

In this manuscript the authors made a long term follow up study of fusion rate and adjacent disc degeneration after anterior discectomy using titanium cages in 41 patients. The manuscript is well written and this reviewer encourage reports of outcome studies after various neurosurgical procedures, making comparisons between centers and own data possible, a necessity for the advancement of surgical techniques. Especially, there are only a few long term outcome studies of the now widely used Titanium cages.

Anders Lewén

Uppsala University, Sweden

For patients with degenerative disc disease at one or two cervical levels, discectomy (removal of the disc) alone results in a shorter hospital stay with a similar rate of fusion of the adjoining vertebrae than surgical techniques that use autograft (using your own bone for a graft). Surgical techniques that use autograft provide a better chance for fusion than those using a cage for additional stability, although the evidence is weak 1,2.

This study was performed to assess the biomechanical properties of the anterior cervical cage fusion constructs, as compared to bone graft fusion constructs. It was interesting to note that the caudad fusion level at C6–7 gave a relatively high stress in the bone graft, which is indeed observed clinically. The cage constructs provided inferior stability as compared to the bone graft constructs, especially for the two-level construct. In the two level fusion constructs, the intermediate vertebra (C6) showed higher stresses than the vertebrae superior and inferior to the fusion (C5 and C7) under all moment loads. This stress levels were much higher in the cage construct, which implies susceptibility of the subsidence or bone collapse in the cage construct.

1. Jacobs WCH, Anderson PG, van Limbeek J, Willems PC, Pavlov P (2004) Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004958.

2 Ruberté LM, Natarajan RN, Andersson GB.(2009)

Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments-A finite element model study.

J Biomech. 2009 Jan 9. [Epub ahead of print]

Kenneth Casey

Detroit, USA

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Sugawara, T., Itoh, Y., Hirano, Y. et al. Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages. Acta Neurochir 151, 303–309 (2009). https://doi.org/10.1007/s00701-009-0217-5

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  • DOI: https://doi.org/10.1007/s00701-009-0217-5

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