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Long-term randomised comparison between a carbon fibre cage and the Cloward procedure in the cervical spine

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Abstract

A prospective randomised study. To compare the long-term outcome of anterior cervical decompression and fusion (ACDF) with a cervical intervertebral fusion cage (CIFC) and the Cloward procedure (CP). We have previously shown that the 2 year outcome of ACDF with the CIFC is the same as for the CP. The fusion rate in CIFC group was, however, only 55%, compared to 85% in CP group. The long-term outcome of CIFC is poorly documented. Ninety-five patients with at least 6 months duration of neck pain and radicular arm pain were randomly allocated for ACDF with the CIFC or the CP. Radiographs were obtained at 2 years. Questionnaires about pain, disability (Neck Disability Index, NDI), distress, quality of life and global outcome were obtained from 83 patients (87%) (43 CIFC, 40 CP) at a mean follow-up time of 6 years (range 56–94 months). There were no significant differences in any outcome variable between the two treatments. For both CP and CIFC the pain intensity improved (P<0.0001) whereas the NDI was unchanged at long-term follow-up compared to preoperatively. In the CIFC group patients with a healed fusion had significantly less mean pain (24 mm) and NDI (26%) than patients with pseudarthrosis (42 and 41, respectively). Furthermore, the mean pain and NDI reported by CIFC patients with a healed fusion was significantly less than in healed CP patients (37 and 38, respectively). The long-term outcome is the same for the CIFC and the CP, with similar improvements of pain but with considerable remaining functional disability. However, in the subgroup of patients with healed CIFC the outcome was clearly better than for the non-healed CIFC group, and also clearly better than for the healed CP group. Thus, if the healing problem associated with the CIFC can be solved the results indicate that a better outcome can be expected with the cage than with the CP.

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References

  1. Abd-Alrahman N, Dokmak AS, Abou-Madawi A (1999) Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir 141:1089–1092

    Article  CAS  Google Scholar 

  2. Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. J Bone Joint Surg 75A:1298–1307

    Google Scholar 

  3. Brooks R with the EuroQol group (1996) EuroQol: the current state of play. Health Policy 37:53–72

    Article  PubMed  CAS  Google Scholar 

  4. Burström K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using EQ-5D. Qual Life Res 10:621–635

    Article  PubMed  Google Scholar 

  5. Clements DH, O´Leary PF (1990) Anterior cervical discectomy and fusion. Spine 15:1023–1025

    Article  PubMed  CAS  Google Scholar 

  6. Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–614

    Article  PubMed  CAS  Google Scholar 

  7. Espersen JO, Buhl M, Eriksen EF, Fode K, Klærke, Krøyer H (1984) Treatment of cervical disc disease using Cloward´s technique: general results, effect of different operative methods and complications in 1,106 patients. Acta Neurochir 70:97–114

    Article  CAS  Google Scholar 

  8. Goldberg EJ, Singh K, Van U, Garretson R, Howard S (2002) Comparing outcomes of anterior cervical discectomy and fusion in workman´s versus non-workman´s compensation population. Spine J 2:408–414

    Article  PubMed  Google Scholar 

  9. Gore DR, Sepic SB (1998) Anterior discectomy and fusion for painful cervical disc disease: a report of 50 patients with an average follow-up of 21 years. Spine 23:2047–2051

    Article  PubMed  CAS  Google Scholar 

  10. Hamburger C, Festenberg FV, Eberhard U (2001) Ventral discectomy with PMMA interbody fusion for cervical disc disease: long-term results in 249 patients. Spine 26:249–255

    Article  PubMed  CAS  Google Scholar 

  11. Javid D, Hedlund R, Vavruch L, Leszniewski W (2001) Is the efficacy of the Cloward procedure overestimated? Technique of evaluation affects the outcome. Eur Spine J 10:222–227

    Article  PubMed  CAS  Google Scholar 

  12. Leclerc A, Niedhammer I, Landre M-F, Ozguler A, Etore P, Pietri-Taleb F (1999) One-year predictive factors for various aspects of neck disorders. Spine 24:1455–1462

    Article  PubMed  CAS  Google Scholar 

  13. Main CJ, Wood PLR, Hollis S, Spanswick CC, Waddell G (1992) The distress and risk assessment method: A simple patient classification to identify distress and evaluate the risk of poor outcome. Spine 17:42–52

    Article  PubMed  CAS  Google Scholar 

  14. Matgé G, Leclercq TA (2000) Rationale for interbody fusion with threaded titanium cages at cervical and lumbar levels: results on 357 cases. Acta Neurochir 142:425–434

    Article  Google Scholar 

  15. Matsunaga S, Kabayama S, Yamamoto T, Yone k, Sakou T, Nakanishi K (1999) Strain on intervertebral discs after anterior cervical decompression and fusion. Spine 24:670–675

    Article  PubMed  CAS  Google Scholar 

  16. Mayer TG, Anagnostis C, Gatchel RJ, Evans T (2002) Impact of functional restoration after anterior cervical fusion on chronic disability in work-related neck pain. Spine J 2:267–273

    Article  PubMed  Google Scholar 

  17. Nachemson AL (1993) Evaluation of results in lumbar spine surgery. Acta Orthop Scand 251:130–133

    CAS  Google Scholar 

  18. Odom GL, Finney W (1958) Cervical disk lesions. JAMA 166:23–28

    CAS  Google Scholar 

  19. Peolsson A, Vavruch L, Öberg B (2002) Disability after anterior decompression and fusion for cervical disc disease. Adv Physther 4:111–124

    Article  Google Scholar 

  20. Peolsson A, Hedlund R, Vavruch L, Öberg B (2003) Predictive factors for the outcome of anterior cervical decompression and fusion. Eur Spine J 12:274–280

    PubMed  Google Scholar 

  21. Persson LCG, Carlsson C-A, Carlsson JY (1997) Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar: A prospective, randomised study. Spine 7:751–758

    Article  Google Scholar 

  22. Persson LCG, Moritz U, Brandt L, Carlsson CA (1997) Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar: a prospective, controlled study. Eur Spine J 6:256–266

    Article  PubMed  CAS  Google Scholar 

  23. Robinson RA, Smith GW (1955) Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223–4

    Google Scholar 

  24. Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2:175–184

    Article  PubMed  CAS  Google Scholar 

  25. Shono Y, MacAfee PC, Cunningham BW, Brantigan JW (1993) A biomechanical analysis of decompression and reconstruction methods in the cervical spine. J Bone Joint Surg 75A:1674–1684

    Google Scholar 

  26. Sonntag VKH, Klara P (1996) Controversy in spine care: is fusion necessary after anterior cervical discectomy? Spine 21:1111–1113

    PubMed  CAS  Google Scholar 

  27. Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A (2002) A prospective randomised comparison between the Cloward Procedure and a carbon fibre cage in the cervical spine: A clinical and radiological study. Spine 27:1694–1701

    Article  PubMed  Google Scholar 

  28. Vernon H, Mior S (1991) The neck disability index: a study of reliability and validity. J Manip Physiol Ther 14:409–415

    CAS  Google Scholar 

  29. Weinhoffer SL, Guyer RD, Herbert M, Griffith SL (1995) Intradiscal pressure measurements above an instrumented fusion: a cadaveric study. Spine 20:526–531

    Article  PubMed  CAS  Google Scholar 

  30. Zoëga B, Kärrholm J, Lind B (2000) Outcome scores in degenerative cervical disc surgery. Eur Spine J 9:137–143

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors especially thank Birgitta Öberg, Waclaw Leszniewski, Davood Javid, Inga-Lill Lindberg and Carl-Henrik Hybbinette for their support. The study has received financial support from the Faculty of Health Sciences at Linköping University and from the Research Council of South-eastern Sweden (FORSS). The experiments comply with the current laws of the country of Sweden inclusive of ethics approval.

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Correspondence to Anneli Peolsson.

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Peolsson, A., Vavruch, L. & Hedlund, R. Long-term randomised comparison between a carbon fibre cage and the Cloward procedure in the cervical spine. Eur Spine J 16, 173–178 (2007). https://doi.org/10.1007/s00586-006-0067-2

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  • DOI: https://doi.org/10.1007/s00586-006-0067-2

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