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Çoklu seviye dejeneratif servikal disk hernilerinde anterior yaklaşımla bıçaklı kafes uygulaması: 156 olguluk klinik seri

Year 2019, Volume: 44 Issue: Supplement 1, 383 - 390, 29.12.2019
https://doi.org/10.17826/cumj.563446

Abstract

Amaç: Klinik çalışmamızda multıple seviyeli servikal dejenaratif disk hernilerinde (2-4 seviye) yaş, cinsiyet, seviye sayısı, şikayet ve bulgular gözönünde bulundurularak anterior servikal diskektomi ile beraber bıçaklı cage uygulaması ve cerrahi sonrası hastaların klinik düzelmeleri, komplikasyon oranları ve radyolojik olarak değerlendirilmeleri amaçlanmıştır.

Gereç ve Yöntem: 2012-2018 yılları arasında 2,3 ve 4 seviyeli servikal dejeneratif disk hernisi tespit edilen 156 hastanın şikayet, semptom, nörolojik muayene, radyolojik bulgular ve cerrahi olarak uygulanan diskektomi ve bıçaklı kafes ile postoperatif sonuçlar ve komplikasyonlar değerlendirilmiştir.  

Bulgular: Hastaların %41.6’sı (65 hasta) erkek, %58.4’ü (91 hasta) kadındı. Yaş aralıkları 32-76 ve yaş ortalamaları 50.68’di. %85.2’si (133 hasta) iki mesafe, %13.5’i (21 hasta) üç mesafe, %1.3’ü (2 hasta) dört mesafe servikal disk hernisine sahipti. Hastaların hepsi daha önce konservatif tedavi olarak ilaç kullanmış ve %79.5’i (124 hasta) fizik tedavi görmüştü. Hastalar postoperatif 3-36 ay ortalama 18 ay izlendi. Komplikasyon olarak, postoperatif erken dönemde 5 hastada nörodefisit, 1hastada yüzeyel yara enfeksiyonu gelişti. 

Sonuç: İki ve daha fazla seviyeli servikal dejeneratif disk hernili ve spondilozlu hastalara uygulanan anterior servikal diskektomi ve bıçaklı kafes  ameliyatları ile   anterior plakla stabilizasyona gerek kalmaksızın servikal bölgenin hareketlerinin korunması sağlanabilir.


Supporting Institution

adana şehir eğitim ve araştırma hastanesi

References

  • Referans 1. Nadiri S. Servikal spondilotik miyelopatide cerrahi yaklaşımın seçimi. Türk Nöroşirurji Dergisi. 2000;10:137–43.
  • Referans 2. Erol F. Servikal spondilotik myelopatide klinik, tanı ve ayırıcı tanı. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb. 2009;234-44.
  • Referans 3. shihara H,KawaguchiY,etal.Adjacentsegmentdiseaseafter anterior cervical interbody fusion. Spine J 2004;4:624–8.
  • Referans 4. Cloward RB: The anterior approach for removal of ruptured cervical discs. J. Neurosurgery 1958; 15: 602-616.
  • Referans 5. Hirsch C: Cervical disc rupture: diagnosis and therapy. Acta Orthop Scan 1964; 30:172-186.
  • Referans 6. Caspar W, Barbier DD, Klara PM: Anterior cervical fusion and Caspar Plate stabilization for cervical trauma. Neurosurgery 1989; 25: 491. Referans 7. Savolainen S, Rinne J, Hernesniemi J: A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery 1998; 43(1):51-55.
  • Referans 8. Zileli M. Servikal Spondilotik Myelopatide Laminektomi. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb., 2009;285-96. Referans 9. Çaylı SR. Servikal Spondilotik Myelopatide Anterior Dekompresyon ve Füzyon. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb. 2009;262-9.
  • Referans 10. Bohlman HH, Emery SE, Goodfellow DB, et al. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 1993;75: 1298–307.
  • Referans 11. Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM, Vaccaro A, Brodke DS, Shaffrey C, Smith JS, Woodard E, Banco RJ, Chapman J, Liu X, Min S, Zhang H, Zhou Z, Wang H, Jin A. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: A systematic review and meta-analysis. Eur Spine J. 2014;23:362–72.
  • Referans 12. Carlsson AM: Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983;16:87–101.
  • Referans 13. Harrison DE, Harrison DD, Cailliet R, et al: Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis? Spine ,2000;25:2072-2078.
  • Referans 14. Yolas C, Ozdemir NG, Okay HO, Kanat A, Senol M, Atci İB, et al. Cervical disc herniation operations through posterior laminoforaminotomy. J Craniovertebr Junction Spine 2016; 7: 91-5. Referans 15. Janssen M, Bono C, Sasso R, Dekutoski M, Gokaslan ZL. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy. Outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine. 2013;38:2247-52. Referans 16. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519–28. Referans 17. Traynelis VC, Arnold PM, Fourney DR, Bransford RJ, Fischer DJ, Skelly AC. Alternative procedures for the treatment of cervical spondylotic myelopathy: arthroplasty, oblique corpectomy, skip laminectomy: evaluation of comparative effectiveness and safety. Spine 2013;38: 210-31.
  • Refertans 18. Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine 2002;27:2431–4.
  • Referans 19. Schwab JS, Diangelo DJ, Foley KT. Motion compensation associated with single-level cervical fusion: where does the lost motion go? Spine 2006;31: 2439–48. Referans 20. Duggal N, Pickett GE, Mitsis DK, et al. Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus 2004;17:E9.
  • Referans 21. Yoon DH, Yi S, Shin HC, et al. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 2006;148:943–50.
  • Referans 22. Yi S, Ahn PG, Kim DH, et al. Cervical artificial disc replacement. Part 2: clinical experience with the cervical artificial disc. Nuerosurg Q 2008;18: 96–103.
  • Referans 23. Kim DH, Cammisa FP, Fessler RG. Dynamic Reconstruction of the Spine. 1st ed. New York, NY: Thieme; 2006.
  • Referans 24. Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine 2007;32:2933–40; discussion 41–2.
  • Referans 25. Silber JS, Anderson DG, Daffner SD, et al. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 2003;28:134–9. Referans 26. Pereira EAC, Chari A, Hempenstall J, Leach J, Chandran H, Cadoux-Hudson T. Anterior cervical discectomy plus intervertebral polyetheretherketone cage fusion over three and four levels without plating is safe and effective long-term. Journal of Clinical Neuroscience. 2013;20:1250–5.
  • Referans 27. Cheng-Wei Chu, Sui-Sum Kung, Tai-Hsin Tsai, Tzuu-Yuan Huang and Shiuh-Lin Hwang. Anterior discectomies and interbody cage fusion without plate fixation for 5-level cervical degenerative disc disease: A 5 year follow-up. Kaohsiung Journal of Medical Sciences 2011;27:524-527.
  • Referans 28. Mootaz Shousha, Ali Ezzati, and Heinrich Boehm: Four-level anterior cervical discectomies and cage-augmented fusıon with and without fixation: European Spinal Journal 2012;21(12):2512-2519.
  • Referans 29. Abd-Alrahman N, Dokmak AS, Abou-Madawi A: Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien) 1999;141:1089-1092.
  • Referans 30. Hacker R.J.,Cauthen J.C., Gilbert T.J., and Griffith S.L.: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 2000;25:2646-2655.

Bladed peek cage using the anterior approach in multiple-level degenerative cervical disc herniation: a case series of 156 patients

Year 2019, Volume: 44 Issue: Supplement 1, 383 - 390, 29.12.2019
https://doi.org/10.17826/cumj.563446

Abstract

Purpose: This study aimed to evaluate the efficacy of cervical discectomy with bladed peek cage and differences in clinical outcomes, complication rates, and radiological findings of patients with multiple-level cervical degenerative disc herniation in terms of age, sex, and number of levels.

Materials and Methods: The following data were assessed: demographic data, patient complaints, symptoms, neurologic examination and radiologic findings, postoperative outcomes, and complications of surgery. We assessed 156 patients who had level 2, 3, and 4 cervical degenerative disc herniation detected between 2012 and 2018 via radiological examination.

Results: Of the patients, 41.6% (n = 65) were men and 58.4% (n = 91) women. The patients were aged 32–76 years, with an average age of 50.68 years. Moreover, 85.2% (n = 133), 13.5% (n = 21), and 1.3% (n = 2) of patients presented with level 2, 3, and 4 cervical degenerative disc herniation, respectively. All patients received medications as a conservative treatment during the preoperative period, and 79.5% (n = 124) underwent physiotherapy. In terms of complications, five patients developed neurological deficit and one developed superficial wound infection during the early postoperative period.

Conclusion: The fusion rate may be similar to the stabilization, and cervical region movements may be achieved after performing anterior cervical plaque surgery with cage as well as anterior cervical discectomy and bladed peek cage surgery in patients with level 2 or higher cervical degenerative disc herniation and/or cervical spondylosis.

References

  • Referans 1. Nadiri S. Servikal spondilotik miyelopatide cerrahi yaklaşımın seçimi. Türk Nöroşirurji Dergisi. 2000;10:137–43.
  • Referans 2. Erol F. Servikal spondilotik myelopatide klinik, tanı ve ayırıcı tanı. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb. 2009;234-44.
  • Referans 3. shihara H,KawaguchiY,etal.Adjacentsegmentdiseaseafter anterior cervical interbody fusion. Spine J 2004;4:624–8.
  • Referans 4. Cloward RB: The anterior approach for removal of ruptured cervical discs. J. Neurosurgery 1958; 15: 602-616.
  • Referans 5. Hirsch C: Cervical disc rupture: diagnosis and therapy. Acta Orthop Scan 1964; 30:172-186.
  • Referans 6. Caspar W, Barbier DD, Klara PM: Anterior cervical fusion and Caspar Plate stabilization for cervical trauma. Neurosurgery 1989; 25: 491. Referans 7. Savolainen S, Rinne J, Hernesniemi J: A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery 1998; 43(1):51-55.
  • Referans 8. Zileli M. Servikal Spondilotik Myelopatide Laminektomi. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb., 2009;285-96. Referans 9. Çaylı SR. Servikal Spondilotik Myelopatide Anterior Dekompresyon ve Füzyon. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb. 2009;262-9.
  • Referans 10. Bohlman HH, Emery SE, Goodfellow DB, et al. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 1993;75: 1298–307.
  • Referans 11. Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM, Vaccaro A, Brodke DS, Shaffrey C, Smith JS, Woodard E, Banco RJ, Chapman J, Liu X, Min S, Zhang H, Zhou Z, Wang H, Jin A. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: A systematic review and meta-analysis. Eur Spine J. 2014;23:362–72.
  • Referans 12. Carlsson AM: Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983;16:87–101.
  • Referans 13. Harrison DE, Harrison DD, Cailliet R, et al: Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis? Spine ,2000;25:2072-2078.
  • Referans 14. Yolas C, Ozdemir NG, Okay HO, Kanat A, Senol M, Atci İB, et al. Cervical disc herniation operations through posterior laminoforaminotomy. J Craniovertebr Junction Spine 2016; 7: 91-5. Referans 15. Janssen M, Bono C, Sasso R, Dekutoski M, Gokaslan ZL. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy. Outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine. 2013;38:2247-52. Referans 16. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519–28. Referans 17. Traynelis VC, Arnold PM, Fourney DR, Bransford RJ, Fischer DJ, Skelly AC. Alternative procedures for the treatment of cervical spondylotic myelopathy: arthroplasty, oblique corpectomy, skip laminectomy: evaluation of comparative effectiveness and safety. Spine 2013;38: 210-31.
  • Refertans 18. Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine 2002;27:2431–4.
  • Referans 19. Schwab JS, Diangelo DJ, Foley KT. Motion compensation associated with single-level cervical fusion: where does the lost motion go? Spine 2006;31: 2439–48. Referans 20. Duggal N, Pickett GE, Mitsis DK, et al. Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus 2004;17:E9.
  • Referans 21. Yoon DH, Yi S, Shin HC, et al. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 2006;148:943–50.
  • Referans 22. Yi S, Ahn PG, Kim DH, et al. Cervical artificial disc replacement. Part 2: clinical experience with the cervical artificial disc. Nuerosurg Q 2008;18: 96–103.
  • Referans 23. Kim DH, Cammisa FP, Fessler RG. Dynamic Reconstruction of the Spine. 1st ed. New York, NY: Thieme; 2006.
  • Referans 24. Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine 2007;32:2933–40; discussion 41–2.
  • Referans 25. Silber JS, Anderson DG, Daffner SD, et al. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 2003;28:134–9. Referans 26. Pereira EAC, Chari A, Hempenstall J, Leach J, Chandran H, Cadoux-Hudson T. Anterior cervical discectomy plus intervertebral polyetheretherketone cage fusion over three and four levels without plating is safe and effective long-term. Journal of Clinical Neuroscience. 2013;20:1250–5.
  • Referans 27. Cheng-Wei Chu, Sui-Sum Kung, Tai-Hsin Tsai, Tzuu-Yuan Huang and Shiuh-Lin Hwang. Anterior discectomies and interbody cage fusion without plate fixation for 5-level cervical degenerative disc disease: A 5 year follow-up. Kaohsiung Journal of Medical Sciences 2011;27:524-527.
  • Referans 28. Mootaz Shousha, Ali Ezzati, and Heinrich Boehm: Four-level anterior cervical discectomies and cage-augmented fusıon with and without fixation: European Spinal Journal 2012;21(12):2512-2519.
  • Referans 29. Abd-Alrahman N, Dokmak AS, Abou-Madawi A: Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien) 1999;141:1089-1092.
  • Referans 30. Hacker R.J.,Cauthen J.C., Gilbert T.J., and Griffith S.L.: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 2000;25:2646-2655.
There are 23 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Emre Bilgin 0000-0002-2394-1503

Gökhan Çavuş 0000-0001-7078-2501

Ali İhsan Ökten 0000-0003-0292-201X

Yurdal Gezercan 0000-0002-4124-2036

Vedat Açık This is me 0000-0002-0371-5883

Ali Arslan 0000-0002-7457-5283

Semih Kıvanç Olguner 0000-0002-5314-4636

İsmail İştemen 0000-0002-2341-4818

Publication Date December 29, 2019
Acceptance Date August 6, 2019
Published in Issue Year 2019 Volume: 44 Issue: Supplement 1

Cite

MLA Bilgin, Emre et al. “Bladed Peek Cage Using the Anterior Approach in Multiple-Level Degenerative Cervical Disc Herniation: A Case Series of 156 Patients”. Cukurova Medical Journal, vol. 44, 2019, pp. 383-90, doi:10.17826/cumj.563446.