Factors Affecting the Risk of Developing Cervical Cage Malposition in Patients with Cervical Discectomy

Abstract

Aim: Cervical discectomy followed by cage placement for fusion is nowadays a commonly used method for the treatment of degenerative cervical spine diseases. One of the complications that can be observed during postoperative follow-up is cervical cage subsidence. At this point, it is investigated in this study the relationship between the loss of endplate brightness observed on early postoperative cervical radiographs and the development of cervical cage subsidence during follow-up. Methods: 100 patients who underwent single-level cervical disc herniation surgery between 2013 and 2023 were selected. The patients were divided into two groups based on the presence or absence of cage subsidence in cervical radiographs taken at the 60-day postoperative follow-up. In all patients included in the study, the presence of endplate brightness loss in the cervical radiographs taken within the day 1 of post-surgery period in the vertebrae adjacent to the cage was evaluated and compared between groups. Results: Cage subsidence was detected in 11 patients (11%), while it was not observed in 89 patients (89%). Among the 11 patients with cage subsidence, endplate brightness loss was identified in 8 patients (72.7%), whereas it was found in 10 patients (11.2%) among the 89 patients without cage subsidence. These results indicate a significant relationship between the loss of endplate brightness observed on early radiographs and the occurrence of cervical cage subsidence during later follow-up (p<0.001). Conclusion: The identification of endplate cortical brightness loss on early postoperative cervical radiographs increases the likelihood of encountering cage subsidence during follow-up. Therefore, these patients may require shorter follow-up intervals.

Keywords

• Cervical disc herniation
• cervical discectomy
• cervical cage subsidence

Servikal Diskektomi Yapılan Hastaların Takiplerinde Servikal Kafes Malpozisyonu Gelişme Riskini Etkileyen Faktörlerin Araştırılması

Abstract

Amaç: Dejeneratif servikal omurga hastalıklarının tedavisinde servikal diskektomi ve bir kafes yerleştirilerek füzyon sağlanması günümüzde en sık uygulanan yöntemlerden biridir. Bu cerrahi sonrası takiplerde görülebilen komplikasyonlardan biri servikal kafes çökmesidir. Bu çalışmada cerrahi sonrası erken dönemde çekilmiş olan servikal grafide görülebilecek olan son plak parlaklık kaybının, takiplerde servikal kafes çökmesi gelişmesi ile ilişkisi araştırılmıştır. Yöntem: 2013-2023 yılları arasında tek seviye servikal disk hernisi cerrahisi uygulanmış olan 100 hasta çalışmaya dahil edilmiştir. Hastalar cerrahi sonrası 60. gün kontrolünde çekilmiş olan servikal grafisinde kafes çökmesi olanlar ve olmayanlar olarak 2 gruba ayrılmıştır. Çalışmada yer alan tüm hastaların ameliyattan sonra ilk 24 saat içerisinde çekilmiş olan servikal grafi görüntülerinde kafese komşu omurlarda son plak parlaklık kaybı olup olmadığı incelenmiş ve elde edilen sonuçlar bu gruplar arasında kıyaslanmıştır. Bulgular: 89 hastada (%89) servikal kafes çökmesi saptanmazken, 11 hastada (%11) servikal kafes çökmesi geliştiği saptanmıştır. Kafes çökmesi gelişen 11 hastanın 8'inde (%72,7), kafes çökmesi meydana gelmeyen 89 hastanın ise10'unda (%11,2) son plak parlaklık kaybı tespit edilmiştir. Bu sonuçlar göstermektedir ki erken dönem grafide saptanan son plak parlaklık kaybı ile ileri takiplerde gelişen servikal kafes çökmesi arasında anlamlı bir ilişki vardır ve son plak parlaklık kaybı tespit edilenlerde servikal kafes çökmesi görülme oranı daha fazladır (p<0,001). Sonuç: Cerrahiden hemen sonrası çekilmiş erken dönem servikal grafide son plak kortikal parlaklık kaybı saptanması, takiplerde kafes çökmesi ile karşılaşılma sıklığını arttırmaktadır. Bu nedenle bu hastaların daha kısa takip aralığı ile dikkatle takip edilmesi düşünülebilir.

Keywords

• Servikal disk hernisi
• servikal diskektomi
• servikal kafes çökmesi

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