Use of Bone Graft Assisted Peek Cage After Anterior Cervical Microdiscectomy: 78 Cases

Year 2021, Volume: 10 Issue: 1, 25 - 31, 30.04.2021

Güray Bulut

https://doi.org/10.47493/abantmedj.2021.29

Abstract

Objective: In this study, the patients who had fusion with the anterior cervical microdiscectomy and the synthetic bone graft (putty) with the diagnosis of degenerative cervical disc herniation; We evaluated age, sex, symptoms, physical examination findings and surgical results in the light of literature.
Materials and Methods: Between April 2015 and April 2017, 78 cases with anterior cervical microdiscectomy and fusion were evaluated retrospectively. Symptoms were supported by physical examination, cervical radiographs and cervical magnetic resonance images and surgical indications were made. Cases; sex, age, symptoms, physical examination, disc distances, radiological findings, complications, relapse, patient satisfaction were evaluated retrospectively.
Results: 74 patients (94.87%) treated with anterior cervical microdiscectomy and putty-assisted peek cage reported benefit from the operation. The mean hospital stay was 1 day. The complication rate was low (2.56%), there was no recurrence and reoperation. The use of cervical collor was not required. No infection. None of the patients had any stability or fusion problems.
Conclusion: Fused with a peek cage supported by synthetic bone graft and made of anterior cervical microdiscectomy is a safe, easy-to-use, effective treatment.

Keywords

servicalAnterior cervical microdiscectomy, cervical disc hernia, peek cage, bone graft

Anterior Servikal Mikrodiskektomi Sonrası Kemik Greft Destekli Peek Cage Kullanılması: 78 Olgu

Abstract

Amaç: Bu çalışmada, dejeneratif servikal disk hernisi tanısı ile anterior servikal mikrodiskektomi (ASMD) ve sentetik kemik greft (putty) ile desteklenmiş peek cage ile füzyon yapılmış olguları; yaş, cins, semptomlar, fizik muayene bulguları ve cerrahi sonuçları ile birlikte literatür ışığında değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Nisan 2015-Nisan 2017 tarihleri arasında kliniğimizde anterior servikal mikrodiskektomi ve füzyon yapılmış 78 olgu retrospektif olarak incelendi. Tüm olgularda dejeneratif disk hastalığı ve osteofitik değişikliklikler vardı. Semptomlar, fizik muayene, servikal radyografiler ve servikal manyetik rezonans görüntüleri ile desteklendi ve cerrahi endikasyon konuldu. Olgular; cins, yaş, semptomlar, fizik muayene, disk mesafeleri, radyolojik bulgular, komplikasyonlar, nüks, hasta memnuniyeti açısından değerlendirildi.
Bulgular: Anterior servikal mikrodiskektomi ve putty destekli peek cage kullanılarak tedavi edilen 74 (%94.87) olgu operasyondan fayda gördüğünü bildirdi. Hastanede kalış süresi ortalama 1 gündü. Komplikasyon oranı %2.56 idi; nüks ve reoperasyon olmadı. Servikal collor kullanımına gerek olmadı. Enfeksiyon, stabilite ya da füzyon sorunu izlenmedi.
Sonuç: Anterior servikal mikrodiskektomi yapılan ve sentetik kemik greftle desteklenmiş peek cage ile füzyon güvenli, kolay uygulanan, etkin bir tedavi yöntemidir.

Keywords

Anterior servikal mikrodiskektomi, servikal disk hernisi, peek cage, kemik greft

References

• Altınörs N, Caner H. Servikal disk hastalığı. In: Zileli M, Özer F. (eds) Omurilik ve omurga cerrahisi'nde. 1. Baskı İzmir: Saray Medikal Yayıncılık 1997: 306-314.
• Callagan PJ, McGill SM. Intervertebral disc herniation: studies on a porcine model exposed to highly repetetive flexion/extension motion with compressive force. Clinical Biomechanics 2001; 16: 28-37.
• Gruber HE, Hanley EN. Observations on morphologic changes in the aging and degenerating human disc: Secondary collagen alterations. BMC Musculoskeletal Disorders 2002: 3: 9.20. Adamson TE: Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: Results of a new technique in 100 cases. J Neurosurg (Suppl) 2001; 1: 51-7.
• Prescher A. Anatomy and pathology of the aging spine. Europen Journal of Radiology 1998; 27: 181-95.
• Greenberg MS. Handbook of neurosurgery. 5 ed.Ontario, Canada: Thieme New York, 2001: 310- 14.
• Ueyama T, Tamaki N, Kondoh T,Miyomato H, Akiyama H, Nagashima T. Non-traumatic acute paraplegia assosiated with cervical disc herniation: a case report. Surg Neurol 1999; 52: 204-7.
• Zeidman SM, Ducker TB. Anterior cervical discectomy. Kaye AH, Black PM. In: Operative neurosurgery. First ed. China:Churchill Livingstone, 2000: 1793-802.
• Cloward RB. The anterior approach for removal of ruptured cervical disc. J Neurosurg 1958; 16: 602-7.
• Smith GW, Robinson RA. The treatment of certain spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone and Joint Surg. 1958; 40A:624-62.
• Agrillo U, Faccioli F, Fachinetti P, Gambardella G, Guizzardi G, Profeta G. Guidelines for the diagnosis and management of the degenerative diseases of cervical spine. J Neurosurg Sci 1999; 43:11-4.
• Bydon M, Mathios D, Macki M, de la Garza-Ramos R, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A. Longterm patient outcomes after posterior cervical foraminotomy: An analysis of 151 cases. J Neurosurg Spine. 2014; 21:727-31.
• Huang D, Du X, Liang H, Hu W, Hu H, Cheng X. Anterior corpectomy versus posterior laminoplasty for the treatment of multilevel cervical myelopathy: A meta-analysis. Int J Surg 2016; 35: 21-7.
• Hirsch C. Cervical disc rupture: diagnosis and therapy. Acta Orthop Scan 1964; 30: 172-86.
• Thorell W, Cooper J, Hellbusch L, Leibrock L. The long term outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement. Neurosurgery 1998; 43: 268-73.
• Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir. 1989; 99(1-2):41-50.
• Donaldson JW, Nelson PB. Anterior cervical discectomy without interbody fusion. Surg Neurol 2002; 57: 219-25.
• Donaldson JW, Nelson PB. Anterior cervical discectomy without interbody fusion. Surg Neurol 2003; 57:219-24.
• White BD, Fitzgerald JJ. To graft or not to graft: rationalizing choice in anterior cervical discectomy. British J Neurosurg. 2005; 19: 148-54.
• Murphy MA, Trimble MB, Piedmonte MR, Kalfas IH. Changes in the cervical foraminal area after anterior discectomy with and without a graft. Neurosurgery 1994; 34: 93-6.
• Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: Results of a new technique in 100 cases. J Neurosurg (Suppl) 2001; 1: 51-7.
• Clarke MJ, Ecker RD, Krauss WE, McClelland RL, Dekutoski MB. Same-segment and adjacent-segment disease following posterior cervical foraminotomy. J Neurosurg Spine 2007; 6: 5-9.
• Ebersold MJ, Raynor RB. Cervical laminotomy, laminectomy, laminoplasty, and foraminotomy. In: Benzel EC (ed), Spine Surgery: Techniques, Complication Avoidance, and Management, Philadelphia: Elsevier Churchill Livingstone, 2005: 387-94.
• Lubelski D, Healy AT, Silverstein MP, Abdullah KG, Thompson NR, Riew KD, Steinmetz MP, Benzel EC, Mroz TE. Reoperation rates after anterior cervical discectomy and fusion versus posterior cervical foraminotomy: A propensity-matched analysis. Spine J 2015; 15: 1277-83.
• Brenke C, Scharf J, Schmieder K, Barth M. High prevalence of heterotopic ossification after cervical disc arthroplasty: Outcome and intraoperative findings following explantation of 22 cervical disc prostheses. J Neurosurg Spine. 2012; 17:141-6.
• Oertel JM, Philipps M, Burkhardt BW. Endoscopic posterior cervical foraminotomy as a treatment for osseous foraminal stenosis. World Neurosurg 2016; 91: 50-7.
• Wagner R, Telfeian AE, Iprenburg M, Krzok G. Minimally invasive fully endoscopic two-level posterior cervical foraminotomy: Technical note. J Spine Surg 2017; 3: 238-42.
• Wirth FP, Dowd GC, Sanders HF, Wirth C. Cervical discectomy: a prospective analysis of three operative techniques. Surg Neurol 2000; 53: 340-8.
• Bolesta MJ, Rechtine GR, Chrin AM. One- and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine J. 2002; 2:197-203.
• Goffin J, van Loon J, Van Calenbergh F, Plets C. Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J Spinal Disord 1995; 8:500-8.
• Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999; 81: 519-28.
• Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: A prospective 2-year study. J Neurosurg Spine 2005; 3: 417-23.
• Zhong ZM, Zhu SY, Zhuang JS, Wu Q, Chen JT. Reoperation after cervical disc arthroplasty versus anterior cervical discectomy and fusion: A meta-analysis. Clin Orthop Relat Res 2016; 474: 1307-16.
• Brenke C, Scharf J, Schmieder K, Barth M. High prevalence of heterotopic ossification after cervical disc arthroplasty: Outcome and intraoperative findings following explantation of 22 cervical disc prostheses. J Neurosurg Spine. 2012; 17:141-6.
• Leung C, Casey AT, Goffin J, Kehr P, Liebig K, Lind B, Logroscino C, Pointillart V. Clinical significance of heterotopic ossification in cervical disc replacement: A prospective multicenter clinical trial. Neurosurgery 2005; 57:759-63. Moatz B, Tortolani PJ. Cervical disc arthroplasty: Pros and cons. Surg Neurol Int 2012; 3: 216-24.
• Goffin J, Van Calenbergh F, van Loon J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C, Sgrambiglia R, Pointillart V. Intermediate follow-up after treatment of degenerative disc disease with the Bryan cervical disc prosthesis: Single-level and bi-level. Spine 2003; 28:2673-78.
• Guyer RD, Shellock J, MacLennan B, Hanscom D, Knight RQ, McCombe P, Jacobs JJ, Urban RM, Bradford D, Ohnmeiss DD. Early failure of metal-on-metal artificial disc prostheses associated with lymphocytic reaction: Diagnosis and treatment experience in four cases. Spine 2011; 36: 492-7.
• Pickett GE, Mitsis DK, Sekhon LH, Sears WR, Duggal N. Effects of a cervical disc prosthesis on segmental and cervical spine alignment. Neurosurg Focus 2004; 17: E5.
• Suetsuna F, Yokoyama T, Kenuka E, Harata S. Anterior cervical fusion using porous hydroxyapatite ceramics for cervical disc herniation: a two-year follow-up. The Spinal Journal 2001; 1: 348-57.
• Özdemir NG, Saygı T, Köksal NHS, Katar S, Kubilay F, Kılıç K. Posterior Approach in Cervical Disc Herniations. İstanbul Med J 2014; 15: 90-4.
• Murtagh R, Castellvi AE. Motion preservation surgery in the spine. Neuroimaging Clin N Am 2014; 24: 287-94.