Clinical results of cervical discectomy and fusion with anchored cage – prospective study with a 24-month follow-up

Czech version

Authors: R. Opšenák; B. Kolarovszki; M. Benčo; R. Richterová; P. Snopko; M. Hanko; K. Varga
Authors‘ workplace: Neurochirurgická klinika JLF UK a UN Martin
Published in: Cesk Slov Neurol N 2018; 81(6): 669-677
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2018669

Overview

Introduction:

Anterior cervical discectomy and fusion (ACDF) using an anchored intervertebral cage represents an alternative to the use of a cage fixed by a conventional plate.

Patients and methods:

Prospective single-center study with a 24-month follow-up. Sixty-one patients who underwent a 1- or 2-level anterior cervical discectomy with implantation of an anchored cage Zero Profile Variable Angle® (DePuy Synthes, Oberdorf, Switzerland) from May 2013 to April 2015 were included in this study. The results of the surgical treatment were evaluated using a visual analogue scale, Odom‘s criteria and neck disability index. Incidence of the intersomatic fusion and complications related to the surgical approach and implant type were assessed postoperatively.

Results:

After the ACDF, there was a decrease in neck and upper-limb pain intensity and an improvement of the patients‘ life quality. Female gender and age below 55 years were identified as risk factors for inadequate effect of the operative treatment. The incidence of intersomatic fusion after 12 months was at 93%. The incidence of complications related to the surgical approach did not differ from other studies. The implant’s zero profile did not act as a preventive factor against postoperative dysphagia. A presence of preexisting dysphagia was a risk factor for incidence of postoperative dysphagia. Neither dislocation nor breakdown of the impant was recorded. The preventive effect against cage subsidence using its stabilisation by two fixating screws was not confirmed. Osteoporosis posed a risk factor for subsidence of the cage. The cage subsidence did not have a significant influence on the efficiency of the surgical treatment or on the incidence of intersomatic fusion.

Conclusion:

The Zero Profile Variable Angle® anchored cage is a safe implant providing favourable results of surgical treatment. The implant’s zero profile does not reduce the incidence of postoperative dysphagia. Stabilisation of the cage in the intervertebral space has no preventive influence against its subsidence which, however, has no influence on the efficiency of the surgical treatment.

Key words:

anterior cervical discectomy – complications – dysphagia – intersomatic fusion – cage subsidence

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Chinese summary - 摘要

颈椎间盘切除术与锚固融合术的临床结果 - 前瞻性研究，随访24个月

介绍：

使用锚定椎间笼的前颈椎间盘切除术和融合术（ACDF）代表了使用由常规板固定的笼子的替代方案。

患者和方法：

前瞻性单中心研究，随访24个月。 2013年5月至2015年4月，61名接受1或2级颈椎前路椎间盘切除术并植入锚定笼

Zero Profile VariableAngle®（DePuy Synthes，Oberdorf，Switzerland）的患者纳入本研究。使用视觉模拟评分，Odom标准和颈部残疾指数评估手术治疗的结果。术后评估了椎间融合的发生率以及与手术入路和种植体类型相关的并发症。

结果：

ACDF后，颈部和上肢疼痛强度下降，患者生活质量得到改善。女性和55岁以下的年龄被确定为手术治疗效果不佳的风险因素。 12个月后椎间融合的发生率为93％。与手术方法相关的并发症发生率与其他研究没有差异。植入物的零曲线并不是预防术后吞咽困难的预防因素。先前存在的吞咽困难是导致术后吞咽困难的一个危险因素。没有植入物的脱位或破裂被记录。使用两个固定螺钉稳定对笼子下沉的预防作用没有被证实。骨质疏松症是笼子下沉的危险因素。笼下沉对手术治疗效率或椎间融合发生率没有显著影响。

结论：

Zero ProfileVariableAngle®锚固笼是一种安全的植入物，可提供有利的手术治疗效果。植入物的零曲线不会降低术后吞咽困难的发生率。椎间隙内椎间盘的稳定对其下沉没有预防性影响，但是对于手术治疗的效率没有影响。

关键词：

颈椎前路椎间盘切除术 - 并发症 - 吞咽困难 - 椎间融合术 - 下陷

Sources

1. Robinson RA, Smith RW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 1955; 96(5): 223– 224.

2. Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 14(7): 409– 415.

3. Bednaříková M, Opavský J. Česká verze dotazníku Neck disability index a její použití u pacientů s bolestmi krčního úseku páteře. Rehabil Fyz Lék 2014; 4: 180– 186.

4. Odom GL, Finney W, Woodhall B. Cervical disc lesions. JAMA 1958; 166(1): 23– 28.

5. Vavruch L, Hedlund R, Javid D et al. Aprospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine (Phila Pa 1976) 2002; 27(16): 1694– 1701.

6. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976) 2002; 27(22): 2453– 2458.

7. Rudinský B, Barsa P, Buchvald P et al. Spinálna chirurgia. Bratislava: Slovak Academic Press 2006: 36– 147.

8. Häckel M, Štětkářová J, Chrobok D et al. Efekt 1- a 2segmentové krční diskektomie s mezitělovou náhradou: prospektivní 1roční studie. Cesk Slov Neurol N 2007; 70/ 103(3): 253– 258.

9. Scholz M, Schnake KJ, Pingel A et al. A new Zero-profile implant for stan-alone anterior cervical interbody fusion. Clin Orthop Relat Res 2011; 469(3): 666– 673. doi: 10.1007/ s11999-010-1597-9.

10. Shao HY, Zhang J, Yang D et al. Case-control study on Zero-profile implant for anterior cervical discectomy and fusion and conventional cage plate internal fixation for the treatment of single segmental cervical intervertebral disc herniation. Zhonqquo Gu Shang 2016; 29(6): 530– 537.

11. Azab W, Abdel-Razek M, Ali A et al. Outcome evaluation of a Zero-profile implant for anterior cervical discectomy with fusion. Turk Neurosurg 2012; 22(5): 611– 617. doi: 10.5137/ 1019-5149.JTN.5646-11.2.

12. Shin JS, Oh SH, Cho PG. Surgical outcome of a Zero-profile device comparing with stand-alone cage and anterior cervical plate with iliac bone graft in the anterior cervical discectomy and fusion. Korean J Spine 2014; 11(3): 169– 177. doi: 10.14245/ kjs.2014.11.3.169.

13. Vanek P, Bradac O, Delacy P et al. Anterior interbody fusion of the cervical spine with Zero-P spacer: prospective comparative study-clinical and radiological results at a minimum 2 years after surgery. Spine (Phila Pa 1976) 2013; 38(13): E792– E797. doi: 10.1097/ BRS.0b013e3182913400.

14. Li Y, Hao D, He B et al The efficiency of Zero-profile implant in anterior cervical discectomy fusion: a prospective controlled long-term follow-up study. J Spinal Disord Tech 2015; 28(10): 398– 403. doi: 10.1097/ BSD. 0000000000000032.

15. Yin M, Ma J, Huang Q et al. The new Zero-P implant can effectively reduce the risk of postoperative dysphagia and complications compared with the traditional anterior cage and plate: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016; 17(1): 430. doi: 10.1186/ s12891-016-1274-6.

16. Vaněk P, Bradáč O, Saur K. Přední mezitělová spondylodéza krční páteře klecí Zero-P (prospektivní studie – radiologické výsledky s minimálně ročním sledováním). Acta Chir Orthop Traumatol Czech 2011; 78(6): 562– 567.

17. Scholz M, Schleicher P, Pabst S et al. A zero-profile anchored spacer in multilevel cervical anterior interbody fusion: biomechanical comparison to established fixation techniques. Spine (Phila Pa 1976) 2015; 40(7): E375– E380. doi: 10.1097/ BRS.0000000000000768.

18. Scholz M, Reyes PM, Schleier P et al. A new standalone cervical anterior interbody fusion device: Biomechanical comparison with established anterior cervical fixation devices. Spine (Phila Pa 1976) 2009; 34(2): 156– 160. doi: 10.1097/ BRS.0b013e31818ff9c4.

19. Martin GJ, Haid RW, MacMillan M et al. Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review. Spine (Phila Pa 1976) 1999; 24(9): 852– 858.

20. Thalgott JS, Fritts K, Giuffre JM. Anterior interbody fusion of the cervical spine with corraline hydroxypaptite. Spine (Phila Pa 1976) 1999; 24(13): 1295– 1299.

21. Lee YS, Kim YB, Park SW. Does a zero-profile anchored cage offer additional stabilization as anterior cervical plate? Spine (Phila Pa 1976) 2015; 40(10): E563– E570. doi: 10.1097/ BRS.0000000000000864.

22. Scholz M, Schelfaut S, Pingel A et al. A cervical „zero-profile“ cage with integrated angle-stable fixation: 24-months results. Acta Orthop Belg 2014; 80(4): 558– 566.

23. Robinson RA, Walker AE, Ferlic DC et al. The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg Am 1962; 44-A: 1569– 1587.

24. Ban D, Liu Y, Cao T et al. Safety of outpatient anterior cervical discectomy and fusion: a systematic review and meta-analysis. Eur J Med Res 2016; 21(1): 34. doi: 10.1186/ s40001-016-0229-6.

25. Khanna R, Kim RB, Lam SK et al. Comparing short-term complications of inpatient versus outpatient single-level anterior cervical discectomy and fusion: an analysis of 6940 patients using the ACS-NSQIP database. Clin Spine Surg 2018; 31(1): 43– 47. doi: 10.1097/ BSD.0000000000000499.

26. Fountas KN, Kapsalaki EZ, Nikolakakos LG et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007; 32(21): 2310– 2317. doi: 10.1097/ BRS.0b013e318154c57e.

27. McCulloch JA, Young HP. Microsurgery for cervical disc disease. In: McCulloch JA, Young HP. Essential of spinal microsurgery. Philadelphia: Lippincott-Raven Publishers 1998: 99– 185.

28. Stewart M, Johnston RA, Stewart I et al. Swallowing performance following anterior cervical spine surgery. J Neurosurg 1995; 9(5): 605– 609.

29. Frempong-Boadu A, Houten JK, Osborn B et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postperative assesment. J Spinal Disord Tech 2002; 15(5): 362– 368.

30. Riley LH 3rd, Skolasky RL, Albert TJ et al. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976) 2005; 30(22): 2564– 2569.

31. Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy anf fusion with allograft and plating: a 5- to 11-year follow-up study. Eur Spine J 2005; 14(7): 677– 682. doi: 10.1007/ s00586-004-0849-3.

32. Kalb S, Reis MT, Cowperthwaite MC et al. Dysphagia after cervical spine surgery: incidence and risk factors. World Neurosurg 2012; 77(1): 183– 187. doi: 10.1016/ j.wneu.2011.07.004.

33. Min Y, Kim WS, Kang SS et al. Incidence of dysphagia and serial videofluoroscopic swallow study findings after anterior cervical discectomy and fusion: a prospective study. Clin Spine Surg 2016; 29(4): E177– E181. doi: 10.1097/ BSD.0000000000000060.

34. Lee M, Bazaz R, Furey C et al. The incidence of dysphagia in anterior cervical surgery as a function of plate design: a prospective study. CSRS 32nd annual meeting. Boston, MA, USA 2004.

35. Fogel GR, McDonnell MF. Surgical treatment of dysphagia after anterior cervical interbody fusion. Spine J 2005; 5(2): 140– 144. doi: 10.1016/ j.spinee.2004. 06.022.

36. Anderson KK, Arnold PM. Oropharyngeal dysphagia after anterior cervical spine surgery: a review. Global Spine J 2013; 3(4): 273– 286. doi: 10.1055/ s-0033-1354253.

37. Dhir J, Carpenter C, Pamde R et al. Radiological outcome of use of Zero P cage in cervical stabilization – short term study. Bone Joint J 2012; 94-B (Supp_X): 142.

38. Wang Z, Zhu R, Yang H et al. Zero-profile implant (Zero-p) versus plate cage benezech implant (PCB) in the treatment of single-level cervical spondylotic myelopathy. BMC Musculoskelet Disord 2015; 16: 290. doi: 10.1186/ s12891-015-0746-4.

39. Mattei TA, Teles AR, Dinh DH. Vertebral body fracture after anterior cervical discectomy and fusion with zero-profile anchored cages in adjacent levels: a cautionary tale. Eur Spine J 2016. In press. doi: 10.1007/ s00586-015-4358-3.

40. Bartels RH, Donk RD, Feuth T. Subsidence of stand alone cervical carbon fibers cages. Neurosurgery 2006; 58(3): 502– 508. doi: 10.1227/ 01.NEU.0000197258.30821.50.

41. Wu WJ, Jiang LS, Liang Y et al. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospektive study. Eur Spine J 2012; 21(7): 1374– 1382. doi: 10.1007/ s00586-011-2131-9.

42. Filip M, Linzer P, Šámal F et al. Bioactive titan cage Implaspin in treatment of degenerative disease of the cervical spine-the results from 2007 till 2008. Chir Narzadow Ruchu Ortop Pol 2010; 75(1): 69– 73.

43. Lee YS, Kim YB, Park SW. Does a zero-profile anchored cage offer additional stabilization as anterior cervical plate? Spine (Phila Pa 1976) 2015; 40(10): E563– E570. doi: 10.1097/ BRS.0000000000000864.

44. Chen Y, Wang X, Lu X et al. Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J 2013; 22(7): 1539– 1546. doi: 10.1007/ s00586-013-2772-y.

45. Cho HJ, Hur JW, Lee JB et al. Cervical Stand-alone polyetheretherketone cage versus zero-profile anchored spacer in single-level anterior cervical discectomy and fusion: minimum 2-year assessment of radiographic and clinical outcome. J Korean Neurosurg Soc 2015; 58(2): 119– 124. doi: 10.3340/ jkns.2015.58.2.119.

46. Suchomel P, Barsa P. Náhrada krční medziobratlové ploténky vložkou Cespace bez použití kosti či její náhrady. Prospektivní studie. Acta Spondylologica 2004; 1: 5– 9.

47. Barsa P, Suchomel P. Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 2007; 16(9): 1395– 1400.

48. Lim TH, Kwon H, Jeon CH et al. Effect of endplate conditions an bone mineral density on the compressive strengt of the graft-endplate interface in anterior cervical spine fusion. Spine (Phila Pa 1976) 2001; 26(8): 951– 956.