Cloward's anterior fusion in the treatment of cervical spinal traumatic injury and degeneration

Diagnosing cervical fusion: a comprehensive literature review

Study Design

Comprehensive literature review.

Purpose

To document the criteria for fusion utilized in these studies to determine if a consensus on the definition of a solid fusion exists.

Overview of Literature

Numerous studies have reported on fusion rates following anterior cervical arthrodesis. There is a wide discrepancy in the fusion rates in these studies. While factors such as graft type, Instrumentation, and technique play a factor in fusion rate, another reason for the difference may be a result of differences in the definition of fusion following anterior cervical spine surgery.

Methods

A comprehensive English Medline literature review from 1966 to 2004 using the key words "anterior," "cervical," and "fusion" was performed. We divided these into two groups: newer studies done between 2000 and 2004, and earlier studies done between 1966 and 2000. These articles were then analyzed for the number of patients, follow-up period, graft type, and levels fused. Moreover, all of the articles were examined for their definition of fusion along with their fusion rate.

Results

In the earlier studies from 1966 to 2000, there was no consensus for what constituted a solid fusion. Only fifteen percent of these studies employed the most stringent definition of a solid fusion which was the presence of bridging bone and the absence of motion on flexion and extension radiographs. On the other hand, the later studies (2000 to 2004) used such a definition a majority (63%) of the time, suggesting that a consensus opinion for the definition of fusion is beginning to form.

Conclusions

Our study suggests that over the past several years, a consensus definition of fusion is beginning to form. However, a large percentage of studies are still being published without using stringent fusion criteria. To that end, we recommend that all studies reporting on fusion rates use the most stringent criteria for solid fusion following anterior cervical spine surgery: the absence of motion on flexion/extension views and presence of bridging trabeculae on lateral x-rays. We believe that a universal adoption of such uniform criteria will help to standardize such studies and make it more possible to compare one study with another.

Anterior cervical plating for the treatment of neoplasms in the cervical vertebrae

OBJECT

To assess clinical outcome and survival in patients with cervical vertebral spinal neoplasms after they have undergone anterior decompression and cervical plate stabilization (ACPS) by using either autologous bone graft or polymethylmethacrylate (PMMA) as the anterior load-bearing support structure.

METHODS

This was a retrospective case study composed of 30 patients harboring cervical spinal vertebral neoplasms who underwent anterior cervical decompression and (ACPS) within a 7-year period. Postoperative immobilization included treatment in a halo brace in two cases and in a hard cervical collar for the remaining patients. Postoperatively most patients underwent radio- and/or chemotherapy. All patients except one benefited from a significantly improved quality of life with decreased pain and/or improved neurological status. The mean Kaplan-Meier survivoral estimate was 35.8 months (range 8 days-11.3 years, with 10 patients alive at most recent follow-up contact). Patients achieved long-term or lifelong mechanical stability in the cervical spine, and only one patient required a repeated posterior stabilization procedure. No hardware-related complications occurred. One patient died 8 days postoperatively of pneumonia. A nonsignificant difference in survival (p = 0.2164) was observed between patients harboring metastatic neoplasms (26.8 months) and those harboring lymphomatous and multiple myeloma neoplasms (54 months).

CONCLUSIONS

Favorable clinical outcome of both neurological symptoms and pain can be achieved using ACPS after surgery for neoplasms in the cervical vertebrae. Furthermore, long-term or lifelong cervical spine mechanical stability with bone fusion is achieved using this technique even when radiation therapy is delivered to the site of the bone graft.

Reoperation in patients after anterior cervical plate stabilization in degenerative disease

STUDY DESIGN

Consecutive case retrospective chart review.

OBJECTIVES

First, to assess whether the number of' patients requiring a second cervical surgical intervention was changed as a result of using anterior cervical plate stabilization, and second, to determine the additional risks and/or benefits associated with the hardware implantation.

SUMMARY OF BACKGROUND DATA

The optimal technique of performing stabilization, arthrodesis, and alignment of a cervical segment after discectomy with neural decompression in degenerative disease has yet to be determined.

METHODS

The charts of 402 patients who had undergone an anterior cervical discectomy and arthrodesis for degenerative disease performed both with and without anterior cervical plate stabilization were reviewed, and reoperation data were compiled. The average follow-up time was 3.8 years (range, 1.5-9.4 years).

RESULTS

Of 365 patients with 1- or 2-level cervical arthrodesis, 22 required a second surgical intervention (20 bone alone, 2 with anterior cervical plate stabilization). The Log-Rank test, which uses all patients and their total follow-up periods, was statistically significant favoring anterior cervical plate stabilization at one and two levels (P = 0.015).

CONCLUSIONS

The addition of anterior cervical plate stabilization in one- and two-level cervical degenerative disease supplements the internal stabilization initially provided by the bone graft, and yields a lower reoperation rate.

Anterior cervical discectomy without interbody fusion: an analysis of 81 cases

An analysis of 81 patients subjected to anterior cervical discectomy without interbody fusion was made. In these, 62 operations were done with the aid of microscopic magnification. Nineteen were done without. The results appeared to be equally favourable. However, these comparable results should be interpreted in the light of patient selection. Only solitary soft discs were selected in the latter group. The concept of "tail" undoubtedly came into play in this group. In the other group, discs or spurs or both, including multiple level involvement with varying degrees of spinal stenosis, were candidates for such a procedure. The magnification provided the added dimensions of direct vision enabling the surgeon to see more and do more. The overall results are comparable to those done with interbody fusion. This fact, plus the relative simplicity and lack of complications, makes this procedure superior to that with fusion.