Rigid-Plating and Cortico-Cancellous Allograft Are Effective for 3-Level Anterior Cervical Discectomy and Fusion: Radiographic and Clinical Outcomes.

Autor: Louie PK; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA., Sexton AC; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA., Bohl DD; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA., Tabaraee E; Stanislaus Orthopaedics, Modesto, CA, USA., Presciutti SM; Department of Orthopaedics, Emory University, Atlanta, GA, USA., Mayo BC; Department of Orthopaedics, University of Illinios at Chicago, Chicago, IL, USA., Paul JC; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA., Saifi C; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA., An HS; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Jazyk: angličtina
Zdroj: Neurospine [Neurospine] 2020 Mar; Vol. 17 (1), pp. 146-155. Date of Electronic Publication: 2019 Apr 12.
DOI: 10.14245/ns.1836052.026
Abstrakt: Objective: To determine the risk factors associated with radiographic changes and clinical outcomes following 3-level anterior cervical discectomy and fusion (ACDF) using rigidplate constructs and cortico-cancellous allograft. ACDF has demonstrated efficacy for treatment of multilevel degenerative cervical conditions, but current data exists in small heterogeneous forms.
Methods: A retrospective review included 98 patients with primary 3-level ACDF surgery at one institution from 2008 to 2013 with minimum 1-year follow-up. Cervical sagittal vertical axis (SVA), segmental height, fusion, and lordosis radiographs were measured preoperatively and at 2 postoperative periods.
Results: Rates of asymptomatic pseudarthroses and total reoperations were 18% and 4%, respectively. Results demonstrated immediate improvements in cervical lordosis (5.5°, p < 0.01) and segmental height (5.0-mm increase, p < 0.01) with little changes in the cervical SVA (3.2-mm increase, p < 0.01). The segmental height decreased from immediate postoperative period to final follow-up (1.7-mm decrease, p < 0.01). Older age was protective against radiolucent lines (p < 0.05). Patient-reported outcomes significantly improved following surgery (p < 0.01). Current smoking status and diagnosis of diabetes mellitus had no impact on radiographic or clinical outcomes. Risk factors were not identified for the 5 reoperations (4%).
Conclusion: Three-level ACDF with rigid-plating and cortico-cancellous allograft is an effective procedure for degenerative diseases of the cervical spine without the application of additional adjuncts or combined anteriorposterior cervical surgeries. Significant improvements in cervical lordosis, segmental height, and segmental alignment can be achieved with little change in cervical SVA and a low rate of reoperations over short-term follow-up. Similarly, patient-reported outcomes show significant improvements.
Databáze: MEDLINE
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