Abstract
OBJECTIVES:To examine the application of bioabsorbable screws for anterior cervical decompression and bone grafting fixation and to study their clinical effects in the treatment of cervical spondylosis.METHODS:From March 2007 to September 2012, 56 patients, 36 males and 20 females (38-79 years old, average 58.3±9.47 years), underwent a novel operation. Grafts were fixed by bioabsorbable screws (PLLA, 2.7 mm in diameter) after anterior decompression. The bioabsorbable screws were inserted from the midline of the graft bone to the bone surface of the upper and lower vertebrae at 45 degree angles. Patients were evaluated post-operatively to observe the improvement of symptoms and evaluate the fusion of the bone. The Japanese Orthopaedic Association (JOA) score was used to evaluate the recovery of neurological functions.RESULTS:All screws were successfully inserted, with no broken screws. The rate of symptom improvement was 87.5%. All of the grafts fused well with no extrusion. The average time for graft fusion was 3.8±0.55 months (range 3-5 months). Three-dimensional reconstruction of CT scans demonstrated that the grafts fused with adjacent vertebrae well and that the screws were absorbed as predicted. The MRI findings showed that the cerebrospinal fluid was unobstructed. No obvious complications appeared in any of the follow-up evaluations.CONCLUSIONS:Cervical spondylosis with one- or two-level involvement can be effectively treated by anterior decompression and bone grafting with bioabsorbable screw fixation. This operative method is safe and can avoid the complications induced by metal implants.
Highlights
Anterior decompression and bone grafting with metal fixation is a standard operation, widely used for the treatment of cervical spondylosis
When the symptoms were evaluated by the Japanese Orthopaedic Association (JOA) score, the recovery rate (RR) of 39 patients was above 75%, the RR of 10 patients was 50%-74% and the RR of 7 patients was 25%-49%
The bioabsorbable screws were composed of poly L/lactide (PLLA), which is created by polymerization with carbon, hydrogen and
Summary
Anterior decompression and bone grafting with metal fixation is a standard operation, widely used for the treatment of cervical spondylosis. A number of devicerelated complications have been reported, such as screw malposition, extrusion, imaging artifacts and even plate abruption [1,2,3]. According to in vitro biomechanical studies on bioabsorbable screws, absorbable screws can provide immediate stability. This new method exhibits higher stability in extension and comparable stability in flexion and axial rotation, but lower stability in lateral bending [4]. We applied cross-interface fixation with bioabsorbable screws for the treatment of cervical spondylosis to avoid metal device-related complications. From March 2007 to September 2012, we performed this novel
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