Comparison between anterior cervical discectomy with fusion by polyetheretherketone cages and tricortical iliac-crest graft for the treatment of cervical prolapsed intervertebral disc

Md Anowarul Islam,Md Fahad Goni,Md Naimur Rahman,Md Masud Rana

doi:10.3329/bsmmuj.v9i3.29776

Abstract

<p>Anterior cervical discectomy with fusion (ACDF) is challenging in relation to the choice of surgical procedure. The objective of this study was to evaluate the clinical outcome of ACDF with tricor-tical iliac crest graft (ICG) and plate screw in comparision to fusion with polyetheretherketone (PEEK) cages filled with autologous iliac crest graft. Forty patients (males 24; females 16 with mean age 45 ± 8.3 years) were randomly divided into two treatment groups (PEEK cage and ICG). Clinical assessment was done using Nurick scale for myelopathy, Odom's criteria for functional outcome and Visual Analogue Scale (VAS) for both neck and arm pain. Seventeen patients were operated for single-level discectomy and fusion by either PEEK cages or ICG. Another 23 patients were operated for two-levels. There were significant postoperative improvements of Nurick scale and VAS during follow-up (after 2 years). According to Odom criteria, 18 patients (90%) were graded excellent in the PEEK cage group compared to 16 patients (85%) in the group with ICG group (statistically not significant). A significant difference (p&lt;0.02) was found in VAS for arm pain after 24 months with less pain in the cage group. Fusion occurred in 17 patients (85%) of the PEEK cage group and 18 patient (90%) of the ICG group. In conclusion, the PEEK cage is superior for fusion rate but the ICG is lack of donor site morbidity.</p><p> </p>

Highlights

Interbody fusion provides spine surgeon the ability to limit abnormal painful motion in the spine
ACDF is indicated for radiculopathy, myelopathy and fracture dislocation of spine.[2]
Thirty consecutive patients referred to the Department of Orthopaedic Surgery from July 2011 to June 2016 were recruited for the study purpose and randomized into two groups: one group for iliac crest graft (ICG) and another for PEEK cage

Summary

Introduction

Interbody fusion provides spine surgeon the ability to limit abnormal painful motion in the spine. Recent treatment modality declares that fusion is the ideal treatment in cervical prolapsed intervertibral disc. Interbody fusion rate is about 92% by anterior cervical discectomy and fusion (ACDF).[1] ACDF is indicated for radiculopathy, myelopathy and fracture dislocation of spine.[2]. Several modalities of surgery for performing ACDF such as Cloward technique, Smith Robinson technique, Bailey/Badgley technique.[1,3] Auto and allo bone graft along with different cages are used for fusion. Various materials have been used for fusion too, as iliac crest graft (ICG),[4] allograft,[1] cement,[5] and bone morphogenetic proteins.[6] If the graft is used without any cage, it could be collapsed, extruded and there could be pseudoarthosis. To achieve further stability plate with screw is used along with bone graft

Methods

Results

Conclusion