Abstract
ObjectionThe overarching goal of our research was to compare the clinical and radiological outcomes with different sizes of cages implantation in anterior cervical discectomy and fusion (ACDF), and to evaluate the effects on surgical and adjacent segmental intervertebral foramina.MethodsThe clinical data of 61 patients were analyzed retrospectively. The radiological data included the surgical intervertebral disk space height before (H0) and after surgery (H), the preoperative mean height of adjacent segments (Hm), the area and height of the surgical and adjacent segment foramen, the surgical segmental Cobb angle (α1), and C2-7Cobb angle (α2). The calculation of clinical data was conducted by Japanese Orthopaedic Association Scores (JOA), the recovery rate of JOA scores and visual analog scales (VAS). In accordance with the different ranges of distraction (H/Hm), patients were classified into three groups: group A (H/Hm<1.20, n=13), group B (1.20≤H/Hm≤1.80, n=37), and group C (H/Hm>1.80, n=11).ResultsAfter the operation and at the final follow-up, our data has demonstrated that the area and height of surgical segmental foramen all increased by comparing those of preoperation in three groups (all P<0.05). However, except for a decrease in group C (all P<0.05), the adjacent segmental foramina showed no significant changes (all P>0.05). The area and height of the surgical segment foramen and the distraction degree were positively correlated (0<R<1, all P<0.05), while the adjacent segments were negatively correlated with it (0<R<1, P=0.002~0.067). JOA scores improved markedly in all groups with similar recovery rates. However, during the final follow-up (P=0.034), it was observed that there were significant differences in visual simulation scores among the three groups.ConclusionThe oversize cage might give a rise to a negative impact on the adjacent intervertebral foramen in ACDF. The mean value of the adjacent intervertebral disk space height (Hm) could be used as a reference standard. Moreover, the 1.20~1.80 fold of distraction (H/Hm) with optimal cages would achieve a better long-term prognosis.
Highlights
Anterior cervical discectomy and fusion (ACDF) was originally described around the 1950s
Patient selection Inclusion criteria: (1) the patients were diagnosed as degenerative cervical spondylosis which was confirmed by preoperative magnetic resonance imaging (MRI), computed tomography (CT), X-ray, and physical examination; (2) single-segment ACDF at the level of C3~C6; (3) the PEEK cage was the product of the same manufacturer (Paonan Biotech Co., Ltd., Taiwan); (4) there was CT scans and plain radiographs of the cervical spine after the operation and at the last follow-up; and (5) patients were followed up for more than 6 months
After expressing the intervertebral distraction degree (H/height of adjacent segments (Hm)) of all patients on the coordinate axis, we found that there were three different segments with the boundary
Summary
Anterior cervical discectomy and fusion (ACDF) was originally described around the 1950s. ACDF was performed using the autograft following the experience of Smith, Robinson, and Cloward [1, 2]. A surging number of studies revealed that some severe complications of the donor site might be developed by the autologous bone graft. These complications included wound hematoma and infection, acute or chronic pain, and injury of the lateral femoral cutaneous nerve and so on, with a rate up to 25.3% [3]. At the beginning of this century, Yang et al found that both of the PEEK cage and the autogenous iliac crest graft would expand the area of the foramen. The postoperative height of the foramen only shows a pattern of growth within the group using the PEEK cage [4]
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