Vertebral Interbody Fusion Research Articles

Surgical treatment of cervical stenotic myelopathy in horses: 73 cases (1983-1992)

Summary Seventy-three horses with cervical stenotic myelopathy underwent cervical vertebral interbody fusion (n = 63) or dorsal laminectomy (n = 10). Neurologic function improved in 77% of horses, and 46% of horses achieved athletic function (racing, race training, or pleasure riding) after cervical vertebral interbody fusion for static and dynamic spinal cord compressive lesions. Neurologic status improved in 4 of 10 horses after dorsal decompression for static compressive spinal cord lesions. The duration of clinical signs prior to surgical intervention was shorter for horses that achieved athletic function or improved by at least 2 neurologic grades than for horses that did not improve in neurologic status or improved 1 neurologic grade after cervical vertebral interbody fusion. The number of cervical spinal cord compressive lesions and age of horses did not affect the long-term surgical outcome of cervical vertebral interbody fusion. Seroma formation, implant failure, right laryngeal hemiplegia, and colitis were nonfatal complications associated with cervical vertebral interbody fusion. Dorsal laminectomy and cervical vertebral interbody fusion of static compressive lesions of the caudal cervical vertebral column were associated with fatal postoperative complications, including vertebral body fracture, spinal cord edema, and implant failure.

Myelography in the late postoperative period in patients subjected to anterior cervical decompression and fusion.

During a 13 year period, 286 patients with cervical disc herniation and/or spondylotic spurs, were subjected to anterior decompression and vertebral interbody fusion with autologous bone. Twenty patients were re-admitted in the late postoperative period due to recurrent radicular symptoms and/or signs of myelopathy. In these patients myelography was performed again. In 14 patients spinal cord compression and/or nerve root involvement at a new level was visualized. At the operated level, however, the myelograms demonstrated a smooth anterior wall in the spinal canal. The series confirms the safety, effectiveness and reliability of the Cloward procedure in achieving long term spinal cord and nerve root decompression, and a solid vertebral interbody fusion.

Radiologic long-term results after cervical vertebral interbody fusion with polymethyl methacrylat (PMMA).

Long-term results of cervical interbody fusion with PMMA were evaluated in a retrospective study. X-ray films of 83 patients were obtainable. Post-operative follow-up in this series was between 15 and 20 years. The results show that PMMA is engrafted after about 2 years. Stable vertebral interbody fusion is obtained in about 90% of cases. Development of malignoma was not observed. Resorptive bone alterations, which can be seen in about 2% of cases one to two years after operation are shown not to be progressive. This process heals and stable fusion develops.

Evaluation of Cervical Spinal Fusion as a Treatment in the Equine “Wobbler” Syndrome

Cervical vertebral interbody fusion was performed on 30 horses affected with cervical vertebral malformation (CVM) or “wobbles” to assess the efficacy of the surgery in either preventing progression of or reversing the neurologic deficit induced by the syndrome. Evaluation of each horse prior to surgery included clinical, radiographic, neurologic, and laboratory examination. Subjects ranged from 3 months to 8 years of age, and included 22 males and 8 females of various breeds. Three normal horses were included as controls. The Cloward method of cervical fusion was used to achieve stabilization at the affected vertebral articulation. Horses were reexamined 3 months after surgery. Clinical improvement was seen in 90% (27 of 30) of the cases. Four horses were returned to training, which had been interrupted by onset of symptoms. Seven were returned to owners as breeding animals. Twelve horses were kept for long‐term studies. Seven horses were sacrificed to examine the surgical site. In 6 of the 7 horses on which necropsy was performed, the most severe histologic lesion in the spinal cord could be predicted from lesions seen radiographically. The spinal cords of control animals were normal. Osseous fusion was dependent on the completeness of removal of disc fibrocartilage during surgery. We conclude that clinical improvement in some horses affected with CVM can be achieved by cervical fusion.

Early Anterior Fusion for Injuries of the Cervical Portion of the Spine

The anterior approach to cervical spine fractures and dislocations offers a unique opportunity for the surgeon to directly visualize and treat the lesion producing spinal cord compression, whether it be a herniated disk or bony fragment from the vertebral body. At the same time the spinal instability may be corrected by a vertebral interbody fusion. If the vertebral body has been crushed, it is possible to replace it, preventing the deformity and instability which might produce further damage to the spinal cord. The problems attending prolonged immobilization in skull traction, the traditional management of cervical spine fractures, are avoided and active rehabilitation is instituted immediately following surgery reducing the time required for bed treatment.