Results of Three Different Surgical Techniques for Cervical Spine FusionPatients faced with a fusion procedure of the cervical spine (neck) for degenerative spine disease have several options to choose from. Fortunately, the surgeon will guide each person through the process. But who guides the surgeon in selecting the "just right" or "best" procedure for the patient?
They rely on high-quality studies published in the last few years. By keeping abreast of the latest medical and surgical journals, surgeons can benefit from tips offered by other surgeons or reports of trends in treatment results.
In this study from Prague (Czech Republic) three interbody fusion techniques are compared: 1) autograft stand-alone, 2) autograft with anterior (front of the spine) plate, and 3) polyetheretherketone (PEEK) cage filled with betatricalcium phosphate and supported by an anterior plate. Each of these approaches has its own benefits and disadvantages, which the authors discuss in detail. They also provide a written description of each procedure technique (no photos or drawings included).
The main purpose of cervical spine fusion is to stabilize the spine in order to reduce pain. Each of these three methods accomplishes this task in slightly different ways. And as this study shows -- with slightly different results measured at the end of two years. Let's take a closer look.
Briefly, group one had the disc removed (discectomy) and bone graft from the pelvis packed into the front of the empty disc space. Group two had the same type of discectomy and the same graft technique but with the addition of a metal plate screwed into the front of the vertebrae. Group three had a discectomy and instead of a bone graft pack, a metal cage filled with bone material was placed in the disc space. Group three also had an anterior plate.
In all cases, the fusion was successful. That's good! But what about the neck pain, neurologic function, and pain that typically occurs at the fusion donor site? Well, at first everything was the same among all three groups. But over time, there were some differences that developed.
For one thing, the stand alone grafts (Group one with no reinforcing anterior plating) started to lose height in the spine. This was compared with at least 10 per cent more height gained and maintained in the other two groups. In general, the overall results in group one (remember, this is the stand-alone graft without plating) were worse with lower patient satisfaction compared with the other two groups.
In group three, the artificial bone graft gave just as good of results as the two groups with real (human) bone material. That is good news because scientists have been working a long time to find a successful substitute for human bone. Substitute bone eliminates the long-term pain and discomfort that often occurs with bone graft taken from the patient's hip.
And there's an added benefit of interbody (between vertebral bones) cages. Cages used in between the vertebral bones support the load and maintain spine height. In this study, results were even better with the added plate along the front of the spine (present in groups two and three).
Until a better stand-alone technique is found, anterior plating will continue to be used in cervical spine fusion procedures. The goal for the future is to develop a cage or other fusion device that doesn't require the additional plating. This would decrease or even eliminate problems with plating such as difficulty swallowing and degeneration that often occurs at the spinal level next to the fused area.
Petr Vanek, MD, et al. Comparison of 3 Fusion Techniques in the Treatment of the Degenerative Cervical Spine Disease. Is Stand-Alone Autograft Really the "Gold Standard?" In Spine. September 1, 2012. Vol. 37. No. 19. Pp. 1645-1651.
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