Abstract
Background:
Anterior cervical discoidectomy with or without fusion is a well established surgical
remedy for cervical prolapsed intervertebral disc (PIVD) disease. If fusion is done
by an iliac bone graft then internal fixation is commonly used to keep the graft in
position. This study was conducted to determine the efficacy and tolerability of shape
memory alloys, especially NiTi (nickel titanium) clips in the stabilization of grafts
following anterior cervical discoidectomy.
Methods:
133 NiTi clips were applied in 119 patients between January 2002 and December 2008.
The patients age ranged from 38–60 years. There were 66 male and 53 females. Various
indications for fixation of the spine included degenerated cervical spondylosis with
single level PIVD (105) and two level PIVD in 14 patients. The cine mode fluoroscopy
confirmed the perioperative correct placement of grafts and clips in all the patients.
Follow-up ranged from 2 to 8 years (mean: 4.6 years).
Results:
Single level discoidectomy was performed in 105 patients and two level disc removal
was done in 14 patients. A single NiTi clip was applied in all the cases except for
14 cases of two level PIVD. No procedural complication or adverse reaction to the
clip was noted. There was no movement at the operated level in dynamic lateral view
X-ray of cervical spine at the 1st postoperative day as well as on follow-up. Graft extrusion was seen in one patient
on the 2nd day after surgery and was reoperated. Bony fusion occurred in all patients after
9 − 12 months of surgery. There was no incidence of breakage or dislodgement of the
clip from the site where it was inserted. No artifact was noted in cervical MRI done
in 33 patients.
Conclusion:
NiTi clips are a simple alternative for cervical spine stabilization after discoidectomy.
Their insertion is simple, minimally invasive, does not require any special set of
instruments and they are much more economical than other established methods of treatment.
These clips are accepted well by human tissue and do not interfere with MRI.
Key words
minimal invasive spine surgery - spinal fusion - cervical fusion - NiTi - shape memory
alloys
