Radiographic Analysis of Fusion Progression Following One-Level Cervical Fusion With or Without Plate Fixation

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) using bone graft or a cage with plate fixation is an accepted technique for the treatment of symptomatic degenerative disc disease. It is, however, debatable whether a plate is really necessary to increase the progress of fusion. Thus, the aim of this randomized and controlled prospective study was to evaluate whether ACDF with a cage and anterior plate fixation results in a greater progress of fusion compared with ACDF using a stand-alone cage.

Methods: 37 candidates for ACDF were treated either with a stand-alone cage (study group) or with a cage+plate fixation (control group). 19 patients were randomized to be stabilized with a stand-alone cage and 18 patients were treated with a cage and additional anterior plate fixation. The progress of cervical fusion over time was compared by radiostereometric analysis (RSA). Follow-up examinations pre- and postoperatively were done using the Visual Analogue Scale (VAS) for neck and arm pain. Radiographic assessment of fusion using an RSA-control was done after one, six and twelve weeks, as well as after six months, and one and two years postoperatively. Mann-Whitney test for unpaired values was used to determine the statistical differences in residual intervertebral motion.

Results: Three-dimensional analysis of segmental motion (left-right, cranio-caudal, and posterior-anterior) did not reveal any statistical differences between both groups at any examination time postoperatively (p>0.05). The VAS score did not differ between the groups (p>0.05).

Conclusion: Anterior plate fixation did not demonstrate an improvement in the progress of fusion in one-level ACDF.

Zusammenfassung

Hintergrund: Die anteriore zervikale Diskektomie und Fusion ist eine etablierte Behandlungstechnik bei symptomatischen degenerativen Halswirbelsäulenerkrankungen mit entsprechender OP-Indikation. Die Fusion kann mit einem Cage als Bandscheibenersatz und zusätzlicher ventraler Plattenosteosynthese bzw. auch ohne zusätzliche Verplattung durchgeführt werden. Trotzdem ist es umstritten, ob eine zusätzliche Plattenosteosynthese die Fusionsprogression des behandelten Segments beschleunigt. Das Ziel dieser prospektiven, randomisierten und kontrollierten Studie war es zu untersuchen, ob die zusätzliche Plattenosteosynthese zu einer beschleunigten Fusion bei mono-segmentalen Fusion führt.

Methoden: 37 Patienten wurden entweder mit „alleinstehendem” Cage (19 Patienten) oder mit zusätzlicher Plattenosteosynthese (18 Patienten) behandelt. Zur Beurteilung der funktionellen Stabilität wurde die Röntgenstereometrische Analyse (RSA) verwendet. Dadurch konnten postoperative segmentale Bewegungen des fusionierten Segments dreimensional mit einer Genauigkeit von <=0,4 mm bestimmt werden. Verlaufsuntersuchungen erfolgten 1 Woche, 6 und 12 Wochen sowie 6, 12 und 24 Monate postoperativ. Für die klinische Beurteilung des Therapieerfolgs (Nuchalgie, Brachialgie) wurde die Visuelle Schmerzanalogskala (VAS) gewählt. Die statistische Signifikanz konnte mit dem Mann-Whitney-u-Test ermittelt werden.

Ergebnisse: Seitens der radiologischen Befunde konnte zu keinem Untersuchungszeitpunkt ein Unterschied hinsichtlich der segmentalen Restbeweglichkeit des fusionierten Segments festgestellt werden. Klinisch bestand ebenfalls zu keinem Zeitpunkt ein Unterschied zwischen den untersuchten Behandlungsgruppen.

Zusammenfassung: Bei der mono-segmentalen zervikalen Fusion wird die Fusionsgeschwindigkeit durch die zusätzliche Plattenosteosynthese nicht beschleunigt.

Key words

spine - bone - fusion - implants - clinical study - radiostereometric analysis

Schlüsselwörter

Wirbelsäule - Knochen - Fusion - Implantate - klinische Studie - Röntgenstereometrische Analyse

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