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Autologous Iliac Bone Graft with Anterior Plating is Advantageous Over the Stand-alone Cage for Segmental Lordosis in Single-level Cervical Disc Disease.
MedLine Citation:
PMID:  23149973     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft and plating has been a standard surgical method for single-level cervical disc disease. The stand-alone cage was introduced to reduce graft-related morbidity. However, problems due to focal kyphosis at the operated level have been on the rise. It has been difficult to derive a conclusive answer from previous studies for the indications of each method. OBJECTIVE:: An interim analysis of a prospective randomized study was performed to compare the sagittal alignment between a stand-alone cage (ACDF-cage) and autologous iliac bone graft and plating (ACDF-plate). METHODS:: Twenty-nine patients were allocated to the ACDF-cage group (M:F=17:12) and 23 to the ACDF-plate group (M:F=14:9). Cobb's angles at the operated segment (segmental angle, SA; lordosis vs. kyphosis) were compared at postoperative 12 months and the other confounding factors were explored. RESULTS:: Demographic features were not different between groups. The fusion method significantly affected segmental alignment at 12 months (p = 0.03; OR, 5.52). Preoperatively, the SA was not different between the groups (p = 0.18) and was similar (p = 0.22) immediately following the operation. However, the SA was significantly more lordotic (p < 0.05) in the ACDF-plate group at postoperative 12 months compared to the ACDF-cage group. There was no other significant risk factor for segmental kyphosis. CONCLUSION:: The stand-alone cage and autologous bone graft with plating had similar clinical outcomes, but stand-alone cage fusion may be disadvantageous from a radiological viewpoint.
Authors:
Chi Heon Kim; Chun Kee Chung; Seokyung Hahn
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-10
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine 2Neuroscience Research Institute, Seoul National University Medical Research Center 3Clinical Research Institute, Seoul National University Hospital 4Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine 5Department of Medicine, Seoul National University College of Medicine.
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