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Comparative Analysis of Three Different Construct Systems for Single-Level Anterior Cervical Discectomy and Fusion: Stand-alone Cage, Iliac Graft Plus Plate Augmentation, and Cage Plus Plating.
MedLine Citation:
PMID:  23027363     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
STUDY DESIGN:: A retrospective cohort-nested longitidinal study. OBJECTIVE:: To evaluate the radiological and clinical functional outcomes after single-level ACDF using three different construct fusion systems using an accurate and reliable methodology. SUMMARY OF BACKGROUND DATA:: Anterior cervical discectomy and fusion (ACDF) is an established procedure that is used three different fusion construct systems: cage alone (CA), iliac tricortical bone block with plate (IP), and cage with plate construct (CP). The outcome of previous study is quite different and did not correlate with experimental studies. METHODS:: ACDF was performed for all 158 patients (90 males and 68 females), and followed for more than 12 months. The patients were divided into the following three treatment groups: CA, IP, and CP. The factors related with outcome were also evaluated. The fusion rate, subsidence rate, and cervical angles were used to measure radiological outcome. Odom's criteria and visual analog scale were used to evaluate clinical outcome. RESULTS:: The fusion rate was higher for patients in the IP (87.1%) and CP (79.5%) groups than in the CA group (63.2%) after 12 months of follow-up (P=0.019). The subsidence rate was lower for patients in the IP (28.1%) and CP (38.5%) groups than for those in the CA group (58.6%) (P=0.010). Subsidence occurred for the anterior height regardless of contructs. Radiating arm pain showed greater relief in the CP group than in the CA group (P=0.015). The CP group improved radiating arm pain more than IP group, but the differences were not statistically significant (P=0.388). Other clinical outcome did not show significant differences. CONCLUSIONS:: The trend of excellent radiological outcome was observed for IP≥CP>CA, respectively. Plating may play a key role to support anterior height. As a result, plating prevents segmental kyphosis and subsidence and promote bone fusion. Although the overall clinical outcomes were not different among the three groups except arm pain, more favorable trends regarding clinical outcome were observed for CP≥IP>CA, respectively.
Authors:
Chang-Hyun Lee; Seung-Jae Hyun; Min Jeong Kim; Jin Sup Yeom; Wook Ha Kim; Ki-Jeong Kim; Tae-Ahn Jahng; Hyun-Jib Kim; Sang Hoon Yoon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-28
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  -     ISSN:  1539-2465     ISO Abbreviation:  J Spinal Disord Tech     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-10-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Department of Neurosurgery †Orthopedic Surgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam ‡Department of Neurosurgery, Wooridul Spine Hospital, Seoul Republic of Korea.
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