Document Detail


A prospective randomized comparison of rectangular titanium cage fusion and iliac crest autograft fusion in patients undergoing anterior cervical discectomy.
MedLine Citation:
PMID:  16506459     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The authors compare clinical outcome and fusion rates after iliac crest autograft (ICAG)- and rectangular titanium cage (RTC)-augmented fusion in patients undergoing anterior cervical discectomy (ACD). METHODS: One hundred consecutive patients with 127 levels of cervical disc disease refractory to conservative treatment were randomized into one of the two treatment groups (ICAG/RTC fusion). The visual analog scale was used by the patient to rate overall pain and head, neck, arm, and donor site pain separately. Myelopathy was documented according to Japanese Orthopaedic Association and Nurick grading systems. Outcome was analyzed using Odom criteria, the 36-Item Short Form (SF-36), and Patient Satisfaction Index scales. Fusion rates were assessed on standard and flexion-extension radiographs. Follow-up data of at least 12 months' duration were available for 95 patients. More residual overall pain after 12 months was documented in patients who underwent ICAG fusion (3.3 +/- 2.5 [ICAG] and 2.2 +/- 2.4 [RTC]; p < 0.05). Although arm and head pain were minimal in both groups, neck pain proved to be the predominant symptom (2.7 +/- 2.5 [ICAG] and 1.9 +/- 2.1 [RTC]), which resolved in only 67 and 48% of RTC- and ICAG-treated patients, respectively (p < 0.05). Myelopathy improved comparably in both groups. Regardless of increased pain in ICAG-treated patients, PSI and SF-36 scores were not significantly different between groups (only four [8%] of 47 ICAG-treated patients and five [10%] of 48 RTC-treated patients were unsatisfied). Good to excellent functional recovery according to Odom criteria was observed in 75 and 79% of ICAG- and RTC-treated patients, respectively. Fusion rates were 81 and 74%, respectively (p = 0.51). CONCLUSIONS: Fusion rates and clinical outcome at 12 months after ACD were comparable between patients who underwent ICAG and RTC fusion. The use of rectangular cages, however, avoids donor site morbidity and reduces overall pain and, thus, seems to be an advantageous treatment alternative.
Authors:
Claudius Thomé; Olaf Leheta; Joachim K Krauss; Dimitris Zevgaridis
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of neurosurgery. Spine     Volume:  4     ISSN:  1547-5654     ISO Abbreviation:  -     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-03-01     Completed Date:  2006-03-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101223545     Medline TA:  J Neurosurg Spine     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1-9     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University Hospital Mannheim, Faculty for Clinical Medicine of the Ruprecht-Karls-University of Heidelberg, Germany. claudius.thome@nch.ma.uni-heidelberg.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Arm
Bone Transplantation*
Cervical Vertebrae / surgery*
Diskectomy / instrumentation*,  methods*
Female
Humans
Ilium / transplantation
Intervertebral Disk
Male
Middle Aged
Pain / etiology,  surgery
Pain Measurement
Prospective Studies
Prosthesis Design
Prosthesis Implantation*
Range of Motion, Articular
Titanium
Transplantation, Autologous
Treatment Outcome
Chemical
Reg. No./Substance:
7440-32-6/Titanium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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