M Lange1, A Philipp, U Fink, R Oeckler. 1. Neurosurgical Department, Klinikum Villingen-Schwenningen, Germany. nch.manfred.lange@klinikumvs.de
Abstract
INTRODUCTION: In cervical discectomy using the ventral approach both, the necessity of replacement of the removed disc space itself as well as the material of the graft, if used, is still a matter of discussion. New approaches are titan-cages, usually filled with autologeous spongiosa. We present in the following study our first experiences using the hollow RABEA-Titan-Cages without filling with spongiosa to avoid the iliac crest complications. MATERIAL AND METHODS: 63 patients (33 male, 30 female, age 25-79 years, mean 52 years) were operated on a degenerative cervical disc herniation by ventral discectomy and replacement of the disc by the cage for fusion. The mean follow-up was 8 months. The preoperative symptoms were radiculopathies (n = 43) and myelopathies (n = 20). The diagnosis was confirmed by CT, MRI, myelography/CT and functional plain x-ray examination excluding instability. Level of the disc herniation: C3/4 n = 3, C4/5 n = 4, C5/6 n = 21, C6/7 n = 23, C7/Th1 n = 5, and 7 cases with 2 levels. In 30 cases we found hard discs, in 13 cases soft discs and in 20 patients combined lesions. All patients were intra- and postoperatively controlled by x-ray examination. RESULTS: Free of complaints were 17 patients, a marked improvement was found in 33 cases, a minor improvement in 10 cases, from those 4 patients additionally suffered from depression or alcoholism and 1 patient had a trauma in the history. 3 patients showed no change. Minor neck pain was reported in 5 cases. The mean postoperative hospitalisation was 8 days. Surgery related complications: temporary radicular palsies n = 5, hoarseness/problems with swallowing n = 5. In 2 cases (3%) with osteoporosis surgical revision of the cage was necessary (one case with ventral dislocation and one case with recurrent nerve root compression). In all other cases the x-ray control proved the correct placement of the cages intra- and postoperatively on discharge. CONCLUSION: For the anterior cervical fusion, the hollow RABEA-Titan-Cages present good clinical results and help to avoid complications from the iliac crest donor site. For long-term results, a longer follow-up and a increased number of patients is required.
INTRODUCTION: In cervical discectomy using the ventral approach both, the necessity of replacement of the removed disc space itself as well as the material of the graft, if used, is still a matter of discussion. New approaches are titan-cages, usually filled with autologeous spongiosa. We present in the following study our first experiences using the hollow RABEA-Titan-Cages without filling with spongiosa to avoid the iliac crest complications. MATERIAL AND METHODS: 63 patients (33 male, 30 female, age 25-79 years, mean 52 years) were operated on a degenerative cervical disc herniation by ventral discectomy and replacement of the disc by the cage for fusion. The mean follow-up was 8 months. The preoperative symptoms were radiculopathies (n = 43) and myelopathies (n = 20). The diagnosis was confirmed by CT, MRI, myelography/CT and functional plain x-ray examination excluding instability. Level of the disc herniation: C3/4 n = 3, C4/5 n = 4, C5/6 n = 21, C6/7 n = 23, C7/Th1 n = 5, and 7 cases with 2 levels. In 30 cases we found hard discs, in 13 cases soft discs and in 20 patients combined lesions. All patients were intra- and postoperatively controlled by x-ray examination. RESULTS: Free of complaints were 17 patients, a marked improvement was found in 33 cases, a minor improvement in 10 cases, from those 4 patients additionally suffered from depression or alcoholism and 1 patient had a trauma in the history. 3 patients showed no change. Minor neck pain was reported in 5 cases. The mean postoperative hospitalisation was 8 days. Surgery related complications: temporary radicular palsies n = 5, hoarseness/problems with swallowing n = 5. In 2 cases (3%) with osteoporosis surgical revision of the cage was necessary (one case with ventral dislocation and one case with recurrent nerve root compression). In all other cases the x-ray control proved the correct placement of the cages intra- and postoperatively on discharge. CONCLUSION: For the anterior cervical fusion, the hollow RABEA-Titan-Cages present good clinical results and help to avoid complications from the iliac crest donor site. For long-term results, a longer follow-up and a increased number of patients is required.