Efficiency of Anterior Interbody Fusion using Cage and Plate in the Distractive Flexion Injury of Cervical Spine

Heui-Jeon Park; Wan-Ki Kim; Ho-Young Ryu

doi:10.4184/jkss.2009.16.2.71

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Park, Kim, and Ryu: Efficiency of Anterior Interbody Fusion using Cage and Plate in the Distractive Flexion Injury of Cervical Spine

Cage vs Tricortical Autoiliac Bone

Journal of Korean Spine Surg 2009;16(2):71-78.

Published online: 21 February 2009

DOI: https://doi.org/10.4184/jkss.2009.16.2.71

Efficiency of Anterior Interbody Fusion using Cage and Plate in the Distractive Flexion Injury of Cervical Spine

Heui-Jeon Park, M.D., Wan-Ki Kim, M.D., Ho-Young Ryu, M.D.

Department of Orthopaedic Surgery, Yonsei University, Wonju College of Medicine, Wonju, Korea

Address reprint requests to Heui Jeon, Park, M.D. Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University #162 Ilsan-dong, Wonju, Kangwon-do, Korea Tel: 82-33-741-1352, Fax: 82-33-746-7326, E-mail: par73@yonsei.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

This is a retrospective study

Objectives

We wanted to evaluate the effectiveness and safety of anterior interbody fusion (AIF) using cage and plate fixation for treating distractive flexion injury of the cervical spine according to the radiological and clinical outcomes.

Summary of the Literature Review

AIF of the cervical spine using autoiliac bone and plate fixation is known as an effective method for treating not only degenerative disease, but also trauma as well. However, the problem lies in the complications that occur at the donor site. To avoid these complications, the fusion method using a cage is becoming more frequently used, but there are not many reports on using a cage and plate for treating trauma in the cervical spine.

Materials and Methods

We retrospectively analyzed 47 patients with distractive flexion injury of the cervical spine and who underwent anterior decompression and interbody fusion with a autoiliac bone graft and plate fixation (Group I, 32 patients) or who underwent anterior decompression and interbody fusion with cage and plate fixation (Group II, 15 patients). We statistically analyzed the changes of the segmental lordosis, the fused segmental body height, the fusion rate on plain radiography and the neurologic recovery with using an ASIA scoring system.

Results

All the cases were fused by 12.6±2.5weeks after operation. The changes of segmental lordosis shows no statistical difference between the two groups (p=0.69). The anterior and posterior vertebral heights of the fused segments of Group I were more decreased than those of Group II, and there was a statistical difference between the two groups (p=0.03, 0.04). The initial and last follow up neurologic statuses were not statistically difference between the two groups (p=0.11)

Conclusions

For the treatment of fracture-dislocation injury in the cervical spine, AIF using a PEEK cage filled with autoiliac bone and plate fixation is an effective method with the least possibility of complications at the donor site, and at the same time, this surgical method shows equally satisfactory results, both radiologically and clinically, as fusion with using a tricortical autoiliac bone graft.

Keywords: Cervical spine, Distractive flexion injury, Anterior interbody fusion, Cage

REFERENCES

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Figures and Tables%

Fig. 1.

A 52-year old male with C6 nerve root injury due to unilateral facet dislocation. (A) Preoperative lateral roentgenogram shows anterior displacement of C5 on C6 body. (B) T2 weighted sagittal MR image shows a C5-6 disc protrusion. (C) Lateral radiograph, immediately after surgery, shows anterior cervical fusion with cervical spine locking plate and tricortical autoiliac bone. (D, E) Lateral roentgenogram of flexion/extension views that show no motion and solid fusion.

Fig. 2.

A 43-year old male with C5 nerve root injury due to bilateral facet dislocation. (A) Preoperative lateral roentgenogram shows anterior displacement of C5 on C6 body. (B) T2 weighted sagittal MR image shows a C5-6 disc protrusion. (C) Lateral radiograph, immediately after surgery, shows anterior cervical fusion with cervical spine locking plate and Solis PEEK cage that packed with cancellous iliac bone. (D, E) Lateral roentgenogram of flexion/extension views that show no motion and solid fusion.

Fig. 3.

Radiograph showing linear and angular measurement.

Table 1.

Demography of patients

		Autobone group (n=32)	Cage group (n=15)	P-value
Age (years)		45.5±14	445.0±13.6	0.53
Sex (M/F)		23/9	10/5	0.72
Smoking		11	6	0.71
Follow up (months)		34.8±17.4	18.2±4.3	0.00
	C4-5(C3-4)	8	5
Fusion level	C5-6	13	6	0.80
	C6-7 (C7-T1)	11	4

Table 2.

Change of local lordosis and body height between two groups

		Autobone group (n=32)	Cage group (n=15)	P-value
Lordotic angle (。)	Postoperation.	5.1±5.6	5.8±4.4
	Last F/U	4.7±4.8	5.3±4.1
	Change of angle (▲)	0.4±4.8	0.5±3.8	0.69
Ant. body height (ABH^*,%)	Postoperation.	3.0±0.9	2.4±0.2
	Last F/U	2.7±0.8	2.3±0.2
	Change of Ht.(▲)^†	-9.2±7.7	-3.4±3.8	0.03
Post. body height. (PBH^*,%)	Postoperation	2.9±0.9	2.3±0.2
	Last F/U	2.7±0.7	2.2±0.1
	Change of Ht.(▲)^†	-5.3±6.2	-3.4±2.7	0.04

^∗ ABH (%) =Anterior body height ×100 Control height

^∗ PBH (%) =Posterior body height ×100 Control height

^† Change of Ht. (�) ABH (%) = LastF/U ABH-Postop. ABH ×100 Postop. ABH

^† Change of Ht. (�) PBH (%) = LastF/U PBH-Postop. PBH ×100 Postop. PBH

Table 3.

Change of local lordosis and body height by injury level (Group II)

	Injury level			P-value
	C4/5 (C3/4) (n=5)	C5/6 (n=6)	C6/7 (n=4)	P-value
Change of lordotic angle (。)	-2.0±4.7	-1.4±1.0	-0.5±3.8	0.29
Change of anterior body height (%)	-2.6±2.6	-2.0±0.9	-6.5±6.2	0.16
Change of posterior body height (%)	-3.7±3.1	-2.4±1.4	-4.7±3.8	0.45

Table 4.

Change of neurological examination

		Autobone group (n=32)	Cage group (n=15)	P-value
	Initial	63.3±35.4	75.8±26.0	0.18
ASIA score	Last F/U	77.5±30.9	84.3±18.7	0.21
	Change of score(▲)	14.1±16.7	8.5±9.8	0.11

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