Research Article
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IN PATIENTS UNDERGOING ANTERIOR CERVICAL DISCECTOMY AND FUSION EFFECT OF BONE MINERAL DENSITY ON FUSION AND FIXATION

Year 2021, Volume: 28 Issue: 2, 221 - 227, 15.06.2021
https://doi.org/10.17343/sdutfd.789263

Abstract

Objective
The aim of this study is to compare the radiological
and clinical results of patients who underwent anterior
cervical discectomy and fusion, and to determine the
relationship between fusion formation and bone mineral
density.
Materials and Methods
A total of 23 patients, who were admitted to the study
with a diagnosis of cervical degenerative disc disease
and cervical spondylosis at a Faculty of Medicine
Orthopedics and Traumatology clinic, were included
in the study. The cases consisted of patients who underwent
anterior discectomy and fusion, and did not
respond to medical treatment for at least 3 months.
Cervical bilateral radiographs of patients were taken
before and after the operation and bone mineral density,
VAS score values, Neck Disability Index, Ishihara
index and SF-36 evaluation results were compared at
the end of the 1st, 3rd, 6th and 12th months.
Results
In the study, the joining rate was found to be 95.6%.
In the non-smoking group at the end of the 3rd month,
the joining success was reached to 45%, 65% at
the 6th month, and 100% at the 12th month. In the
smoker group, the joining success at the 3rd month
was 35%, 55% at the 6th month and 85% at the 12th
month. A statistically significant relationship was observed
between the changes in the Ishihara index
values and the standard of living of patients and functional
results. The functional results were compared
with the cervical index, and a significant improvement
was observed in the functional results with a significant
correction of the cervical index.
Conclusion
Nowadays, the most suitable intervention is considered
to be the anterior approach in midline cervical
disc hernias. This intervention, which can be performed
with or without fusion, is a situation to be decided
according to the patient's stability problem. It can be
concluded that autograft, allograft, cage or plate-screw
application results require comparison of results
in long-term follow-up. Moreover, in radiological examinations,
if there is a flattening or kyphotic deformity
in the inclination of the cervical spine in the sagittal
plane, it is difficult to correct the sagittal deformity in
the spondylotic spine, which has been fused in places
with posterior intervention, and it increases the
existing kyphotic deformity, making posterior cervical
decompression impossible.

References

  • 1. Zileli M, Özer F. Omurilik ve omurga cerrahisi. Meta Basım Matbaacılık Hizmetleri.İzmir 2002; 739-46.
  • 2. Brigham CD, Tsahakis PJ. Anterior cervical foraminotomy and fusion. Surgical technique and results. Spine 1995;20(7):766-70.
  • 3. Dasgupta R. Re-reading the salaryman in Japan: Crafting masculinities. Routledge 2012.
  • 4. Kuran O. Columma Vertebralis, İn; Sistematic Anatomy (Kuran O, ed), 3. Baskı, Filiz Kitabevi, 1993;74.
  • 5. Dvorak J, Sandler A. Historical Perspective Hubert von Luschka: Pioneer of Clinical Anatomy. Spine 1994;19(21):2478-82.
  • 6. Payne EE, Spillane JD. The cervical spine an anatomico-pathological study of 70 specimens (using a special technique) with particular reference to the problem of cervical spondylosis. Brain 1957;80(4):571-96.
  • 7. Özbek Z, Özkara E, Yağmur İ, Arslantaş A. Servikal Komşu Segment Hastalığı. Osmangazi Tıp Dergisi 2018;40(2):101-6.
  • 8. Grasso G, Landi A. Long Term Radiological And Clinical Evaluation Of Simple Cervical Discectomy Versus Anterior Fusion With Peek Cage. 2018;9(2):87-92
  • 9. Bradford DS, Zdeblick TA. The spine.Lippincott Williams & Wilkins, 2004.
  • 10. Fernyhough JC, White J,LaRocca H. Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 1991;16(10):561-4.
  • 11. Birch J. Efficiency of the Ishihara test for identifying red‐green colour deficiency. Ophthalmic and Physiological Optics 1997;17(5):403-8.
  • 12. Ware J, John E. SF-36 health survey. Lawrence Erlbaum Associates Publishers, 1999;1227-46.
  • 13. Cleland JA, Fritz JM, Whitman JM, Palmer JA. The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy. Spine 2006;31(5):598-602.
  • 14. Cline ME, Herman J, Shaw ER, Morton RD. Standardization of the visual analogue scale. Nursing research 1992.
  • 15. Abbed KM, Coumans JV. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery 2007;60:1-28.
  • 16. Hyong IH, Kim HS, Lee SY. The effect of immediate pain and cervical ROM of cervical pain patients on stretching and manipulation. The Journal of Korean Physical Therapy 2009;21(4):1-7.
  • 17. Kaner T, Özer AF. İatrojenik Spinal Deformiteler. Türk Nöroşirürji Dergisi 2013;23(2):74-82.
  • 18. Chang SW, Kakarla UK, Maughan PH, DeSanto J, Fox D, Theodore N, et al. Four-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Neurosurgery 2010;66(4):639-47.
  • 19. Isomi T, Panjabi MM, Wang JL, Vaccaro AR, Garfin SR, Patel T. Stabilizing potential of anterior cervical plates in multilevel corpectomies. Spine 1999;24(21):2219.
  • 20. DiAngelo DJ, Foley KT, Vossel KA. Rampersaud YR, Jansen TH. Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine 2000; 25(7):783-95.
  • 21. Galler RM, Dogan S, Fifield MS, Bozkus H, Chamberlain RH, Sonntag VK,et al. Biomechanical comparison of instrumented and uninstrumented multilevel cervical discectomy versus corpectomy. Spine 2007;32(11):1220-6.
  • 22. Samartzis D, Shen FH, Goldberg EJ, An HS. Is autograft the gold standard in achieving radiographic fusion in one-level anterior cervical discectomy and fusion with rigid anterior plate fixation? Spine 2005;30(15):1756-61.
  • 23. Ryu SI, Lim JT, Kim SM, Paterno J, Kim DH. Comparison of the biomechanical stability of dense cancellous allograft with tricortical iliac autograft and fibular allograft for cervical interbody fusion. European Spine Journal 2006;15(9):1339-45.
  • 24. Roberts S, Urban JP, Evans H, Eisenstein SM. Transport properties of the human cartilage endplate in relation to its composition and calcification. Spine 1996; 21(4):415-20.
  • 25. Boger DC. Traction device to improve CT imaging of lower cervical spine. American journal of neuroradiology.1986;7(4):719-21.
  • 26. Baleriaux D, Noterman J, Ticket L. Recognition of cervical soft disk herniation by contrast-enhanced CT. American Journal of Neuroradiology 1983;4(3):607-8.
  • 27. Jahnke R, Hart B. Cervical stenosis, spondylosis, and herniated disc disease. Radiologic Clinics of North America 1991;29(4):777-91.
  • 28. Daniels DL, Grogan JP, Johansen JG, Meyer GA, Williams AL, Haughton VM. Cervical radiculopathy: computed tomography and myelography compared. Radiology 1984;151(1):109-13.
  • 29. Fukushima T, Ikata T, Taoka Y, Takata S. Magnetic resonance imaging study on spinal cord plasticity in patients with cervical compression myelopathy. Spine 1991;16(10):534-8.
  • 30. Mann KS,Khosla VK, Gulati DR. Cervical spondylotic myelopathy treated by single-stage multilevel anterior decompression: A prospective study. Journal of neurosurgery, 1984;60(1):81-7.

ANTERİOR SERVİKAL DİSKEKTOMİ VE FÜZYON UYGULANAN HASTALARDA KEMİK MİNERAL YOĞUNLUĞUNUN FÜZYON VE FİKSASYON ÜZERİNE ETKİSİ

Year 2021, Volume: 28 Issue: 2, 221 - 227, 15.06.2021
https://doi.org/10.17343/sdutfd.789263

Abstract

Amaç
Bu çalışmanın amacı, anterior servikal diskektomi ve
füzyon uyguladığımız hastaların radyolojik ve klinik
sonuçlarını karşılaştırmak ve füzyon oluşumu ile kemik
mineral yoğunluğu arasındaki ilişkiyi saptamaktır.
Gereç ve Yöntem
Çalışmaya, Celal Bayar Üniversitesi Tıp Fakültesi
Hastanesi Ortopedi ve Travmatoloji kliniğinde servikal
dejeneratif disk hastalığı ve servikal spondiloz tanıları
ile başvuran toplam 23 hasta dahil edildi. Olgular en
az 3 ay süreyle tıbbi tedaviye yanıt vermeyen anterior
diskektomi ve füzyon uygulanan hastalardan oluştu.
Hastaların operasyon öncesi ve sonrası servikal bilateral
grafileri alınarak, 1-3-6. ve 12. ay sonunda kemik
mineral yoğunluğu, VAS skor değerleri, Boyun Engellilik
İndeksi, Ishihara indeksi ve SF-36 değerlendirme
sonuçları belirlenerek karşılaştırıldı.
Bulgular
Çalışmada kaynama oranı %95,6 bulundu 3. ayda
sigara içmeyen grupta kaynama oranı %45, 6.ayda
%65, 12. ayda %100’e ulaşıldı. Sigara içen grupta
3.ayda kaynama oranı %35, 6. ayda %55, 12. ayda
ise % 85 bulundu. Ishihara indeksi değerlerindeki
değişim ile hastaların yaşam standardı ve fonksiyonel
sonuçlar arasında istatistiksel olarak anlamlı ilişki
gözlendi. Hastalarda fonksiyonel sonuçlar ile servikal
indeks kıyaslanarak, servikal indeksin anlamlı bir şekilde
düzeltilmesi ile fonksiyonel sonuçlarda anlamlı
bir iyileşme izlendi.
Sonuç
Günümüzde orta hat yerleşimli servikal disk hernilerinde
en uygun girişim anterior yaklaşımdır. Füzyonlu
ya da füzyonsuz yapılabilecek bu girişim hastanın
stabilite sorununa göre karar verilecek bir durumdur.
Otogreft, allogreft, kafes ya da plak-vida uygulama
sonuçları, uzun dönem takiplerde sonuçların karşılaştırmasını
gerekli kılmaktadır. Radyolojik incelemelerde
servikal omurganın sagital plandaki eğiminde düzleşme
veya kifotik deformite varsa posterior girişim
ile yer yer füzyon olmuş spondilotik omurgada sagital
deformiteyi düzeltmenin güç olması, mevcut olan kifotik
deformiteyi artırması nedeniyle posterior servikal
dekompresyon uygulanamaz hale gelmektedir.

References

  • 1. Zileli M, Özer F. Omurilik ve omurga cerrahisi. Meta Basım Matbaacılık Hizmetleri.İzmir 2002; 739-46.
  • 2. Brigham CD, Tsahakis PJ. Anterior cervical foraminotomy and fusion. Surgical technique and results. Spine 1995;20(7):766-70.
  • 3. Dasgupta R. Re-reading the salaryman in Japan: Crafting masculinities. Routledge 2012.
  • 4. Kuran O. Columma Vertebralis, İn; Sistematic Anatomy (Kuran O, ed), 3. Baskı, Filiz Kitabevi, 1993;74.
  • 5. Dvorak J, Sandler A. Historical Perspective Hubert von Luschka: Pioneer of Clinical Anatomy. Spine 1994;19(21):2478-82.
  • 6. Payne EE, Spillane JD. The cervical spine an anatomico-pathological study of 70 specimens (using a special technique) with particular reference to the problem of cervical spondylosis. Brain 1957;80(4):571-96.
  • 7. Özbek Z, Özkara E, Yağmur İ, Arslantaş A. Servikal Komşu Segment Hastalığı. Osmangazi Tıp Dergisi 2018;40(2):101-6.
  • 8. Grasso G, Landi A. Long Term Radiological And Clinical Evaluation Of Simple Cervical Discectomy Versus Anterior Fusion With Peek Cage. 2018;9(2):87-92
  • 9. Bradford DS, Zdeblick TA. The spine.Lippincott Williams & Wilkins, 2004.
  • 10. Fernyhough JC, White J,LaRocca H. Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 1991;16(10):561-4.
  • 11. Birch J. Efficiency of the Ishihara test for identifying red‐green colour deficiency. Ophthalmic and Physiological Optics 1997;17(5):403-8.
  • 12. Ware J, John E. SF-36 health survey. Lawrence Erlbaum Associates Publishers, 1999;1227-46.
  • 13. Cleland JA, Fritz JM, Whitman JM, Palmer JA. The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy. Spine 2006;31(5):598-602.
  • 14. Cline ME, Herman J, Shaw ER, Morton RD. Standardization of the visual analogue scale. Nursing research 1992.
  • 15. Abbed KM, Coumans JV. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery 2007;60:1-28.
  • 16. Hyong IH, Kim HS, Lee SY. The effect of immediate pain and cervical ROM of cervical pain patients on stretching and manipulation. The Journal of Korean Physical Therapy 2009;21(4):1-7.
  • 17. Kaner T, Özer AF. İatrojenik Spinal Deformiteler. Türk Nöroşirürji Dergisi 2013;23(2):74-82.
  • 18. Chang SW, Kakarla UK, Maughan PH, DeSanto J, Fox D, Theodore N, et al. Four-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Neurosurgery 2010;66(4):639-47.
  • 19. Isomi T, Panjabi MM, Wang JL, Vaccaro AR, Garfin SR, Patel T. Stabilizing potential of anterior cervical plates in multilevel corpectomies. Spine 1999;24(21):2219.
  • 20. DiAngelo DJ, Foley KT, Vossel KA. Rampersaud YR, Jansen TH. Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine 2000; 25(7):783-95.
  • 21. Galler RM, Dogan S, Fifield MS, Bozkus H, Chamberlain RH, Sonntag VK,et al. Biomechanical comparison of instrumented and uninstrumented multilevel cervical discectomy versus corpectomy. Spine 2007;32(11):1220-6.
  • 22. Samartzis D, Shen FH, Goldberg EJ, An HS. Is autograft the gold standard in achieving radiographic fusion in one-level anterior cervical discectomy and fusion with rigid anterior plate fixation? Spine 2005;30(15):1756-61.
  • 23. Ryu SI, Lim JT, Kim SM, Paterno J, Kim DH. Comparison of the biomechanical stability of dense cancellous allograft with tricortical iliac autograft and fibular allograft for cervical interbody fusion. European Spine Journal 2006;15(9):1339-45.
  • 24. Roberts S, Urban JP, Evans H, Eisenstein SM. Transport properties of the human cartilage endplate in relation to its composition and calcification. Spine 1996; 21(4):415-20.
  • 25. Boger DC. Traction device to improve CT imaging of lower cervical spine. American journal of neuroradiology.1986;7(4):719-21.
  • 26. Baleriaux D, Noterman J, Ticket L. Recognition of cervical soft disk herniation by contrast-enhanced CT. American Journal of Neuroradiology 1983;4(3):607-8.
  • 27. Jahnke R, Hart B. Cervical stenosis, spondylosis, and herniated disc disease. Radiologic Clinics of North America 1991;29(4):777-91.
  • 28. Daniels DL, Grogan JP, Johansen JG, Meyer GA, Williams AL, Haughton VM. Cervical radiculopathy: computed tomography and myelography compared. Radiology 1984;151(1):109-13.
  • 29. Fukushima T, Ikata T, Taoka Y, Takata S. Magnetic resonance imaging study on spinal cord plasticity in patients with cervical compression myelopathy. Spine 1991;16(10):534-8.
  • 30. Mann KS,Khosla VK, Gulati DR. Cervical spondylotic myelopathy treated by single-stage multilevel anterior decompression: A prospective study. Journal of neurosurgery, 1984;60(1):81-7.
There are 30 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Research Articles
Authors

Zafer Şen 0000-0003-0807-6715

Serkan Erkan 0000-0001-6251-6991

Publication Date June 15, 2021
Submission Date September 2, 2020
Acceptance Date January 25, 2021
Published in Issue Year 2021 Volume: 28 Issue: 2

Cite

Vancouver Şen Z, Erkan S. ANTERİOR SERVİKAL DİSKEKTOMİ VE FÜZYON UYGULANAN HASTALARDA KEMİK MİNERAL YOĞUNLUĞUNUN FÜZYON VE FİKSASYON ÜZERİNE ETKİSİ. Med J SDU. 2021;28(2):221-7.

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