Surgical results and factors affecting outcome in Multi-level cervical myelopathic patients treated with ACDF with standalone PEEK cages
Main Article Content
Keywords
ACDF –Standalone PEEK Cages¬- Multilevel cervical disc disease -Cervical spondylotic myelopathy.
Abstract
To assess long-term outcomes following two or three levels anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK) cages and to determine factors that may affect the surgical outcome. Methods: from September 2016 to April 2022, in Alzhraa University hospital an overall 90 subjects of mean age 55.07 ± 7.73 years (40–70) with 2 or 3 levels CSM were prospectively followed after ACDF wit standalone PEEK cages. All Patients had been evaluated utilizing the modified Japanese Orthopaedic Association (mJOA) scale and Nurick grade. The study examined the impact of age, length of symptoms, cervical curvature, and the existence or lack of preoperative high signal intensity inside the spinal cord on each participant. Plain radiograph and MRI were obtained for all patients preoperatively and postoperatively. Results: During the last follow-up, the clinical outcomes, which encompassed mJOA score, Nurick grading, and Odom’s criteria (excellent, good, fair and poor). The mJOA score was 11.33 ± 2.01 points before surgery and 13.07 ± 1.82 points 1 year after surgery (P=0.002). The Nurick Grading system score was 2.49 ± 0.97 before surgery and 1.88 ± 0.76 1 year after surgery. There were 15 participants (16.7%) possess excellent results, 64 participants (71.1%) possess good results, 8 participants (8.9%) possess fair results and 3 patients (3.3%) possess poor results. All of the recipients had solid fusion 12 months following surgeries. Conclusions: For degenerative cervical disc diseases linked to myelopathy, multilevel ACDF using stand-alone PEEK cages filled with autogenous bone after decompression is a common and very effective surgical option. The most significant prognostic factor was baseline duration and severity of myelopathy of myelopathy followed by age of the patient and associated medical comorbidities.
References
2- Seng C., Benjamin P.B., Siddiqui A., et al. Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. The Spine Journal 13. (2013); 723-731.
3- Rhee J.M., Basra S., Riew K.D. Cervical myelopathy in: Bridwell K. H. and DeWald R.L.: the text book of spine surgery, Wolters Kluwer /Lippncott Williams & Wilkins. (2011); pp. 212-224.
4- Herkowitz H. and Myles L. Cervical Spondylotic Myelopathy: Surgical Management in : Herkowitz H.N., Garfin S.R., Eismont F.J., et al, (eds.): Rothman-Simeone THE SPINE. Elsevier. (2011); pp. 762-790.
5- Greenberg M.S. Degenerative Cervical Disc Disease and Cervical Myelopathy, Handbook of Neurosurgery. Thieme. (2016); pp. 1083-1095.
6- Mummaneni P.V., Kaiser M.G., Matz P.G., Anderson P.A., et al. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg: Spine. (2009); 11:130-141.
7- Emery S.E., Bohlman H.H., Bolesta M.J., et al. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up J Bone Joint Surg Am. (1998); 80:941-951.
8- Chen Y., Wang X., Yang X.L.L., et al. Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up, Eur Spine J. (2013); 22:1539–1546.
9- Chiles B., Leonard M.A., Choudhri H.F., et al. Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery. (1999); 44: 762-769.
10- Liao J.C., Niu C.C., Chen W.J., Chen L.H. Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical Diskectomy and fusion. IntOrthop. (2008); 32(5):643–648.
11- Song K.J., Lee K.B. A preliminary study of the use of cage and plating for single-segment fusion in degenerative cervical spine disease. J ClinNeurosci. (2006); 13:181–187.
12- Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. (1972); 95:87-100.
13- Lad S.P., Patil C.G., Berta S., et al. National trends in spinal fusion for cervical spondylotic myelopathy. SurgNeurol. (2009); 71:66–69.
14- Montgomery D.M. and Brower R.S. Cervical spondylotic myelopathy. Clinical syndrome and natural history. OrthopClin North Am. (1992); 23:487–493.
15- Ebersold M.J., Pare M.C., Quast L.M. Surgical treatment for cervical spondylitc myelopathy. J Neurosurg. (1995); 82:745–751.
16- Hillard V.H., Apfelbaum R.I. Surgical management of cervical myelopathy: indications and techniques for multilevel cervical Diskectomy. Spine J. (2006); 6(6 Suppl):S242–S251.
17- Lin Q., Zhou X., Wang X., et al. A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy, Eur Spine J. (2012); 21:474–481
18- Oh M.C., Zhang H.Y., Park J.Y., et al. Two-level anterior cervical Diskectomy versus one-level corpectomy in cervical spondylotic myelopathy. Spine. (2009); 34:692–696.
19- Hwang S.L., Lee K.S., Su Y.F., et al. Anterior corpectomy with iliac bone fusion or Diskectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease. J Spinal Disord Tech. (2007); 20:565–570.
20- Hirai T., Okawa A., Arai Y., et al. Middle-Term Results of a Prospective Comparative Study of Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy. SPINE. Lippincott Williams & Wilkins. (2011); 36: 23, pp. 1940-1947.
21- Suri A., Chabbra R.P.S., Mehta V.S., et al. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. The Spine J. Elsevier. (2003); 3: 33-45.
22- Tetreault L., Nouri A., Singh A., et al. Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy Undergoing Surgical Treatment: A Survey of Members from AOSpine International, WORLD NEUROSURGERY.(2014);81[3/4]:623-633, www.WORLDNEUROSURGERY.org.
23- Sakai K., Yoshii T., Hirai T., et al. Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty, Eur Spine J, Springer, (2016).
24- Yamazaki T., Yanaka K., Sato H., et al. Cervical Spondylotic Myelopathy: Surgical Results and Factors Affecting Outcome with Special Reference to Age Differences, www.neurosurgery-online.com, Neurosurgery. (2003); 52:122-126.
25- Tani T., Ishida K., Ushida T., et al. Intraoperative electroneurography in the assessment of the level of operation for cervical spondylotic myelopathy in the elderly. J Bone Joint Surg (Br). (2000); 82-B: 269-274.
26- Macdonald R.L., Fehlings M.G., Tator C.H., et al. Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg (1997); 86: 990 – 997.
27- Chung S.S., Lee C.S., Chung K.H. Factors affecting the surgical results of expansive laminoplasty for cervical spondylotic myelopathy, International Orthopaedics (SICOT) (2002); 26:334–338.
28- Sampath R., Bendebba M., Davis J.D., et al. Outcome of patients treated for cervical myelopathy. Spine, Lippincott Williams & Wilkins. (2000); 25: 670 – 676.
29- Demircan M.N., Kutlay A.M., Colak A., et al , Multilevel cervical fusion without plates, screws or autogenous iliac crest bone graft, Journal of Clinical Neuroscience. El seveir. (2007); 723-728.
30- Ahn J.S., Lee J.K., Kim B.K. Prognostic factors that affect the surgical outcome of the laminoplasty in cervical spondylotic myelopathy. Clin Orthop Surg. (2010); 2:98‑104.
31- Holly L.T., Matz P.G., Anderson P.A., et al. Clinical prognostic indi¬cators of surgical outcome in cervical spondylotic myelopathy. J Neurosurg Spine. (2009); 11:112-118.
32- Mastronardi L., Ducati A., and Ferrante L. Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up, Acta Neurochir (Wien), Springer-Verlag. (2006); 148: 307–312.
33- Guven M., Murat C., Bahadir A., et al. Comparison of Anterior Cervical Discectomy Fusion Techniques: Bladed and Non Bladed PEEK Cages. Turk Neurosurg. (2016); 26(3):404-410.
34- Topuz k., Colak A., Kaya S., et al. Two-level contiguous cervical disc disease treated with peek cages packed with demineralized bone matrix: results of 3-year follow-up , Eur Spine J (2009); 18:238–243.
35- Yu S., Li F., Yan N., et al. Anterior Fusion Technique for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Analysis of Surgical Outcome of Patients with Different Number of Levels Fused. (2014); 9: 3. doi.org/10.1371/journal.pone.0091329.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.