Outcomes nach ventraler Spondylodese der Halswirbelsäule - eine klinische Untersuchung von 368 Patienten

Zusammenfassung

Ziel: Welche Faktoren beeinflussen das Outcome nach ventralen Spondylodesen der Halswirbelsäule aufgrund von degenerativen Erkrankungen? Ist eine Cage-Sinterung mit einem schlechteren Outcome vergesellschaftet? Material und Methode: Im Rahmen einer prospektiven klinischen Studie operierten wir in der Zeit von September 1997 bis Januar 2005 in der neurochirurgischen Klinik des Unfallkrankenhauses Berlin 368 Patienten aufgrund einer degenerativen Erkrankung der Halswirbelsäule mittels ventraler Spondylodese mit Cage-Implantation. Alle Patienten wurden nach einem Jahr nachuntersucht. Ergebnisse: Ein günstiger Krankheitsverlauf war bei jüngeren Patienten, Pathologien in der unteren Halswirbelsäule und monosegmentalen Spondylodesen zu beobachten. Keinen Einfluss auf den Krankheitsverlauf hatten das Geschlecht der Patienten und eine postoperative Sinterung des Implantats. Schlussfolgerung: Günstige operative Ergebnisse lassen sich durch die frühzeitige Therapie moderater Pathologien mit geeigneten Implantaten erreichen. Eine moderate Sinterung verschlechtert das Ergebnis nicht.

Abstract

Aim: The object of this study was to identify those factors with a direct influence on the treatment outcome of anterior cervical fusion. The clinical relevance of intervertebral cage subsidence in the course of disease is discussed. Material and Methods: In a prospective clinical study we followed up 368 patients with degenerative disease of the cervical spine one year after anterior fusion and cage implantation. Results: We found a statistically significant association between a good outcome and young adults with monosegmental fusion of the lower cervical spine. Conclusions: Early treatment of moderate degenerative cervical disc diseases using an intervertebral cage and anterior fusion leads to a good outcome. Subsidence of the cage does not correlate with a poor outcome.

ventrale Spondylodese der Halswirbelsäule - Prädiktoren des Outcomes - Cage - Sinterung

cervical anterior fusion - predictors of outcome - cage - subsidence

Literatur

• 1 Smith G W, Robinson R A. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion.  J Bone Joint Surg [Am]. 1958;  40 607-623
• 2 Cloward R. The anterior approach for removal of ruptured cervical discs.  J Neurosurg. 1958;  15 602-617
• 3 Meier U, Kemmesis D. Erfahrungen mit 6 verschiedenen intervertebrodiskalen Spacern zur Spondylodese der Halswirbelsäule.  Orthopäde. 1999;  33 1290-1299
• 4 Japanese Orthopedic Association . Criteria on the evaluation of the treatment of cervical myelopathy.  J Jpn Orthop Assoc. 1976;  50 5
• 5 Hirabayashi K, Miyakawa J, Satomi K. Operative results and postoperative progression of ossification among patients with ossification of the posterior longitudinal ligament.  Spine. 1981;  6 354-364
• 6 Yoshida M, Otani K, Shibasaki K, Ueda S. Expansive laminoplasty with reattachement of the spinous process and extensor musculature for cervical myelopathy.  Spine. 1992;  17 491-497
• 7 Bärlocher C B, Barth A, Krauss J K, Binggeli R, Seiler R W. Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients.  Neurosurg Focus. 2002;  12 Article 4
• 8 Hacker R J, Cauthen J C, Gilbert T J, Griffith S L. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage.  Spine. 2000;  25 2646-2655
• 9 Korinth M C, Krüger A, Oertel M F, Gilsbach J M. Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease: results in 292 patients with monoradiculopathy.  Spine. 2006;  31 1207-1214
• 10 Savolainen S, Rinne J, Hernesniemi J. A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary.  Neurosurgery. 1998;  43 51-55
• 11 Türeyen K. Disc height loss after anterior cervical microdiscectomy with titanium intervertebral cage fusion.  Acta Neurochir. 2003;  145 565-569
• 12 Zevgarides D, Thomé L, Krauss J K. Prospective controlled study of rectangular titanium cage fusion compared with iliac crest autograft fusion in anterior cervical discectomy.  Neurosurg Focus. 2002;  12 Article 2
• 13 Hacker R J. A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results.  J Neurosurg. 2000;  93 222-226
• 14 Hamburger C, Festenberg F, Uhl E. Ventral discectomy with PMMA interbody fusion for cervical disc disease: long-term results in 249 patients.  Spine. 2001;  26 249-255
• 15 Heidecke V, Rainov N G, Marx T, Burkert W. Outcome in Cloward anterior fusion for degenerative cervical spinal disease.  Acta Neurochir. 2000;  142 283-291
• 16 Hwang S L, Hwang Y E, Lieu A S. Outcome analyses of interbody titanium cage fusion used in the anterior discectomy for cervical degenerative disc disease.  J Spinal Disord Tech. 2005;  18 326-331
• 17 Peolsson A, Hedlund R, Vavruch L, Öberg B. Predictive factors for the outcome of anterior cervical decompression and fusion.  Eur Spine J. 2003;  12 274-280
• 18 Salame K, Quaknine G ER, Razon N, Rochkind S. The use of carbon fibre cages in anterior cervical interbody fusion. Report of 100 cases.  Neurosurg Focus. 2002;  12 1-5
• 19 Palit M, Schoffermann J, Goldhtwaite N. Anterior discectomy and fusion for the management of neck pain.  Spine. 1999;  24 2224-2228
• 20 Vesper J, Meier U. Langzeitverlauf bei operierten Patienten mit degenerativen Erkrankungen der Halswirbelsäule. Berichte aus der Medizin. Aachen; Shaker-Verlag 2000
• 21 Espersen J O, Buhl M, Eriksen E F. Treatment of cervical disc disease using Cloward's technique. Part I: General results, effect of different operative methods and complications in 1106 patients.  Acta Neurochir. 1984;  70 97-114
• 22 Löfgren H, Johannsson V, Olsson T, Ryd Leif, Levander B. Rigid fusion after Cloward operation for cervical disc disease using autograft, allograft or xenograft. A randomized study with radiostereometric and clinical follow-up assessment.  Spine. 2000;  25 1908-1916
• 23 Peolsson A, Hedlund R, Vavruch L. Prediction of fusion and importance of radiological variables for the outcome of anterior cervical decompression and fusion.  Eur Spine J. 2004;  13 229-234
• 24 Lesion F, Bouasakao N, Clarisse J, Rousseaux M, Jomin M. Results of surgical treatment of radiculopathy caused by arthrosis based on 1000 operations.  Surg Neurol. 1985;  23 350-355
• 25 Hirabayashi K. Diagnosis and surgical management for cervical spondylotic myelopathy. Instructional course lectures, 1. EFORT-Kongress. Paris; Masson 1993 1: 38-46
• 26 Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity.  J Manipulative Physiol Ther. 1991;  14 409-415
• 27 Matgé G, Leclercq T A. Rationale for interbody fusion with treaded titanium cages at cervical and lumbar levels. Results on 357 cases.  Acta Neurochir. 2000;  142 425-434
• 28 Yonenobu K. Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment?.  Eur Spine J. 2000;  9 1-7
• 29 Cauthen J C, Kinard R E, Vogler J B. Outcome analysis of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients.  Spine. 1998;  23 188-192
• 30 Lin C N, Wu Y C, Wang N P, Howng S L. Preliminary experience with anterior interbody titanium cage fusion for treatment of cervical disc disease.  Kaohsiung J Med Sci. 2003;  19 208-215
• 31 Hahn R, Hoffmann B, Jasper M, Sepehrnia A. Microsurgical anterior discectomy with cage fusion for treatment of cervical radiculopathy: follow-up of 80 patients concerning subsidence and clinical outcome after three months. Abstract, 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Strasbourg, 7. - 11. 5. 2005. 
• 32 Zevgarides D, Thomé L, Krauss J K. Prospective controlled study of rectangular titanium cage fusion compared with iliac crest autograft fusion in anterior cervical discectomy.  Neurosurg Focus. 2002;  12 Article 2
• 33 Niu C C, Chen L H, Lai P L, Fu T S, Chen W J. Trapezoidal titanium cage in anterior cervical interbody fusion: a clinical experience.  Chang Gung Med J. 2005;  28 212-221
• 34 Matgé G. Cervical cage fusion with 5 different implants: 250 cases.  Acta Neurochir. 2002;  144 539-550
• 35 Matgé G, Leclercq T A. Rationale for interbody fusion with treated titanium cages at cervical and lumbar levels. Results on 357 cases.  Acta Neurochir. 2000;  142 425-434
• 36 Assietti R, Beretta F, Arienta C. Two-level anterior cervical discectomy and cage-assisted fusion without plates.  Neurosurg Focus. 2002;  12 Article 3
• 37 Moreland D B, Asch H L, Clabaux D E. Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft.  Spine J. 2004;  4 184-191
• 38 Vavruch L, Hedlund R, Javid D, Lesznewski W, Shalabi A. A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine.  Spine. 2001;  27 1694-1701
• 39 Wilke H J, Kettler A, Goetz C, Claes L. Subsidence resulting from simulated postoperative neck movements. An in vitro investigation with a new cervical fusion cage.  Spine. 2000;  25 2762-2770
• 40 Fürderer S, Schöllhuber F, Rompe J D, Eysel P. Einfluss von Design und Implantationstechnik auf das Risiko der progredienten Sinterung verschiedener HWS-Cages.  Orthopäde. 2002;  31 466-471
• 41 Bostelmann R, Heidecke V, Helmbrecht A. Vergleich zwischen PEEK- versus Titan-Cage bei zervikaler ventraler Fusion. Ein retrospektiver Erfahrungsbericht. Abstracts, 27. Jahrestagung Sektion Wirbelsäule der DGNC, Günzburg, 17. - 18. 9. 2004. 
• 42 Lim T H, Kwon H, Jeon C H. Effect of endplate conditions and bone mineral density on the compressive strength of the graft-endplate interface in anterior cervical spine fusion.  Spine. 2001;  26 951-956
• 43 Truumees E, Demetropoulos C K, Yang K H, Herkowitz H N. Failure of human cervical endplates: a cadaveric experimental model.  Spine. 2003;  28 2204-2208
• 44 Brower R S, Herkowitz H N, Kurz I. Effect of distraction on union rate of Smith-Robinson type anterior cervical discectomy and fusion. Presented at the 20th Annual Meeting of the Cervical Spine Research Society, Palm Dessert, CA. 1992