Download PDF
Z Orthop Ihre Grenzgeb 2000; 138(5): 452-458
DOI: 10.1055/s-2000-10177
WIRBELSÄULE

Georg Thieme Verlag Stuttgart · New York

Operative Ergebnisse der monosegmentalen ventralen Fusion mit Plattenosteosynthese bei der therapieresistenten chronischen Zervikobrachialgie

Surgical Results of Single Cervical Spinal Fusion by Plate Osteosynthesis in Chronic Cervical Radiculopathy.L.  Perlick, D.  Zander, N.  Kraft, T.  Wallny, O.  Diedrich, O.  Schmitt
  • Klinik und Poliklinik für Orthopädie (Direktor: Prof. Dr. med. O. Schmitt, Rheinische-Friedrich-Wilhelms-Universität)
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Also available at
    Permissions and Reprints

Zusammenfassung.

Einleitung: Bei der ventralen zervikalen Spondylodese ohne Plattenosteosynthese sind Komplikationen in Form von Spanresorptionen mit daraus resultierender Kyphosierung und Spandislokationen bekannt. Neben den radiologischen und klinischen Ergebnissen sollte diese Studie den Effekt der zusätzlichen Plattenosteosynthese auf das zervikale Alignment erfassen. Material und Methode: Es wurden die operativen Ergebnisse eines Kollektives von 44 Patienten mit therapieresistenten chronischen Zervikobrachialgien und radiologisch nachweisbaren degenerativen Veränderungen ermittelt, bei denen eine monosegmentale ventrale Spondylodese mit Plattenosteosynthese durchgeführt wurde. Neben den klinischen Ergebnissen wurden die radiologische Entwicklung der HWS-Lordose und die segmentale Kyphosierung evaluiert. Ergebnisse: Die Gesamtlordose verbesserte sich radiologisch von 15,4° auf 18,5° sowie der segmentale Winkel von 2,6° auf 7,7°. Ein segmentaler postoperativer Korrekturverlust ließ sich nicht nachweisen. Nach 12 Monaten waren 95 % und nach 36 Monaten 100 % sicher knöchern durchbaut. Klinisch besserten sich die Brachialgien deutlicher (80 %) als die lokalen Nackenschmerzen (66 %). Diskussion: Die Plattenosteosynthese verhindert erfolgreich die postoperative Kyphosierung und Spandislokation. Die klinischen Ergebnisse und Durchbauungsraten entsprechen dem Vorgehen ohne ergänzende Osteosynthese. Langzeitstudien sind zur Beurteilung des klinischen Verlaufs in Abhängigkeit von der segmentalen Kyphosierung erforderlich.

Introduction: In anterior cervical stabilization, collapsise of the grafted bone with resulting localized kyphosis and graft dislocation has been reported. It was the aim of this clinical trial to evaluate the benefit of additional plating while taking specific implant-related complications into account. Methods: The results of single level anterior cervical spinal fusion were evaluated. In 44 patients suffering from chronic cervical radicular pain with degenerative changes, arthrodesis with iliac-crest bone and plate fixation was performed. Apart from elinical parameters, the pre- and postoperative segmental kyphosis and cervical lordosis were evalualed. Results: The total cervical alignment increased from 15.4° to 18.5° while the alignment of the fused segment increased from 2.6° to 7.7°. Postoperative decrease of correction did not occur. Bony fusion was confirmed in 95 % after 12 months and 100 % aller 36 months. Our results show that patients had more relief from radicular pain (80 %) ihan from unspecific neck pain (66 %). Discussion: In single level anterior cervical fusion, additional plating successfully prevents dislocation of the bone graft and postoperative kyphosis. The clinical results and pseudarthrosis rate do not differ from studies without plating. Long. term follow-up studies are necessary to show the benefit of the reduced postoperative kyphosis.

Schlüsselwörter:

Plattenosteosynthese - Halswirbelsäule - ventrale Spondylodese

Key words:

Anterior plating - cervical spine - anterior spondylodesis

Literatur

  • 01 Aebi  M, Zuber  K, Marchesi  D. Treatment of cervical spine injuries with anterior plating. Indications, techniques and results.  Spine. 1991;  16 38-45
    Google Scholar
  • 02 Bayley  J C, Yoo  J U, Kruger  D M, Schlegel  J. The role of distraction in improving the space available for the cord in cervical spondylosis.  Spine. 1995;  20 771-775
    Google Scholar
  • 03 Bertalaffny  H, Eggert  H R. Complications of anterior discectomy without fusion in 450 patients.  Acta Neurochir Wien. 1989;  99 41-50
    Google Scholar
  • 04 Blauth  M, Schmidt  U, Dienst  M, Knop  C, Lobenhofer  P, Tscherne  H. Langzeitergebnisse von 57 Patienten nach ventraler interkorporeller Spondylodese der unteren Halswirbelsäule.  Unfallchirurg. 1996;  99 925-939
    Google Scholar
  • 05 Böhler  J, Gaudernak  T. Anterior plate stabilisation of the lower cervical spine.  J Trauma. 1980;  20 203-205
    Google Scholar
  • 06 Brown  J A, Havel  P, Ebraheim  N, Greenblatt  S H, Jackson  W T. Cervical stabilization by plate and bonefusion.  Spine. 1988;  13 236-240
    Google Scholar
  • 07 Caspar  W, Dragos  D B, Klara  P M. Anterior cervical fusion and Caspar plate stabilisation for cervical trauma.  Neursosurgery. 1989;  25 491-502
    Google Scholar
  • 08 Caspar  W, Geisler  F H, Pitzen  T, Johnson  T A. Anterior cervical plate stabilisation in one- and two-level degenerative disease: overtreatment or benefit?.  J Spinal Disorders. 1998;  11 1-11
    Google Scholar
  • 09 Cauthen  J C, Kinard  R E, Vogler  J B, Jackson  D E, DePaz  O B, Hunter  O L, Wassenburger  L B, Williams  V W. Outcome of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients.  Spine. 1998;  23 188-192
    Google Scholar
  • 10 Chen  I CH. Biomechanical evaluation of subcortical versus bicortical screw purchase in anterior cervical spine plating.  Acta Neurochir. 1996;  138 167-173
    CrossrefPubMedGoogle Scholar
  • 11 Clausen  J D, Ryken  T C, Traynelis  V C, Sawin  P D, Dexter  F, Goel  V K. Biomechanical evaluation of Caspar and cervical spine locking plate system in a cadaveric model.  J Neurosurg. 1996;  84 1039-1045
    PubMedGoogle Scholar
  • 12 Cloward  R B. The anterior approach for removal of ruptured cervical disk.  J Neurosurg. 1958;  15 602-617
    CrossrefPubMedGoogle Scholar
  • 13 Cloward  R B. Anterior surgical approach to the cervical spine: The Cloward procedure.  Spine. 1988;  13 823-827
    PubMedGoogle Scholar
  • 14 Conolly  P J, Esses  S, Kostuik  J P. Anterior cervical fusion: Outcome analysis of patients fused with and without anterior cervical plates.  J Spinal Disord. 1996;  9 202-206
    PubMedGoogle Scholar
  • 15 Cuatico  W. Anterior cervical discectomy without interbody fusion. A analysis of 81 cases.  Acta Neurochir. 1981;  57 269-274
    CrossrefPubMedGoogle Scholar
  • 16 DePalma  A F, Rothmann  R H, Lewinneck  R E, Canale  S T. Anterior interbody fusion for severe cervical disc Regeneration.  Surg Gynecol Obstet. 1972;  134 755-758
    PubMedGoogle Scholar
  • 17 Emery  S E, Fischer  J R, Bohlmann  H H. Three-level anterior cervical discectomy and fusion. Radiographic and clinical results.  Spine. 1997;  22 2622-2625
    CrossrefPubMedGoogle Scholar
  • 18 Espersen  J O, Buhl  M, Eriksen  E F, Fode  K, Klaerke  A, Kroyer  L, Lindeberg  H, Madsen  C B, Strange  P, Wohlert  L. Treatment of cervical disc disease using Cloward's technique.  Acta Neurochirurgica. 1984;  70 97-114
    CrossrefPubMedGoogle Scholar
  • 19 Garvey  T A, Eismont  F J, Roberti  L J. Anterior decompression, structural bone grafting, and Caspar plate stabilization methods in human cadaveric modell.  Spine. 1992;  17 431-435
    PubMedGoogle Scholar
  • 20 Gore  D R, Sepic  S B. Anterior cervical fusion for degenerated or protruced discs: A review of one hundredfortysix patients.  Spine. 1984;  9 667-671
    PubMedGoogle Scholar
  • 21 Goto  S, Mochizuki  M, Kita  T, Kobayashi  Y, Sodeyama  T, Watanabe  T, Kitahara  H, Moriya  H. Anterior surgery in four consecutive technical phases for cervical spondylotic myelopathy.  Spine. 1993;  18 1968-1973
    PubMedGoogle Scholar
  • 22 Goto  S, Kita  T. Long-term follow-up evaluation of surgery for ossification of the posterior longitudinal ligament.  Spine. 1995;  20 2247-2256
    PubMedGoogle Scholar
  • 23 Grob  D. Operative Therapie bei radikulären Beschwerden der degenerativen Halswirbelsäulen.  Orthopädische Praxis. 1996;  25 554-557
    PubMedGoogle Scholar
  • 24 Hankinson  H L, Wilson  C B. Use of the operation microscope in anterior cervical discetomy without fusion.  J Neurosurg. 1975;  43 452-456
    PubMedGoogle Scholar
  • 25 Hirsch  C, Wickbom  I, Linstrom  A, Rosengren  K. Cervical-disc-resektion. A follow-up of myelographic and surgical procedure.  J Bone Joint Surg. 1037;  45A 1811-1821
    PubMedGoogle Scholar
  • 26 Katsuura  A, Hukuda  S, Imanaka  T, Miyamoto  S, Kanemoto  M. Anterior cervical plate used in degenerative disease can maintain cervical lordosis.  J Spinal Disorders. 1996;  9 470-476
    PubMedGoogle Scholar
  • 27 Klages  G. Zur Behandlung zervikaler Bandscheibenvorfälle.  Zbl. Neurochirurgie. 1985;  46 218-228
    PubMedGoogle Scholar
  • 28 Kostuik  J P, Esses  S L, Conolly  P J, Suh  P B. Anterior cervical plate fixation with the titanium hollow screw plate system (THSP).  Spine. 1993;  18 1273-1278
    PubMedGoogle Scholar
  • 29 Louis  R. Traitement des traumatismes cervicaux.  Nouvelle Presse Med. 1979;  8 1931-1937
    PubMedGoogle Scholar
  • 30 Lunsford  L D, Bissonette  P J, Janetta  P J, Sheptak  P E, Zorub  D S. Anterior surgery for cervical disc disease. Part 1 - Treatment of lateral disc herniation in 253 cases.  J Neurosurg. 1980;  53 71-74
    PubMedGoogle Scholar
  • 31 Martins  A N. Anterior cervical discectomy with and without interbody bone graft.  J Neurosurg. 1976;  44 290-295
    PubMedGoogle Scholar
  • 32 Munoz  F LO, Heras  B G, Lopez  V C, Siguero  J JA. Comparison of three techniques of anterior fusion in single-level cervical disc herniation.  Eur Spine J. 1998;  7 512-516
    CrossrefPubMedGoogle Scholar
  • 33 Murphy  M A, Trimble  M B, Piedmonte  M R, Kalfas  L H. Changes in the cervical foraminal area after anterior discectomy with and without a graft.  J Neurosurg. 1994;  43 93-96
    PubMedGoogle Scholar
  • 34 Murphy  M G, Gado  M. Anterior cervical discectomy without interbody bone graft.  J Neurosurg. 1972;  37 71-74
    PubMedGoogle Scholar
  • 35 Pitzen  T, Wilke  H J, Caspar  W, Claes  L, Streudel  W L. Evaluation of a new monocortical screw for anterior cervical fusion and plating by combined biomechanical and clinical study.  Eur Spine J. 1999;  8 382-387
    CrossrefPubMedGoogle Scholar
  • 36 Plötz  G M, Benini  B, Kramer  M. Die mikrotechnische vordere Diskektomie ohne Fusion beim zervikalen Bandscheibenvorfall mit radikulären Beschwerden.  Orthopädische Praxis. 1996;  25 546-553
    PubMedGoogle Scholar
  • 37 Pointillart  V, Cernier  A, Vital  J M, Senegas  J. Anterior discectomy without interbody fusion for cervical disc herniation. Eur Spine J 1995: 45-51
    Google Scholar
  • 38 Riley  L H, Robinson  R A, Johnson  K A, Walker  A E. The results of anterior interbody fusion of the cervical spine. Review of ninety-three consecutive cases.  J Neurosurg. 1969;  30 127-133
    PubMedGoogle Scholar
  • 39 Ripa  D R, Kowall  M G, Meyer  P R, Rusin  J J. Series of ninetytwo traumatic cervical spinal injuries stabilized with anterior ASIF plate fusion technique.  Spine. 1991;  16 46-55
    PubMedGoogle Scholar
  • 40 Robertson  J T. Anterior removal of cervical disc without fusion.  Clin Neurosurg. 1973;  20 259-261
    PubMedGoogle Scholar
  • 41 Robinson  R A, Walker  A E, Ferlic  D C, Wiecking  D K. The results of anterior interbody fusion of the cervical spine.  J Bone Joint Surg. 1962;  44-5 1569-1587
    PubMedGoogle Scholar
  • 42 Robinson  R A, Smith  G W. Anterolateral disc removal and interbody fusion for cervical spine syndrom.  Bull Johns Hopkins. 1955;  96 223-224
    PubMedGoogle Scholar
  • 43 Rosenorn  J, Hansen  E B, Rosenorn  M A. Anterior cervical discetomy with and without fusion: Aprospective study.  J Neurosurg. 1983;  59 252-255
    PubMedGoogle Scholar
  • 44 Savoleinen  S, Rinne  J, Hernesniemi  J. A prospective randomized study of anterior single-level cervical disc operation with long-term follow-up: Surgical fusion is unnecessary.  Neurosurgery. 1998;  43 51-55
    PubMedGoogle Scholar
  • 45 Schmitt  O. Operative Therapie bei Halswirbelsäulenerkrankungen - Indikationsstellung. In: Springorum, H.-W., B.-D. Katthagen (Hrsg) Aktuelle Schwerpunkte der Orthopädie. Thieme Stuttgart, New York; 1990: 17-28
    Google Scholar
  • 46 Schneeberger  A G, Boos  N, Schwarzenbach  O, Aebi  M. Anterior cervical interbody fusion with plate fixation for chronic spondylitic radiculopathy: a 2- to 8-year follow up.  J Spinal Disorders. 1999;  12 215-220
    PubMedGoogle Scholar
  • 47 Shapiro  S. Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy.  J Neurosurg. 1996;  84 161-165
    PubMedGoogle Scholar
  • 48 Simmons  E H, Bhalla  S K, Butt  W P. Anterior cervical discectomy and fusion. A clinical and biomechanical study with eight-year follow-up. Discography: technique and Interpretation of results.  J Bone Joint Surg. 1969;  51B 225-237
    PubMedGoogle Scholar
  • 49 Smith  S A, Lindsey  R W, Deherty  B J, Alexander  J, Dickson  J H. An in vitro biomechanical comparison of the Oroczo and AO locking plate for anterior cervical spine fixation.  J Spinal Disord. 1995;  8 220-223
    PubMedGoogle Scholar
  • 50 Smith  G W, Robinson  R A. The treatment of certain cervical-spine disorders by anterior removal of the intervetebral disc and interbody fusion.  J Bone Joint Surg. 1958;  40A 607-624
    PubMedGoogle Scholar
  • 51 Sweasy  T A, Hoff  J T. Posterior approach to the cervical disc disease and cervical spondylosis. In: M. B. Camins, P. O. Leary (Eds.) Disorders of the cervical spine. 1992: 417-426
    Google Scholar
  • 52 Tscherne  H, Illgner  A. Ventrale Spondylodese der Halswirbelsäule.  Operat Orthop Traumatol. 1991;  3 147-157
    PubMedGoogle Scholar
  • 53 Van Limbeek  J W, Jacobs  C H, Anderson  P G, Pavlov  P W. A systematic literature review to identify the best method for a single level anterior cervical interbody fusion.  Eur Spine J. 2000;  9 129-136
    CrossrefPubMedGoogle Scholar
  • 54 White  A, Southwick  W, Deponte  R, Gainor  J W, Hardy  R. Relief of pain by anterior cervical spine fusion for spondylosis.  J Bone Joint Surg. 1973;  55A 525-534
    PubMedGoogle Scholar
  • 55 Wilson  D H, Campbell  D D. Anterior cervical discectomy without bone graft. Report of 71 cases.  J Neurosurg. 1977;  47 551-555
    PubMedGoogle Scholar
  • 56 Zoega  B, Kärrholm  J, Lind  B. One-level cervical spine fusion.  Acta Orthop Scand. 1998a;  69 363-368
    PubMedGoogle Scholar
  • 57 Zoega  B, Kärrholm  J, Lind  B. Plate fixation adds stability to two-level anterior fusion in the cervical spine: a randomized study using radiostereometry.  Eur Spine J. 1998b;  7 302-307
    CrossrefPubMedGoogle Scholar

Dr. med. Lars Perlick

Orthopädische Universitätsklinik RegensburgBRK-Rheumazentrum

Kaiser-Karl-V-Allee 3

93077 Bad Abbach

Phone: Tel. ++49-9405/18-2401

Fax: Fax ++49-9405/18-2920

Email: E-mail: lars@drperlick.de