Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2002 Sep;9(3):238-244. Korean.
    Published online Sep 30, 2002.
    https://doi.org/10.4184/jkss.2002.9.3.238
    Copyright © 2002 Korean Society of Spine Surgery
    Original Article

    Three-level Anterior Cervical Discectomy and Fusion with Cervical Plate

    Suk-Ha Lee, M.D.,* Sung-Tae Lee, M.D.,* Yong-Keun Lee, M.D.,** Jae-Ik Shim, M.D., Taik-Seon Kim, M.D., Young-Bae Kim, M.D. and Hyun-Sik Ahn, M.D.*
      • Department of Orthopedic Surgery, Korea Veterans Hospital, Seoul, Korea.
      • *Department of Orthopedic Surgery, College of Medicine, Konkuk University, Minjung Hospital, Seoul, Korea.
      • **Department of Neurosurgery, College of Medicine, Konkuk University, Minjung Hospital, Seoul, Korea.
    • Address reprint requests to Suk-Ha Lee, M.D. Department of Orthopaedic Surgery, College of Medicine, Konkuk University, #1 Hwayang-dong, Gwanjin-gu, Seoul 143-701, Korea. Tel: 82-2-450-9685, Fax: 82-2-457-2930, Email: sukha-osdr@hanmail.net

    Abstract

    Study Design

    Retrospective study.

    Objectives

    To evaluate the clinical and radiological outcomes by the method of three-level anterior cervical discectomy and fusion with cervical plate.

    Summary of Literature Review

    The arthrodesis rate and outcome for patients having three-level anterior cervical discectomy and fusion procedures is disappointing. The success of arthrodesis depends on several factors including bone graft type, size, and additional anterior plate fixation.

    Materials and Methods

    Five patients (average age, 69 years; all males) were observed. All had a anterior discectomy, placement of autogenous tricortical iliac bone graft at three-levels and application of a Orion plate. Clinical and radiologic results of bony union, cervical lordosis and intervertebral disc height were assessed.

    Results

    All clinical symptoms of patients had been resolved after operation. The postoperative scores by the criteria of Odom are 2 in excellent and 3 in good. The bony unions were achieved in all cases in the average 12 weeks after surgery (minimum 8 weeks, maximum 20 weeks). The sum of three-level intervertebral disc height in average was increased from 14.8 mm preoperatively to 25.4 mm postoperatively. The average angle of cervical lordosis was corrected from 18o preoperatively to 27o postoperatively.

    Conclusions

    The three-level anterior cervical discectomy and fusion with Orion plate and autogenous tricortical iliac bone graft results in effective surgical treatment, which produces good clinical outcome, early and solid bony union, restoration of the normal cervical lordosis and disc space height.

    Keywords
    Cervical spine; Anterior discectomy; 3-level fusion; Orion plate

    Figures

    Fig. 1
    Preoperative radiograph shows decreased cervical lordosis (160) with severe narrowing of disc space, osteophyte formation and spondylolisthesis C4.

    Fig. 2
    Preoperative MRI shows 3-level (C4-5-6-7) disc herniation with cord impingement.

    Fig. 3
    3-level anterior discectomy and fusion was done by using autogenous tricortical iliac bone graft and Orion plate fixation. 12 weeks later, postoperative radiograph shows solid bony union and restoration of lordosis (340).

    Tables

    Table 1
    Odom's Criteria

    Table 2
    Radiologic Fidings

    References

      1. Ahn JS, Lee JK, Yang JY, Lee HH. Change of the lordosis on cervical spine after anterior interbody fusion with autogenous iliac strut bone graft. J Korean Soc Spine Surg 2001;8:468–474.
      1. An HS, Evanich CJ, Bruce H, Nowicki BS, Haughton VM. Ideal thickness of Smith-Robinson graft for anterior cervical fusion. Spine 1993;18:2043–2047.
      1. Bohler J, Gaudernak T. Anterior plate stabilization for fracture-dislocation of the lower cercical spine. J Trauma 1980;20:203–205.
      1. Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. J Bone Joint Surg 1993;75-A:1298–1307.
      1. Bolesta MJ, Rechtine GR, Chrin AM. Three-and four-level anterior cervical discectomy and fusion with plate fixation, a prospective study. Spine 2000;25:2040–2046.
      1. Caspar W, Geisler FH, Pitzen T, Johson TA. Anterior cervical plate stabilization in one and two level degenerative ; diseaseovertreatment or benefit. J Spinal Disord 1998;11:1–11.
      1. Connolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion : Outcome analysis of patients fused with and without anterior cervical plates. J Spinal Disord 1996;9:202–206.
      1. Eck KR, Bridwell KH, Ungacta FF, Lapp MA, Lenke LG, Riew KD. Analysis of titanium mesh cages in adults with minimum two-year follow-up. Spine 2000;25:2407–2415.
      1. Emery SE, Bolesta MJ, Banks MA, Jones PK. Robinson anterior cervical fusion. Comparison of the standard and modified techniques. Spine 1994;19:660–663.
      1. Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion: Radiographic and clinical results. Spine 1997;22:2622–2625.
      1. Farey ID, Mcafee PC, Davis RF, Long DM. Pseudoarthrosis of the cervical spine after anterior arthrodesis. J Bone Joint Surg 1990;72-A:1171–1177.
      1. Fernyhough JC, White JI, Larocca H. Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 1991;16 suppl:S561–S564.
      1. Karasick D. Anterior cervical spine fusion: struts, plug, and plates. Skeletal radiol 1993;22:85–94.
      1. Kim WJ, Kim KH, Choy WS. Anterior discectomy and fusion with or without plate fixation for one level cervical disc herniation. J Korean Soc Spine Surg 2000;7:373–378.
      1. Lowery GL, McDonough RF. The significant of hardware failure in anterior cervical plate fixation. Spine 1998;23(2):181–187.
      1. Majd ME, Vadhva M, Holt RT. Anterior cervical reconstruction using titanium cages with anterior plating. Spine 1999;24(15):1604–1610.
      1. Moon MS, Ok IY, Song SW. Anterior interbody fusion of the cervical spine. Clinical study of 56 cases. J Korean Orthop Assoc 1985;20:851–860.
      1. Mutoh N, Shinomiy K, Furuya K, Yamaura I, Satoh H. Pseudoarthrosis and delayed union after anterior cervical fusion. International Orthopedics 1993;17:286–289.
      1. Natio M, Kurose S, Oyama M, Sugioka Y. Anterior cervical fusion with the Caspar instrumentation system. International Orthopedics 1993;17:73–76.
      1. Odom GL, Finney W, Woodhall B, Durham NC. Cervical disc lesions. JAMA 1958;166:23–28.
      1. Park HJ, Choi YS. Anterior cervical fusion with ASIF plate. J Korean Orthop Assoc 1993;28:1572–1582.
      1. Riew KD, Rhee JM. The use of titanium mesh cages in the cervical spine. Clin Orthop 2002;394:47–54.
      1. Song KJ, Lee KB. Anterior cervical discectomy and fusion in degenerative cervical diseases: Comparative study between plating and non-plating groups. J Korean Orthop Assoc 2000;35:141–147.
      1. White AA III, Southwich WO, Deponte RJ, Gainor JW, Hardy R. Relief of pain by anterior cervical fusion for spondylosis. J Bone Joint Surg 1973;55-A:525–534.
      1. Zdeblick TA, Bohlman HH. Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strutgrafting. J Bone Joint Surg 1989;71A:170–182.
      1. Zdeblick TA, Ducker TB. The use of freeze-dried allograft bone for anterior cervical fusions. Spine 1991;16:726–729.
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    MeSH Terms
    Animals
    Arthrodesis
    Diskectomy*
    Humans
    Intervertebral Disc
    Lordosis
    Retrospective Studies
    Transplants
    Metrics
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