ANALYSIS OF THE RESULTS OF TREATMENT OF PATIENTS WITH DISCO-RADICULAR CONFLICT OF THE CERVICAL SPINE USING THE METHOD OF DISCECTOMY AND ANTERIOR INTERBODY FUSION FOR A FOUR-YEAR PERIOD
Abstract
Background. Degenerative diseases of the cervical spine are an actual problem of modern health care and affect mainly patients of working age. Currently, there is no consensus on the choice of one or another method of anterior fixation of the cervical spine, and the results of such interventions are largely contradictory.
Aim: is to analyze the results of surgical treatment of patients with disco-radicular conflict (DRC) of the cervical spine using the method of discectomy and anterior spinal fusion for a four-year period.
Material and methods. The study included 105 patients with DRC of the cervical spine who underwent microsurgical discectomy with the installation of an interbody cage. Evaluation of the results was carried out by studying the neurological status and data of neuroimaging methods. To study the clinical efficacy were used: the index of the cervical spine (NDI); visual analogue scale (VAS); scales of postoperative outcomes of Macnab and Nurick, as well as analysis of complications. Dynamic evaluation was made in the period from 36 months to 60 months (median 48 months) after surgery.
Results. When analyzing the results of surgical treatment, there was a significant reduction in pain in the cervical spine from 47 mm to 22 mm on average (p=0,03), and in the upper extremities from an average of 58 mm to 23 mm (p=0,02). 48 months after the operation, positive dynamics in functional status was recorded from 64% (56; 78) to 18% (14;20) (p=0,01). Predominantly good and excellent outcomes on the Macnab scale were noted – 92% and objective improvement on the Nurick scale – 97%. Adverse effects were recorded in 4,5% of cases, significant degeneration of adjacent segments was diagnosed in 8 (7,5%) patients, while a full-fledged bone block was verified after 4 years in 97 (93%).
Conclusion. The method of anterior cervical diskectomy and fusion in the treatment of patients with DRC of the cervical spine allows to achieve good clinical and functional results in both early and late postoperative periods, with low risks of perioperative complications.
References
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16. Jadik S., Miller F., Pietila A. Cervical arthroplasty with the M6-C artificial disc in degenerative disease of the cervical spine // Arch Med. 2015. Vol. 13. №5. P.1-6.
17. Kasliwal M.K., Baskin D.S., Traynelis V.C. Failure of porous tantalum cervical interbody fusion devices: two-year results from a prospective, randomized multicenter clinical study // J Spinal Disord Tech. 2013. Vol. 26. №5. P.239-245. DOI: 10.1097/ BSD.0b013e318241e70f.
18. Li Z., Zhao Y., Tang J., et al. A comparison of a new zeroprofile, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up study // Eur Spine J. 2017. Vol. 26. №4. P.1129-1139. DOI: 10.1007/ s00586-016-4739-2.
19. Lofgren H., Engquist M., Hoffmann P., et al. Clinical and radiological evaluation of Trabecular Metal and the Smith-Robinson technique in anterior cervical fusion for degenerative disease: a prospective, randomized, controlled study with 2-year follow-up // Eur Spine J. 2010. Vol. 19. №3. P.464-473. DOI: 10.1007/s00586009-1161-z.
20. Papacci F., Rigante L., Fernandez E., et al. Anterior cervical discectomy and interbody fusion with porous tantalum implant. Results in a series with long-term follow-up // J Clin Neurosci. 2016. Vol. 33. P.159-162. DOI: 10.1016/j.jocn.2016.03.036.
21. Phan K., Pelletier M.H., Rao P.J., et al. Integral fixation titanium/polyetheretherketone cages for cervical arthrodesis: Evolution of cage design and early radiological outcomes and fusion rates // Orthop Surg. 2019. Vol. 6. P.1-8. DOI: 10.1111/ os.12413.
22. Robertson J.T., Papadopoulos S.M., Traynelis V.C. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study // J Neurosurg Spine. 2005. Vol. 3. №6. P.417-423. DOI: 10.3171/ spi.2005.3.6.0417.
23. Sasso R.C., Anderson P.A., Riew K.D., Heller J.G. Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial // Orthopedics. 2011. Vol. 34. №11. P.889. DOI: 10.3928/01477447-20110922-24.
24. Seaman S., Kerezoudis P., Bydon M., et al. Titanium vs polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature // J Clin Neurosci. 2017. Vol. 44. P.2329. DOI: 10.1016/j.jocn.2017.06.062.
25. Vleggeert-Lankamp C.L.A., Janssen T.M.H., van Zwet E., et al. The NECK trial: effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blinded randomized controlled trial // The Spine. 2018. Vol. 21. P.2-32. DOI: 10.1016/j. spinee.2018.12.013.
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3. Бывальцев В.А., Калинин А.А., Шепелев В.В., и др. Хирургическая тактика лечения пациентов с тандем-стенозом шейного и поясничного отделов позвоночника на основе дифференцированного клинико-инструментального алгоритма // Травматология и ортопедия России. 2018. Т. 24. № 1. C. 53-64.
4. Бывальцев В.А., Сороковиков В.А., Калинин А.А., Белых Е.Г. Анализ результатов переднего шейного спондилодеза с использованием гибридного кейджа PCB Evolution за двухлетний период // Вопросы нейрохирургии им. Н.Н. Бурденко. 2013. № 1. С. 37–45.
5. Бывальцев В.А., Степанов И.А., Алиев М.А., и др. Сравнение результатов тотальной артропластики протезом Discover и переднего шейного спондилодеза в хирургическом лечении дегенеративного заболевания шейных межпозвонковых дисков: метаанализ рандомизированных исследований // Травматология и ортопедия России. 2018. Т. 24. № 4. С. 137-147. DOI: 10.21823/2311-2905-2018-24-4-137-147.
6. Сухомел П., Бывальцев В.А. Анализ результатов использования искусственных дисков PRODISC CTM для артропластики шейных дисков за 2-летний период у 54 пациентов // Вопросы нейрохирургии. 2008. № 3. С. 20-24.
7. Шепелев В.В., Бывальцев В.А., Калинин А.А., и др. Анализ результатов этапных декомпрессивно-стаблизирующих вмешательств при лечении пациентов с тандем-стенозами позвоночного канала в шейном и поясничном отделах позвоночика // Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук. 2016. Т. 110. № 4. С. 85-90.
8. Cabraja M., Oezdemir S., Koeppen D., Kroppenstedt S. Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages // BMC Musculoskelet Disord. 2012. Vol. 13. P. 172. DOI: 10.1186/1471-2474-13-172
9. Chang H., Baek D.H., Choi B.W. Efficacy of Zero-Profile implant in anterior fusion to treat degenerative cervical spine disease: comparison with techniques using bone graft and anterior plating // J Neurol Surg A Cent Eur Neurosurg. 2015. Vol. 76 № 4. P. 268-273. DOI: 10.1055/s-0034-1389091
10. Chen L., Nie L., Zhang L., Hou Y. Fusion versus discover cervical disc in two-level cervical disc disease: a prospective, randomized study // Int Orthop. 2009. Vol. 33. P. 1347-1351.
11. Chong E., Pelletier M.H., Mobbs R.J., Walsh W.R. The design evolution of interbody cages in anterior cervical discectomy and fusion: a systematic review // BMC Musculoskelet Disord. 2015. Vol. 16. P. 99. DOI: 10.1186/s12891-015-0546-x
12. Davis R.J., Nunley P.D., Kim K.D. et al. Two-level total disc replacement with Mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results // J Neurosurg spine. 2013. Vol. 22. № 1. P. 15-25. DOI: 10.3171/2014.7.SPINE13953
13. Fraser J.F., Härtl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates // J Neurosurg Spine. 2007. Vol. 6. № 4. P. 298–303. DOI: 10.3171/spi.2007.6.4.2
14. Gornet M.F., Burkus J.K., Shaffrey M.E., et al. Cervical disc arthroplasty with prestige LP disc versus anterior cervical discectomy and fusion: seven-year outcomes // International journal of spine surgery. 2016. Vol. 10. P. 24. DOI: 10.14444/3024
15. Hu B., Yang X., Hu Y., et al. The n-HA/PA66 cage versus the PEEK cage in anterior cervical fusion with single-level discectomy during 7 years of follow-up // World Neurosurg. 2018. Vol. 18. P 1-7. DOI: 10.1016/j.wneu.2018.11.251
16. Jadik S., Miller F., Pietila A. Cervical arthroplasty with the M6-C artificial disc in degenerative disease of the cervical spine // Arch Med. 2015. Vol. 13. № 5. P. 1-6.
17. Kasliwal M.K., Baskin D.S., Traynelis V.C. Failure of porous tantalum cervical interbody fusion devices: two-year results from a prospective, randomized multicenter clinical study // J Spinal Disord Tech. 2013. Vol. 26. № 5. P. 239-245. DOI: 10.1097/BSD.0b013e318241e70f
18. Li Z., Zhao Y., Tang J., et al. A comparison of a new zero-profile, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up study // Eur Spine J. 2017. Vol. 26. № 4. P 1129-1139. DOI: 10.1007/s00586-016-4739-2
19. Lofgren H., Engquist M., Hoffmann P., et al. Clinical and radiological evaluation of Trabecular Metal and the Smith-Robinson technique in anterior cervical fusion for degenerative disease: a prospective, randomized, controlled study with 2-year follow-up // Eur Spine J. 2010. Vol. 19. № 3. P. 464-473. DOI: 10.1007/s00586-009-1161-z
20. Papacci F., Rigante L., Fernandez E., et al. Anterior cervical discectomy and interbody fusion with porous tantalum implant. Results in a series with long-term follow-up // J Clin Neurosci. 2016. Vol. 33. P. 159-162. DOI: 10.1016/j.jocn.2016.03.036
21. Phan K., Pelletier M.H., Rao P.J., et al. Integral fixation titanium/polyetheretherketone cages for cervical arthrodesis: Evolution of cage design and early radiological outcomes and fusion rates // Orthop Surg. 2019. Vol. 6. P. 1-8. DOI: 10.1111/os.12413
22. Robertson J.T., Papadopoulos S.M., Traynelis V.C. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study // J Neurosurg Spine. 2005. Vol. 3. № 6. P. 417–423. DOI: 10.3171/spi.2005.3.6.0417
23. Sasso R.C., Anderson P.A., Riew K.D., Heller J.G. Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial // Orthopedics. 2011. Vol. 34. № 11. P. 889. DOI: 10.3928/01477447-20110922-24
24. Seaman S., Kerezoudis P., Bydon M., et al. Titanium vs polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature // J Clin Neurosci. 2017. Vol. 44. P. 23-29. DOI: 10.1016/j.jocn.2017.06.062
25. Vleggeert-Lankamp C.L.A., Janssen T.M.H., van Zwet E., et al. The NECK trial: effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatement of cervical disc herniation; a double-blinded randomized controlled trial // The Spine. 2018. Vol. 21. P. 2-32. DOI: 10.1016/j.spinee.2018.12.013
REFERENCES
1. Byvaltsev V.A., Kalinin A.A., Aliyev M.A., et al. Clinical efficacy of laminoplasty in the treatment of patients with multilevel degenerative diseases of the cervical spine // Prakticheskaya medicina. 2018. Vol. 16. №9. P.82-86. (in Russian)
2. Byvaltsev V.A., Kalinin A.A., Stepanov I.A., et al. Analysis of the results of the use of total arthroplasty of the intervertebral disk of the cervical spine with the prosthesis M6-C: a multicenter study // Voprosy nejrohirurgii im N.N. Burdenko. 2017. Vol. 81. №5. P.46-55. (in Russian)
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Published
2019-12-07
How to Cite
КАЛИНИН, Андрей Андреевич et al.
ANALYSIS OF THE RESULTS OF TREATMENT OF PATIENTS WITH DISCO-RADICULAR CONFLICT OF THE CERVICAL SPINE USING THE METHOD OF DISCECTOMY AND ANTERIOR INTERBODY FUSION FOR A FOUR-YEAR PERIOD.
Sibirskij Medicinskij Zurnal (Irkutsk) = Siberian Medical Journal (Irkutsk) 16+, [S.l.], v. 157, n. 2, p. 17-22, dec. 2019.
ISSN 1815-7572. Available at: <http://smj.ismu.baikal.ru/index.php/osn/article/view/336>. Date accessed: 26 july 2026.
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Original research
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