Subsidence of Cylindrical Cage ($AMSLU^{TM}$ Cage) : Postoperative 1 Year Follow-up of the Cervical Anterior Interbody Fusion

  • Joung, Young-Il (Department of Neurosurgery Hanyang University Medical Center) ;
  • Oh, Seong-Hoon (Department of Neurosurgery Hanyang University Medical Center) ;
  • Ko, Yong (Department of Neurosurgery Hanyang University Medical Center) ;
  • Yi, Hyeong-Joong (Department of Neurosurgery Hanyang University Medical Center) ;
  • Lee, Seung-Ku (Department of Neurosurgery Hanyang University Medical Center)
  • Published : 2007.11.30

Abstract

Objective : There are numerous reports on the primary stabilizing effects of the different cervical cages for cervical radiculopathy. But, little is known about the subsidence which may be clinical problem postoperatively. The goal of this study is to evaluate subsidence of cage and investigate the correlation between radiologic subsidence and clinical outcome. Methods : To assess possible subsidence, the authors investigated clinical and radiological results of the one-hundred patients who underwent anterior cervical fusion by using $AMSLU^{TM}$ cage during the period between January 2003 and June 2005. Preoperative and postoperative lateral radiographs were measured for height of intervertebral disc space where cages were placed intervertebral disc space was measured by dividing the sum of anterior, posterior, and midpoint interbody distance by 3. Follow-up time was 6 to 12 months. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Results : Subsidence was found in 22 patients (22%). The mean value of subsidence was 2.21 mm, and mean subsidence rate was 22%. There were no cases of the clinical status deterioration during the follow-up period No posterior or anterior migration was observed. Conclusion : The phenomenon of subsidence is seen in substantial number of patients. Nevertheless, clinical and radiological results of the surgery were favorable. An excessive subsidence may result in hardware failure. Endplate preservation may enables us to control subsidence and reduce the number of complications.

Keywords

References

  1. Brooke NS, Rorke AW, King AT : Preliminary experience of carbon fiber cage prostheses for treatment of cervical spine disorders. Br J Neurosurg 11 : 221-227, 1997 https://doi.org/10.1080/02688699746285
  2. Cho DC, Oh SH, Lee KS, Hong HJ, Yi HJ : Short-term results of anterior cervical fusion with cylindrical cage($AMSLU^{TM}$). J Korean Neurosurg Soc 35 : 569-573, 2004
  3. Cunningham BW, Kanayama M, Parker LM : Osteogenic protein versus autologous interbody arthrodesis in the sheep thoracic spine: A comparative endoscopic study using the Bagby and Kuslich interbody fusion device [in process citation]. Spine 24: 509-518, 1999 https://doi.org/10.1097/00007632-199903150-00002
  4. Curylo LJ, Lindsey RW, Doherty BJ, LeBlanc A: Segmental variations of bone mineral density in the cervical spine. Spine 21: 319-322, 1996 https://doi.org/10.1097/00007632-199602010-00013
  5. Gary W, R.Scott Graham, William C : Graft subsidence after instrument-assisted anterior cervical fusion. J Neurosurg (Spine 2) 97 : 186-192, 2002 https://doi.org/10.3171/spi.2002.97.2.0186
  6. Gercek E, Arlet V, Dcliscle J, Marchesi D : Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 12 : 513-516, 2003 https://doi.org/10.1007/s00586-003-0539-6
  7. Hacker RJ : A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results. J Neurosurg 93 (Suppl2) : 222-226, 2000
  8. Hollowell JP, Vollmer DG, Wilson CR, Pintar FA, Yoganandan N: Biomechanical analysis of thoracolumbar interbody constructs: how important is the endplate? Spine 21 ; 1032-1036, 1996 https://doi.org/10.1097/00007632-199605010-00007
  9. Kettler A, Wilke HJ, Claes L: Effects of neck movements on stability and subsidence in cervical interbody fusion: an in vitro study. J Neurosurg 94 (Suppl1) : 97-107, 2001 https://doi.org/10.3171/jns.2001.94.1.0097
  10. Luirjes WF : The $AMSLU^{TM}$ cage : a minimally invasive procedure for anterior cervical interbody fusion. KAECH 21 : 235-247, 2002
  11. Matge G : Anterior interbody fusion with the BAK-cage in cervical spondylosis. Acta Neurochir (Wien) 140 : 1-8, 1998 https://doi.org/10.1007/s007010050049
  12. Matge G, Leclercq TA: Rationale for interbody fusion with threaded titanium cages at cervical and lumbar levels. Results on 357 cases. Acta Neurochir 142: 425-433, 2000 https://doi.org/10.1007/s007010050453
  13. Odom GL, Finney W, Woodhall B : Cervical disc lesions. JAMA 166: 23-28, 1958 https://doi.org/10.1001/jama.1958.02990010025006
  14. Panjabi MM, White AA, Johnson RM : Cervical spine mechanics as a function of transection of components. J Biomech 8: 327-336, 1975 https://doi.org/10.1016/0021-9290(75)90085-8
  15. Shono Y, McAfee PC, Cunningham BW: A biomechanical analysis of decompression and reconstruction methods in the cervical spine: Emphasis on a carbon-fiber-composite cage. J Bone Joint Surg [Am] 75: 1674-1684, 1993 https://doi.org/10.2106/00004623-199311000-00012
  16. Van Limbeek J, Jacobs WC, Anderson PG, Pavlov PW: Asystematic literature review to identity the best method for a single level anterior cervical interbody fusion. Eur Spine J 9: 129-136, 2000 https://doi.org/10.1007/s005860050223
  17. Vavruch L, Hedlung R, Javid D, Leszniewski W, Shalabi A: A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine 27: 1694-1701, 2002 https://doi.org/10.1097/00007632-200208150-00003
  18. Wigfield CC, Nelson RJ : Non autologous interbody fusion materials in cervical spine surgery: how strong is the evidence to justify their use? Spine 26: 687-694, 2001 https://doi.org/10.1097/00007632-200103150-00027
  19. Wilke HJ, Kettler A, Goetz C, Claes L : Subsidence resulting from simulated postoperative neck movements: an in vitro investigation with a new cervical fusion cage. Spine 25 : 2762-2770, 2000 https://doi.org/10.1097/00007632-200011010-00008
  20. Zdeblick TA, Ghanayem AJ, Rapoff AJ : Cervical interbody fusion cages: An animal model with and without bone morphogenetic protein. Spine 23: 758-765; discussion 766, 1998 https://doi.org/10.1097/00007632-199804010-00002