• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.335-341
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• 2010

Objective : Anterior cervical corpectomy with fusion (ACF) or laminoplasty may be associated with substantial number of complications for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with significant cord compression. For more safe decompression and stabilization in multilevel cervical OPLL with prominent cord compression, we propose circumferential cervical surgery (selective ACF and laminoplasty) based on our favorable experience. Methods : Twelve patients with cervical myelopathy underwent circumferential cervical surgery and all patients showed multilevel OPLL with Signal change of the spinal cord on magnetic resonance imaging (MRI). A retrospective review of clinical, radiological. and surgical data was conducted. Results : There were 9 men and 3 women with mean age of 56.7 years and a mean follow up period of 15.6 months. The average corpectomy level was 1.16 and laminoplasty level was 4.58. The average Japanese Orthopedic Association score for recovery was 5.1 points and good clinical results were obtained in 11 patients (92%) (p < 0.05). The average space available for the cord improved from 58.2% to 87.9% and the average Cobb's angle changed from 7.63 to 12.27 at 6 months after operation without failure of fusion (p < 0.05). Average operation time was 8.36 hours, with an estimated blood loss of 760 mL and duration of bed rest of 2.0 days. There were no incidences of significant surgical complications, including wound infection. Conclusion : Although the current study examined a small sample with relatively short-term follow-up periods, our study results demonstrate that circumferential cervical surgery is considered favorable for safety and effectiveness in multilevel OPLL with prominent cord compression.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.105-110
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• 2007

Objective : This purpose of this study was to determine the clinical efficiency and applicability, and to analyze the radiologic findings of the anterior cervical approach using two synthetic cages for interbody fusion. Methods : A total of 41 patients with cervical diseases underwent anterior discectomy and interbody fusion with the PEEK $Solis^{TM}$ cage in 21 patients and the carbon composite $Osta-Pek^{TM}$ cage in 20 patients. Outcome assessment was done using Odom's criteria. Radiological assessment was performed with respect to subsidence, bony fusion and lordosis. The mean follow-up period was 13 months. Results : There were 34 [92.9%] successful cases. The average height of the disc space 12 months after surgery compared the height just after surgery was decreased over 3mm in 4 cases, indicating severe subsidence. The use of these synthetic cages have provided the increase in postoperative cervical lordosis. Conclusion : There were no significant differences between the $Solis^{TM}$ and $Osta-Pek^{TM}$ cages on clinical and radiologic outcomes. Both $Solis^{TM}$ and $Osta-Pek^{TM}$ cages showed low subsidences and complications associated with hardware with good clinical outcomes, high fusion rates, restored disc heights, and restored cervical lordosis.

• Asian Spine Journal
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• v.12 no.6
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• pp.1092-1099
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• 2018

Study Design: In-vitro biomechanical investigation. Purpose: To evaluate the biomechanical effects of the degeneration of the biodegradable cervical plates developed for anterior cervical discectomy and fusion (ACDF) on fusion and adjacent levels. Overview of Literature: Biodegradable implants have been recently introduced for cervical spine surgery. However, their effectiveness and safety remains unclear. Methods: A linear three-dimensional finite element (FE) model of the lower cervical spine, comprising the C4-C6 vertebrae was developed using computed tomography images of a 46-year-old woman. The model was validated by comparison with previous reports. Four models of ACDF were analyzed and compared: (1) a titanium plate and bone block (Tita), (2) strong biodegradable plate and bone block (PLA-4G) that represents the early state of the biodegradable plate with full strength, (3) weak biodegradable plate and bone block (PLA-1G) that represents the late state of the biodegradable plate with decreased strength, and (4) stand-alone bone block (Bloc). FE analysis was performed to investigate the relative motion and intervertebral disc stress at the surgical (C5-C6 segment) and adjacent (C4-C5 segment) levels. Results: The Tita and PLA-4G models were superior to the other models in terms of higher segment stiffness, smaller relative motion, and lower bone stress at the surgical level. However, the maximal von Mises stress at the intervertebral disc at the adjacent level was significantly higher in the Tita and PLA-4G models than in the other models. The relative motion at the adjacent level was significantly lower in the PLA-1G and Bloc models than in the other models. Conclusions: The use of biodegradable plates will enhance spinal fusion in the initial stronger period and prevent adjacent segment degeneration in the later, weaker period.

• Journal of Korean Neurosurgical Society
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• v.44 no.4
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• pp.217-221
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• 2008

Objective : Although anterior cervical discectomy and fusion (ACDF) is the standard treatment for degenerative cervical disc disease, concerns regarding adjacent level degeneration and loss of motion have suggested that arthroplasty may be a better alternative. We have compared clinical and radiological results in patients with cervical disc herniations treated with arthroplasty and ACDF. Methods : We evaluated 53 patients treated for cervical disc herniations with radiculopathy, 21 of whom underwent arthroplasty and 32 of whom underwent ACDF. Clinical results included the Visual Analogue Scale (VAS) score for upper extremity radiculopathy, neck disability index (NDI), duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring cervical lordosis, segmental lordosis and segmental range-of-movement (ROM) of operated and adjacent disc levels. Results : Mean hospital stay (5.62 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.10 vs 2.92 weeks, p<0.05) were significantly shorter in the arthroplasty than in the fusion group. Mean NDI and extremity VAS score improved after 12 months in both groups. Although it was not significant, segmental ROM of adjacent levels was higher in the fusion group than in the arthroplasty group. And, segmental motion of operated levels in arthroplasty group maintained more than preoperative value at last follow up. Conclusion : Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Although it was not significant, ROM of adjacent segments was less in the arthroplasty group. Motion of operated levels in arthroplasty group was preserved at last follow up.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.211-219
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• 2017

Objective : This study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM). Methods : From January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2-7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade. Results : The mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups. Conclusion : This study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.360-364
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• 2000

Objective : To investigate the prognostic factors associated with outcome in patients with ossification of posterior longitudinal ligament. Method : During the past 4 years, we have operated on 35 patients with cervical OPLL. Anterior cervical decompression(total or subtotal corpectomy, discectomy, and removal of the OPLL) and interbody fusion with iliac bone were performed in all patients. Results : Eight cases(22.9%) were continuous type, 11(31.4%) segmental, 13(37.1%) Mixed, and 3(8.6%) localized type. Thirty-two patients(91.4%) showed an excellent or good results. Conclusion : These results indicate that surgical treatment should be considerated in case of clinical grading higher than II and the surgical outcome is worse when duration of preoperative symptom is longer and when percentage of spinal narrowing is higher. Anterior cervical decompression and interbody fusion seems to be a better method in patients with lesions limited to one or two level. Age at surgery did not significantly affect the outcom.

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.12-17
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• 2014

Objective : Anterior cervical discectomy and fusion (ACDF) is often complicated by subsidence, pseudoarthrosis, kyphosis, and graft donor site morbidities. To decrease the occurrence of these complications, various types of cages have been developed. We designed this retrospective study to analyze and compare the efficacy and outcomes of ACDF using double cylindrical cages (DCC) (BK Medical, Seoul, Korea) versus an anterior cervical plating system with autogenous iliac crest grafts. Methods : Forty-eight patients were treated with autograft and plating (plate group), and 48 with DCC group from October 2007 to October 2011. We analyzed construct length, cervical lordotic curvarture, the thickness of the prevertebral soft tissue, segmental instability, and clinical outcomes. Results : There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups. The prevertebral soft tissue was thinner in the DCC group than the plate group immediately after surgery and at the 3-, 6-, and 12-month follow-ups. The difference in interspinous distance on flexion-extension was shorter in the plate group than the DCC group at the 3- and 6-month follow-ups. However, there was no significant difference in this distance between the two groups at the 12-month follow-up. Conclusion : A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

• Journal of Korean Neurosurgical Society
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• v.56 no.2
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• pp.114-120
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• 2014

Objective : At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure. Methods : Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images. Results : In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was $9.77mm^2$ (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability. Conclusions : Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed.

• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.6-12
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• 2013

Objective : This consecutive retrospective study was designed to analyze and to compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using a fibular and femur allograft with anterior cervical plating. Methods : A total of 88 consecutive patients suffering from cervical degenerative disc disease (DDD) who were treated with ACDF from September 2007 to August 2010 were enrolled in this study. Thirty-seven patients (58 segments) underwent anterior interbody fusion with a femur allograft, and 51 patients (64 segments) were treated with a fibular allograft. The mean follow-up period was 16.0 (range, 12-25) months in the femur group and 19.5 (range, 14-39) months in the fibular group. Cage fracture and breakage, subsidence rate, fusion rate, segmental angle and height and disc height were assessed by using radiography. Clinical outcomes were assessed using a visual analog scale and neck disability index. Results : At 12 months postoperatively, cage fracture and breakage had occurred in 3.4% (2/58) and 7.4% (4/58) of the patients in the femur group, respectively, and 21.9% (14/64) and 31.3% (20/64) of the patients in the fibular group, respectively (p<0.05). Subsidence was noted in 43.1% (25/58) of the femur group and in 50.5% (32/64) of the fibular group. No difference in improvements in the clinical outcome between the two groups was observed. Conclusion : The femur allograft showed good results in subsidence and radiologic parameters, and sustained the original cage shape more effectively than the fibular allograft. The present study suggests that the femur allograft may be a good choice as a fusion substitute for the treatment of cervical DDD.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.496-500
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• 2013

Objective : To evaluate the successful fusion rate in postmenopausal women with single-level anterior cervical discectomy and successful fusion (ACDF) and identify the significant factors related to bone successful fusion in pre- and postmenopausal women. Methods : From July 2004 to December 2010, 108 consecutive patients who underwent single-level ACDF were prospectively selected as candidates. Among these, the charts and radiological data of 39 women were reviewed retrospectively. These 39 women were divided into two groups : a premenopausal group (n=11) and a postmenopausal group (n=28). To evaluate the significant factors affecting the successful fusion rate, the following were analyzed : the presence of successful fusion, successful fusion type, age, operated level, bone mineral density, graft materials, stand-alone cage or plating with autologous iliac bone, subsidence, adjacent segment degeneration, smoking, diabetes mellitus, and renal disease. Results : The successful fusion rates of the pre- and postmenopausal groups were 90.9% and 89.2%, respectively. There was no significant difference in the successful fusion rate or successful fusion type between the two groups. In the postmenopausal group, three patients (10.8%) had successful fusion failure. In the postmenopausal group, age and subsidence significantly affected the successful fusion rate (p=0.016 and 0.011, respectively), and the incidence of subsidence in patients with a cage was higher than that in patients with a plate (p=0.030). Conclusion : Menopausal status did not significantly affect bone successful fusion in patients with single-level ACDF. However, in older women with single-level ACDF, the combination of use of a cage and subsidence may unfavorably affect successful fusion.