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Anterior Cervical Intercorporal Fusion in Patients With Osteoporotic or Tumorous Fractures Using a Cement Augmented Cervical Plate System: First Results of a Prospective Single Center Study.

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Anterior Cervical Intercorporal Fusion in Patients With Osteoporotic or Tumorous Fractures Using a Cement Augmented Cervical Plate System: First Results of a Prospective Single Center Study.

J Spinal Disord Tech. 2012 Oct 15;

Authors: Waschke A, Walter J, Duenisch P, Kalff R, Ewald C

Abstract
STUDY DESIGN:: Prospective observational clinical study. OBJECTIVE:: The aim of this study is to evaluate the technical feasibility and the safety of additional cement augmentation of anterior cervical implants in patients with poor bone quality due to osteoporosis or tumor infiltration. SUMMARY OF BACKGROUND DATA:: With an increasing number of elderly patients in spinal surgery the problem of implant dislocation after cervical instrumentation will become a more and more important problem. Whereas in the thoracolumbar area cement augmented screws have become widely accepted to ensure a rigid fixation in patients with reduced bone quality there are no data concerning an additional intravertebral cement augmentation after cervical plating. METHODS:: Nine patients (4 male, 5 female, mean age 62.8?y) with newly diagnosed fractures of one or two cervical vertebrae due to tumor infiltration (6 cases) or osteoporosis (3 cases) were included in our study. A standard one or two level cervical corpectomy with vertebral body replacement by an in situ expandable titanium cage and additional anterior plating was carried out. After this, additional cement augmentation was performed as a vertebroplasty of the anterior two thirds of the cranial and caudal adjacent vertebra via a new anterior hole. The cement should enclose the screws as well as stabilize the endplates of the adjacent vertebrae. Follow up comprised clinical examinations, SF-36 questionnaire and visual analogue scale 3, 6, and 12 months after surgery. Cervical spine radiographs were obtained 3 and 6 months after surgery, computed tomography 6 and 12 months after surgery. RESULTS:: The median follow up was 10 months with a range of 4-18 months. There was no intraoperative cement leakage into the spinal canal. The visual analogue scale decreased from 8.2 to 4.2 at 6 months, physical and mental component summaries of SF-36 increased significantly from 27.7 to 36.1 and 31.5 to 48.6 at 6 months respectively. Loosening of screws or plates was not detected throughout the whole observation period. There was one subsidence of a titanium cage into an adjacent vertebra without any clinical consequences. There was no adjacent fracture during the follow-up period and other surgical interventions or revisions were not necessary in any patient. CONCLUSIONS:: In patients with severe osteoporosis or in patients with advanced tumor disease, excellent surgical, clinical and radiological results are possible following our method. In our opinion, a second step posterior approach can be avoided by this technique.

PMID: 23073150 [PubMed – as supplied by publisher]

Related Articles

Anterior Cervical Intercorporal Fusion in Patients With Osteoporotic or Tumorous Fractures Using a Cement Augmented Cervical Plate System: First Results of a Prospective Single Center Study.

J Spinal Disord Tech. 2012 Oct 15;

Authors: Waschke A, Walter J, Duenisch P, Kalff R, Ewald C

Abstract
STUDY DESIGN:: Prospective observational clinical study. OBJECTIVE:: The aim of this study is to evaluate the technical feasibility and the safety of additional cement augmentation of anterior cervical implants in patients with poor bone quality due to osteoporosis or tumor infiltration. SUMMARY OF BACKGROUND DATA:: With an increasing number of elderly patients in spinal surgery the problem of implant dislocation after cervical instrumentation will become a more and more important problem. Whereas in the thoracolumbar area cement augmented screws have become widely accepted to ensure a rigid fixation in patients with reduced bone quality there are no data concerning an additional intravertebral cement augmentation after cervical plating. METHODS:: Nine patients (4 male, 5 female, mean age 62.8▒y) with newly diagnosed fractures of one or two cervical vertebrae due to tumor infiltration (6 cases) or osteoporosis (3 cases) were included in our study. A standard one or two level cervical corpectomy with vertebral body replacement by an in situ expandable titanium cage and additional anterior plating was carried out. After this, additional cement augmentation was performed as a vertebroplasty of the anterior two thirds of the cranial and caudal adjacent vertebra via a new anterior hole. The cement should enclose the screws as well as stabilize the endplates of the adjacent vertebrae. Follow up comprised clinical examinations, SF-36 questionnaire and visual analogue scale 3, 6, and 12 months after surgery. Cervical spine radiographs were obtained 3 and 6 months after surgery, computed tomography 6 and 12 months after surgery. RESULTS:: The median follow up was 10 months with a range of 4-18 months. There was no intraoperative cement leakage into the spinal canal. The visual analogue scale decreased from 8.2 to 4.2 at 6 months, physical and mental component summaries of SF-36 increased significantly from 27.7 to 36.1 and 31.5 to 48.6 at 6 months respectively. Loosening of screws or plates was not detected throughout the whole observation period. There was one subsidence of a titanium cage into an adjacent vertebra without any clinical consequences. There was no adjacent fracture during the follow-up period and other surgical interventions or revisions were not necessary in any patient. CONCLUSIONS:: In patients with severe osteoporosis or in patients with advanced tumor disease, excellent surgical, clinical and radiological results are possible following our method. In our opinion, a second step posterior approach can be avoided by this technique.

PMID: 23073150 [PubMed - as supplied by publisher]

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