Failure Patterns in Standalone Anterior Cervical Discectomy and Fusion Implants.
World Neurosurg. 2017 Dec;108:676-682
Authors: Alonso F, Rustagi T, Schmidt C, Norvell DC, Tubbs RS, Oskouian RJ, Chapman JR, Fisahn C
BACKGROUND: Anterior cervical discectomy and fusion is usually carried out utilizing an allograft or autograft implant and anterior screw-supported plate. There was a rise in using standalone cage units as a consequence of ease of use and research suggesting a decrease charge of acute postoperative dysphagia. We evaluation our expertise with standalone cage units and determine danger elements, patterns of failure, and revision surgical procedure approaches.
METHODS: We carried out a retrospective case collection of sufferers handled at a single tertiary care establishment between March 2014 and March 2015. Inclusion standards have been aged 18-100 years, 1- or 2-level anterior cervical discectomy and fusion with a standalone cervical cage. Information collected included demographics, comorbidities, Charlson comorbidity rating, major prognosis, and surgical traits. Descriptive statistics have been carried out for danger of readmission, implant failure, revision, and different problems.
RESULTS: We recognized 211 sufferers who met our examine standards. Common surgical time was 107 ± 43 minutes, with an estimated blood lack of 84.6 ± 32.four mL. There have been 11 (5.2%) readmissions. There have been 10 (four.74%) implant failures (5 involving single-level surgical procedure and 5 involving 2-level surgical procedure), with 7 instances of pseudoarthrosis. Mechanisms of failure included a C5 physique fracture, fusion in a kyphotic alignment after graft subsidence, and acute spondylolisthesis.
CONCLUSIONS: Revision surgical procedure after standalone anterior cervical implants may be advanced. Posterior cervical fusion stays a precious strategy to keep away from attainable vertebral physique fracture and lack of fusion space related to the elimination of implants secured by way of the endplates of adjoining vertebral our bodies.
PMID: 28942019 [PubMed – indexed for MEDLINE]