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Tag: anterior cervical discectomy|anterior cervical discectomy and fusion|article link|formation sign|spur

Radiological Changes in Anterior Cervical Discectomy and Fusion with Cage and Plate Construct: The Significance of the Anterior Spur Formation Sign.

By wp_zaman

Radiological Changes in Anterior Cervical Discectomy and Fusion with Cage and Plate Construct: The Significance of the Anterior Spur Formation Sign.

Spine (Phila Pa 1976). 2011 Apr 19;

Authors: Song JS, Taghavi CE, Hsu DW, Song KJ, Song JH, Lee KB

Structured AbstractStudy design. Retrospective reviewObjective. To analyze the changes of fusion process and radiologic parameters during the postoperative period after anterior cervical discectomy and fusion with cage and plate construct (ACDF-CPC).Summary of background data. Due to its well-reported efficacy, plate augmentation has been performed in order to avoid the various complications associated with the cage alone procedure. The radiological changes at the fusion site following ACDF-CPC have yet to be fully explored.Methods: Seventy-eight patients (122 fusion sites) who underwent ACDF-CPC, were observed at 6 weeks, 3, 6, 12, and 24 months postoperatively. Fusion status was classified into three categories: Type I (pseudoarthrosis), Type II (borderline), and Type III (fusion). Changes at the fusion site were described through radiologic parameters at each follow-up time point. In addition, the ability of the radiological parameters to predict fusion rates was analyzed.Results: The fusion process following ACDF-CPC progresses slower when compared to the standard procedure utilizing autograft. Fusion between bone graft chips begins at six weeks after surgery. At three months, initial bone bridging between graft and host bones begins to form. Anterior spur formation occurs at 3 to 6 months, and “kissing” lesions form at 6 to 12 months. Bony incorporation is achieved at 1 to 2 years. Persistent or newly developed Type I at the one year follow up exhibited significantly higher pseudoarthrosis rates in comparison to rates determined at the three and six month time points. Among 29 subsidence cases, nine of the 16 (56.3%) cases that exhibited anterior spur formation eventually achieved fusion. Whereas, two of the 13 (15.4%) cases that did not exhibit anterior spur formation eventually achieved fusion. In cases that demonstrated anterior spur formation, the fusion rate was significantly higher than in cases without it (p = 0.016).Conclusion: The fusion process following ACDF-CPC progresses slower than the standard procedure utilizing autograft. Cage subsidence of greater than two millimeters or a radiolucent defect or halo sign are poor prognostic signs, indicating a high probability for pseudoarthrosis when detected radiographically after one year postoperatively. The anterior spur formation sign and “kissing” lesion, on the other hand, represent signs for eventual successful fusion.

PMID: 21508883 [PubMed – as supplied by publisher]