Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study

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Object

The authors conducted a study to evaluate and compare prospectively the implantation of either an empty carbon fiber composite frame cage (CFCFC) or an iliac crest autograft after anterior cervical discectomy (ACD) for cervical disc herniation with monoradiculopathy.

Methods

Thirty-six consecutive patients with one-level radiculopathy due to single-level cervical disc herniation were treated by ACD, and implantation of either an empty CFCFC (24 patients) or an iliac crest autograft (12 patients). Radiological and clinical assessments were performed preoperatively, immediately postoperatively; and at 3, 6, and 12 months postoperatively. Fusion, at the 12-month follow-up examination was demonstrated in 96% of the patients in the cage group and in 100% of those in the autograft group. The mean anterior intervertebral body height was 3.7 mm preoperatively and 3.9 mm at 12 months in the CFCFC, and 4.1 and 3.8 mm, respectively, in the autograft group. In cage-treated patients, neck pain, as measured using the visual analog scale (VAS) (Score 0 = minimum; 10 = maximum) decreased from 6.4 preoperatively to 2.0 at 12 months, and radicular pain, decreased from 8.4 preoperatively to 1.5 at 12 months. In the autograft group, neck pain changed from a mean preoperative VAS score of 7.2 to 2.5 at 12 months, and radicular pain decreased from a preoperative mean of 7.8 to 1.4 at 12 months. Analysis of the 12-Item Short Form Health Survey domains and the Oswestry Disability Index scores indicated a significant improvement in both the Physical and Mental Component Summary domains in both groups.

Conclusions

Implantation of an empty CFCFC or a tricortical iliac crest autograft after ACD are safe and reliable options for the treatment of cervical disc herniation causing one-sided radiculopathy. Both procedures produced equally satisfying clinical and radiological results, leading to a high fusion rate and maintaining intervertebral height. Implantation of an empty CFCFC has the advantages of avoiding any donor site morbidity and requiring a significantly shorter operative time.

Abbreviations used in this paper:ACD = anterior cervical discectomy; ACDF = ACD and fusion; AIH = anterior intervertebral height; CFCFC = carbon fiber composite frame cage; MCS = Menial Component Summary; MR = magnetic resonance; ODI = Oswestry Disability Index; PCS = Physical Component Summary; SF-12 = 12-Item Short Form Health Survey; VAS = visual analog scale.

Article Information

Address reprint requests to: Michael Payer, M.D., Department of

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photograph showing an empty CFCFC.

  • View in gallery

    Images obtained in a 48-year-old woman with a right-sided C5–6 disc herniation (upper) and a 41-year-old woman with a right-sided C6–7 disc herniation (lower). Upper Left: Preoperative sagittal MR image. Upper Center: Lateral radiograph acquired on postoperative Day 3. Upper Right: Lateral radiograph obtained 12 months postoperatively, demonstrating fusion across a CFCFC without cage subsidence. Lower Left: Preoperative sagittal MR image. Lower Center: Lateral radiograph acquired on postoperative Day 3. Lower Right: Lateral radiograph obtained 12 months postoperatively, demonstrating fusion across a CFCFC with cage subsidence into upper endplate of lower vertebra.

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    Lateral flexion (left) and extension (right) radiographs obtained in a 34-year-old patient with a left-sided C6–7 disc herniation, demonstrating the absence of bone bridging and residual mobility 12 months after cage insertion.

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