Implantation of an empty carbon fiber composite frame cage after single-level anterior cervical discectomy in the treatment of cervical disc herniation: preliminary results

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  • 1 Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
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Object. The authors sought to evaluate retrospectively the radiological and clinical outcome of anterior cervical discectomy followed by implantation of an empty carbon fiber composite frame cage (CFCF) in the treatment of patients with cervical disc herniation and monoradiculopathy.

Methods. Twenty-five consecutive patients (12 men, 13 women, mean age 45 years) with monoradiculopathy due to cervical disc herniation were treated by anterior cervical discectomy followed by implantation of an empty CFCF cage. On lateral flexion—extension radiographs segmental stability at a mean follow up of 14 months (range 5–31 months) was demonstrated in all 25 patients, and bone fusion was documented in 24 of 25 patients. The mean anterior intervertebral body height was 3.4 mm preoperatively and 3.8 mm at follow up in 20 patients. In these patients the mean segmental angle (angle between lower endplate of lower and upper vertebra) was 0.9° preoperatively and 3.1° at follow up. In the remaining five patients preoperative images were not retrievable.

Self-scored neck pain based on a visual analog scale (1, minimum; 10, maximum) changed from a preoperative average of 5.6 to an average of 2 at follow up; radicular pain was reduced from 7.7 to 2.1 postoperatively. Analysis of the SF12 questionnaires showed a significant improvement in both the physical capacity score (preoperative mean 32.4 points; follow up 46 points) and the mental capacity score (preoperative mean 45.8 points; follow up 57.5 points).

Conclusions. Implantation of an empty CFCF cage in the treatment of cervical disc herniation and monoradiculopathy avoids donor site morbidity associated with autologous bone grafting as well as the use of any supplementary material inside the cage. Restoration or maintenance of intervertebral height and thus segmental lordosis and a very high rate of segmental stability and fusion are achieved using this technique.

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Contributor Notes

Address reprint requests to: Michael Payer, M.D., Department of Neurosurgery, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211 Genève 14, Switzerland. email: mpayer@hotmail.com.
  • 1.

    Abd-Alrahman N, , Dokmak A, & Abou-Madawi A: Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir 141:10891092, 1999 Abd-Alrahman N, Dokmak A, Abou-Madawi A: Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir 141:1089–1092, 1999

    • Search Google Scholar
    • Export Citation
  • 2.

    Agrillo U, , Mastronardi L, & Puzzilli F: Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite: preliminary observations in 45 consecutive cases of soft-disc herniation. J Neurosurg (Spine 3) 96:273276, 2002 Agrillo U, Mastronardi L, Puzzilli F: Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite: preliminary observations in 45 consecutive cases of soft-disc herniation. J Neurosurg (Spine 3) 96:273–276, 2002

    • Search Google Scholar
    • Export Citation
  • 3.

    Bärlocher C, , Barth A, & Krauss J, et al: Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interpostition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 12 (1):Article 4, 2002 Bärlocher C, Barth A, Krauss J, et al: Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interpostition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 12(1):Article 4, 2002

    • Search Google Scholar
    • Export Citation
  • 4.

    Bartels R, , Donk R, & Azn R: Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage. J Neurosurg (Spine 1) 95:4042, 2001 Bartels R, Donk R, Azn R: Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage. J Neurosurg (Spine 1) 95:40–42, 2001

    • Search Google Scholar
    • Export Citation
  • 5.

    Brooke N, , Rorke A, & King A, et al: Preliminary experience of carbon fiber cage prostheses for treatment of cervical spine disorders. Br J Neurosurg 11:221227, 1997 Brooke N, Rorke A, King A, et al: Preliminary experience of carbon fiber cage prostheses for treatment of cervical spine disorders. Br J Neurosurg 11:221–227, 1997

    • Search Google Scholar
    • Export Citation
  • 6.

    Cloward RB: The anterior approach for removal of ruptured cervical disc. J Neurosurg 15:602617, 1958 Cloward RB: The anterior approach for removal of ruptured cervical disc. J Neurosurg 15:602–617, 1958

    • Search Google Scholar
    • Export Citation
  • 7.

    Dowd GC, & Wirth FP: Anterior cervical discectomy: is fusion necessary? J Neurosurg (Spine 1) 90:812, 1999 Dowd GC, Wirth FP: Anterior cervical discectomy: is fusion necessary? J Neurosurg (Spine 1) 90:8–12, 1999

    • Search Google Scholar
    • Export Citation
  • 8.

    Floyd T, & Ohnmeiss D: A meta-analysis of autograft versus allograft in anterior cervical fusion. Eur Spine J 9:398403, 2000 Floyd T, Ohnmeiss D: A meta-analysis of autograft versus allograft in anterior cervical fusion. Eur Spine J 9:398–403, 2000

    • Search Google Scholar
    • Export Citation
  • 9.

    Hacker RJ, , Cauthen JC, & Gilbert TJ, et al: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:26462655, 2000 Hacker RJ, Cauthen JC, Gilbert TJ, et al: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:2646–2655, 2000

    • Search Google Scholar
    • Export Citation
  • 10.

    Hamburger C, , Festenberg F, & Uhl E: Ventral discectomy with pmma interbody fusion for cervical disc disease: long-term results in 249 patients. Spine 26:249255, 2001 Hamburger C, Festenberg F, Uhl E: Ventral discectomy with pmma interbody fusion for cervical disc disease: long-term results in 249 patients. Spine 26:249–255, 2001

    • Search Google Scholar
    • Export Citation
  • 11.

    Husag L, & Probst C: Microsurgical anterior approach to cervical discs. Review of 60 consecutive cases of discectomy without fusion. Acta Neurochir 73:229242, 1984 Husag L, Probst C: Microsurgical anterior approach to cervical discs. Review of 60 consecutive cases of discectomy without fusion. Acta Neurochir 73:229–242, 1984

    • Search Google Scholar
    • Export Citation
  • 12.

    Katsuura A, , Hukuda S, & Saruhashi Y, et al: Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320324, 2001 Katsuura A, Hukuda S, Saruhashi Y, et al: Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324, 2001

    • Search Google Scholar
    • Export Citation
  • 13.

    Klara P, , McLain R, & Boden S: Is fusion necessary after anterior cervical discectomy? Spine 21:11121113, 1996 (Letter) Klara P, McLain R, Boden S: Is fusion necessary after anterior cervical discectomy? Spine 21:1112–1113, 1996 (Letter)

    • Search Google Scholar
    • Export Citation
  • 14.

    Madawi AA, , Powell M, & Crockard HA: Biocompatible osteoconductive polymer versus iliac graft. A prospective comparative study for the evaluation of fusion pattern after anterior cervical discectomy. Spine 21:21232129, 1996 Madawi AA, Powell M, Crockard HA: Biocompatible osteoconductive polymer versus iliac graft. A prospective comparative study for the evaluation of fusion pattern after anterior cervical discectomy. Spine 21:2123–2129, 1996

    • Search Google Scholar
    • Export Citation
  • 15.

    Papavero L, , Zwönitzer R, & Burkard I, et al: A composite bone graft substitute for anterior cervical fusion: assessment of osseointegration by quantitative computed tomography. Spine 27:10371043, 2002 Papavero L, Zwönitzer R, Burkard I, et al: A composite bone graft substitute for anterior cervical fusion: assessment of osseointegration by quantitative computed tomography. Spine 27:1037–1043, 2002

    • Search Google Scholar
    • Export Citation
  • 16.

    Pointillart V, , Cernier A, & Vital J, et al: Anterior discectomy without interbody fusion for cervical disc herniation. Eur Spine J 4:4551, 1995 Pointillart V, Cernier A, Vital J, et al: Anterior discectomy without interbody fusion for cervical disc herniation. Eur Spine J 4:45–51, 1995

    • Search Google Scholar
    • Export Citation
  • 17.

    Robinson R, & Smith G: Antero-lateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223224, 1955 Robinson R, Smith G: Antero-lateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223–224, 1955

    • Search Google Scholar
    • Export Citation
  • 18.

    Salame K, , Ouaknine G, , Razon N, & Rochkind S: The use of carbon fiber cages in anterior cervical interbody fusion. Report of 100 cases. Neurosurg Focus 12 (1):Article 1, 2002 Salame K, Ouaknine G, Razon N, Rochkind S: The use of carbon fiber cages in anterior cervical interbody fusion. Report of 100 cases. Neurosurg Focus 12(1):Article 1, 2002

    • Search Google Scholar
    • Export Citation
  • 19.

    Samandouras G, , Shafafy M, & Hamlyn P: A new anterior cervical instrumentation system combining an intradiscal cage with integrated plate: an early technical report. Spine 26:11881192, 2001 Samandouras G, Shafafy M, Hamlyn P: A new anterior cervical instrumentation system combining an intradiscal cage with integrated plate: an early technical report. Spine 26:1188–1192, 2001

    • Search Google Scholar
    • Export Citation
  • 20.

    Schnee C, , Freese A, & Weil R, et al: Analysis of harvest morbidity and radiographic outcome using autograft for anterior cervical fusion. Spine 22:22222227, 1997 Schnee C, Freese A, Weil R, et al: Analysis of harvest morbidity and radiographic outcome using autograft for anterior cervical fusion. Spine 22:2222–2227, 1997

    • Search Google Scholar
    • Export Citation
  • 21.

    Sigot-Luizard M: Evaluation biologique du composite Osta-Pek (carbone-Perekk) utilisé en chirurgie rachidienne. Rachis 12:93100, 2000 (Fr) Sigot-Luizard M: Evaluation biologique du composite Osta-Pek (carbone-Perekk) utilisé en chirurgie rachidienne. Rachis 12:93–100, 2000 (Fr)

    • Search Google Scholar
    • Export Citation
  • 22.

    Sonntag V, , McLain R, & Boden S: Is fusion necessary after anterior cervical discectomy? Spine 21:11111112, 1996 (ltr) Sonntag V, McLain R, Boden S: Is fusion necessary after anterior cervical discectomy? Spine 21:1111–1112, 1996 (ltr)

    • Search Google Scholar
    • Export Citation
  • 23.

    Thalgott J, , Fritts K, & Giuffre J, et al: Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Spine 24:12951299, 1999 Thalgott J, Fritts K, Giuffre J, et al: Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Spine 24:1295–1299, 1999

    • Search Google Scholar
    • Export Citation
  • 24.

    Van Limbeek J, , Jacobs WC, & Anderson PG, et al: A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. Eur Spine J 9:129136, 2000 Van Limbeek J, Jacobs WC, Anderson PG, et al: A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. Eur Spine J 9:129–136, 2000

    • Search Google Scholar
    • Export Citation
  • 25.

    Watters WC III, & Levinthal R: Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow up. Spine 19:23432347, 1994 Watters WC III, Levinthal R: Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow up. Spine 19:2343–2347, 1994

    • Search Google Scholar
    • Export Citation
  • 26.

    Yamamoto I, , Ikeda A, & Shibuya N, et al: Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. Spine 16:272279, 1991 Yamamoto I, Ikeda A, Shibuya N, et al: Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. Spine 16:272–279, 1991

    • Search Google Scholar
    • Export Citation
  • 27.

    Zevgaridis D, , Thomé C, & Krauss J: Prospective controlled study of rectangular titanium cage fusion compared with iliac crest autograft fusion in anterior cervical discectomy. Neurosurg Focus 12 (1):Article 2, 2002 Zevgaridis D, Thomé C, Krauss J: Prospective controlled study of rectangular titanium cage fusion compared with iliac crest autograft fusion in anterior cervical discectomy. Neurosurg Focus 12(1):Article 2, 2002

    • Search Google Scholar
    • Export Citation

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