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Bone graft should not be omitted in cloward procedure for cervical radiculopathy
Department of Neuroorthopedics, Ryhov Hospital, Jönköping.
MR-Center, Ryhov Hospital, Jönköping.
Department of Radiology, County Hospital, Eksjö-Nassjö, Sweden.
Department of Neuroorthopedics, Ryhov Hospital, Jönköping.
1998 (Engelska)Ingår i: Neuro-Orthopedics, ISSN 0177-7955, Vol. 23, nr 1-2, s. 17-27Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

24 patients from a consecutively serie operated on by an one-level Cloward cervical procedure were retrospectively studied 3-9 years after the surgery. 13 patients had received a bone graft and 11 had not. The clinical results were improved after operation with bone graft; better sensation (p 0.001), better muscle strength (p 0.01) and less pain (p 0.02). Radiography and MRI showed a solid fusion in all the patients with bone graft and in none without. The occurrence of compression on the spinal cord or nerve roots in the adjacent segments as well as in the operated segments did not differ between the groups. We recommend bone graft to be included in the Cloward procedure.

Ort, förlag, år, upplaga, sidor
1998. Vol. 23, nr 1-2, s. 17-27
Nyckelord [en]
Adjacent segments, Bone graft, Cervical fusion, Cloward procedure
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-79467OAI: oai:DiVA.org:liu-79467DiVA, id: diva2:542559
Tillgänglig från: 2012-08-02 Skapad: 2012-08-02 Senast uppdaterad: 2012-08-02Bibliografiskt granskad
Ingår i avhandling
1. Outcome and bone grafts in surgical treatment of cervical disc disease: A clinical evaluation using MRI, radiostereometry and measurements of microcirculation and the quality of life
Öppna denna publikation i ny flik eller fönster >>Outcome and bone grafts in surgical treatment of cervical disc disease: A clinical evaluation using MRI, radiostereometry and measurements of microcirculation and the quality of life
2000 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The purpose of this thesis was to evaluate the outcome after surgical treatment of cervical disc disease and the influence of different bone grafting methods.

192 patients were studied, of which 149 were treated surgically. They all presented with radiculopathy and/ or myelopathy, and were subjected to an anterior cervical discectomy and fusion as described by Cloward, except for 8 patients operated with a posterior decompression.

43 patients due for surgery were prospectively randomized to fusion with either auto-, allo- or xenograft. 33 of these patients were then monitored by radiostereornetric analysis (RSA) after 6, 12 and 24-50 (mean 37) months, including conventional radiography at the final follow-up. All 43 patients were examined clinically, including pain rating pre- and postoperatively with a final follow-up by an unbiased observer. Mobility could be demonstrated by RSA in 9 patients after one year and at the final follow-up in 6, with no difference between bone grafts. Conventional radiography showed final mobility in only 1 out of these 6 patients. The clinical results were not influenced by whether mobility could be demon strated or not. There was a tendency towards better clinical results in the patients fused with an autograft.

13 patients operated without bone graft had a less favourable clinical outcome compared with 11 patients operated with autograft, retrospectively studied 6- 9 years postoperatively.

The normal postoperative course was followed prospectively in 25 consecutive patients by MRI and clinical reviews, preoperatively and 3 days, 3, 6, 12 and 24 months postoperatively. The results demonstrated that the decompression by an anterior procedure should not be evaluated by MRI until at least 3 months postoperatively. This is because surgical debris behind the bone dowel is impossible to distinguish from remaining osteophytes or disc fragments. MRI-findings of foraminal narrowing were common postoperatively among patients with no remaining radiculopathy. A rim sign was permanent with high signal enhancement around the bovine xenograft after i. v. contrast, indicating fibrous healing.

Surgically treated patients experienced a pain reduction as measured by visual analogue pain scales (VAS) and showed an improvement in clinical findings, when followed by unbiased observers at least 2 years after surgery. Some recurrence of pain and other symptoms was common 3 to 6 months postoperatively. The improvement in quality of life measured by Sickness Impact Profile (SIP) in 43 operated patients was mainly temporary, even if a sustained improvement after 2 years was observed among the operated patients that were referred directly to us.

No corresponding changes in pain, clinical findings or SIP were seen among 41 conservatively treated patients, matched for gender and age.

Measurements of microcirculation and electromyography in the trapezius muscles during increased static load before and 9 months after surgery (27 patients) showed a tendency towards increased microcirculation and increased muscle activation. There was a more evident response on the less painful side, as well as among the 8 patients operated using a posterior approach.

Ort, förlag, år, upplaga, sidor
Linköping: Linköpings universitet, 2000. s. 58
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 621
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-28059 (URN)12823 (Lokalt ID)91-7219-578-9 (ISBN)12823 (Arkivnummer)12823 (OAI)
Disputation
2000-03-31, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Svenska)
Opponent
Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2012-10-25Bibliografiskt granskad

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