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MRI and clinical course after anterior cervical decompression and fusion: A prospective two years longitudinal evaluation showing fibrous union of the bovine graft
Department of Neuroorthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
MR-Center, Ryhov Hospital, Jönköping.
National Social Insurance Hospital (Research and Rehabilitation Centre), Tranås, Sweden.
Department of Neuroorthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
1999 (English)In: Neuro-Orthopedics, ISSN 0177-7955, Vol. 26, no 1, 19-31 p.Article in journal (Refereed) Published
Abstract [en]

Study design. Twenty-five consecutive patients were studied prospectively after one-level anterior cervical decompression and fusion according to Cloward with bovine bone graft. Objectives. To monitor, by MRI, the postoperative changes at the fused and adjacent levels together with the longitudinal clinical course. Summary of background data. MRI has become the primary preoperative examination of cervical disc disease/spondylosis, but experience of the normal postoperative findings is still limited. Methods. MRI was performed preoperative and after three days, three six, 12 and 24 months accompanied with clinical reviews. Results. Up to six months postoperatively, the surgical debris behind the bone dowel was impossible to distinguish from remaining parts of osteophytes or disc fragments. A rim sign was permanent with high signal around but only slight enhancement in the bone transplant after i.v. contrast. Twelve patients had foraminal stenosis at the operated level, but only two of them had radicular pain. There was small amounts of epidural scar tissue. Four patients developed a severe degeneration at the adjacent levels, all of which had had some changes preoperatively. Clinically, we found improvement in muscle strength and sensory function, lowered pain rating (VAS) and 19 patients experience a good outcome. Three to six months postoperatively there was a period with some recurrence of symptoms. Conclusions. The decompression by an anterior procedure should not be evaluated by MRI until at least three months postoperatively. Asymptomatic foraminal stenosis was common postoperatively. The bovine xenograft (SurgiboneR) had a fibrous healing. The clinical results were satisfactory as evaluated by an unbiased observer.

Place, publisher, year, edition, pages
1999. Vol. 26, no 1, 19-31 p.
Keyword [en]
Cervical vertebrae, Magnetic resonance imaging, Prospective studies, Spinal fusion, Transplantation heterologous
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-79468OAI: oai:DiVA.org:liu-79468DiVA: diva2:542560
Available from: 2012-08-02 Created: 2012-08-02 Last updated: 2012-08-02Bibliographically approved
In thesis
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
Open this publication in new window or tab >>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 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 58 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 621
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28059 (URN)12823 (Local ID)91-7219-578-9 (ISBN)12823 (Archive number)12823 (OAI)
Public defence
2000-03-31, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-25Bibliographically approved

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Löfgren, HåkanLevander, Bo

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