Surgical Outcome of Anterior Cervical Discectomy and Fusion (ACDF) with Autologous Bone Graft from Iliac Bone and Miniplate Application Over It

  • RIAZ -UR-REHMAN Department of Neurosurgery, Lady Reading Hospital, Peshawar
  • MUHAMMAD NAWAZ KHAN Hayatabad Medical Complex Peshawar
  • SAJJADULLAH . Department of Neurosurgery, Lady Reading Hospital, Peshawar
  • ATTIYA NASIR Hayatabad Medical Complex Peshawar
  • ANIF- UR-RAHMAN Hayatabad Medical Complex Peshawar, Pakistan
Keywords: Cervical radiculopathy, ACDF, Miniplate, Iliac bone graft

Abstract

Objectives: To know the surgical outcome of ACDF with autologous bone graft from iliac bone and miniplate application over it.
Materials and Methods: This prospective study was conducted in the Department of Neurosurgery, Hayatabad Medical Complex and Lady Reading Hospital Peshawar from 1st June 2017 to 31 December 2018. Only those patients having prolapsed intervertebral cervical discs or cervical stenosis were included while those with multiple level involvement, trauma, fracture and previously operated patients for any cervical pathology were excluded. Pre-op and postoperative data were documented. For all patients, tricortical iliac bone autograft and rigid plate instrumentation was used to optimize fusion cervical collar was not used post op. Acquired data were analyzed with SPSS v20.
Results: Total 83 patients fulfilled the inclusion criteria and enrolled in the study. Out of these, 48 patients were males and 35 were females. The age range was from 17 to 63 with a mean age 52 years ± 2.5.The C5 – C6 was the commonest site for fusion C6 – C7, C3 – C4 and C4 – C5 were less common. Odom’s criteria was applied to determine the outcome of the procedure. Excellent results were noted in 70 (82%). Ten (12.05%) patients had good results. 
Conclusion: The ACDF with the tricortical iliac bone autograft and mini plate application is the choice treatment in appropriately selected patients. It increases chances of fusion and abates the need for post op cervical collar. 

References

1. Todd AG. Cervical spine: degenerative conditions. Current Reviews in Musculoskeletal Medicine, 2011; 4: 168–174.
2. Caridi JM. Cervical radiculopathy: a multicentre review. HSS Journal. 2012; 7: 266–273.
3. Radhakrishnan K, Litchy W J, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester Minnesota, 1976 through 1990.Brain, 1994; 117: 325–335.
4. Litchy W J, Radhakrishnan K, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester Minnesota, 1976 through 1990. Brain, 1994; 117: 325–335.
5. Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS Journal, 2011; 7: 265–272.
6. Pumberger M, Caridi JM, Hughes AP. Cervical radiculopathy: a review. HSS Journal, 2011; 7: 265–272. 7. Todd AG. Cervical spine degenerative conditions. Current Reviews in Musculoskeletal Medicine, 2011; 4: 168–174. 8. Akhavan-Sigari R, Rohde V, Alaid A. Cervical spinal canal stenosis and central disc herniation C3 C4 in a man with primary complaint of thigh pain. Journal of Neurological Surgery Reports, 2013; 74: 101–104. 9. Clavenna A, Dossett AB. Anterior cervical diskectomy and fusion. Operative Techniques in Sports Medicine, 2005; 13: 90–95. 10. Lees F, Turner JW. Natural history and prognosis of cervical spondylosis. British Medical Journal, 1963; 2:1607-9. 11. Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine, 1996; 21: 1877-83.
12. Zdeblick T, Ducker TB. The use of freeze-dried allograft bone for anterior cervical fusions. Spine, 1991; 16: 726-9.
13. Paramore CG, Dickman CA, Sanntag VK. Radiographic and clinical follow up review of Casper plates in 49 patients. J Neurosurg. 1996; 84: 957-61.
14. Barnes B, Hiad RWJ, Rodts GEJ, Subach BR, Kaiser MG. Early results using the Atlantis anterior cervical plate system. Neurosurg Focus, 2002; 12: 13-16.
15. Orzco RT. Osteossintese en las fractures de raquis cervical. Rev Orthop Traumatol. 1977; 14: 285-8.
16. Wang JC, McDonough PW, Endow KK, Delamarter RB. Increased fusionrates with cervical platting for two-level anterior cervical discectomy and fusion. Spine, 2000; 25: 41-5.
17. Kaiser MG, Haid RWJ, Subach BR, Barnes B, Roodts GEJ. Anterior cervical platting enhances arthodesis after discectomy and fusion with cortical allograft. Neurosurgery, 2001; 50: 229-36.
18. Khan I, Burhan M. Titanium miniplates use: a simple and effective method of preventing bone graft dislodgment in anterior cervical discectomy and fusion. Rawal Med J. 2009; 34 (1): 7-
Published
2019-09-27
Section
Original Article