Article
Influence of age and fusion material on clinical results after cervical monosegmental fusion
Einfluss des Alters und Fusionsmaterials auf das Ergebnis der zervikalen monosegmentalen Fusion
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Published: | April 23, 2004 |
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Outline
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Objective
Age dependent differences in bone quality possibly require a distinct selection of fusion material. Since the radiological and clinical result might be influenced by the constitution of the contact zone between implant and vertebral body e.g. by kyphosis of the cervical spine, this retrospective study analyses the influence of fusion material and age on the results in monosegmental cervical fusion.
Methods
155 cervical monosegmental fusions (1/3 female) were retrospectively analysed between 1998 and 2002. 102 fusions were performed by titanium cage (TC), 53 by autologous pelvic bone graft (PBG). Four age groups were formed: group I below 45 years with 37 patients (23,9%) using TC and 21 patients (13,5%) using PBG. In the age group II (45-55 years) 30 patients (19,4%) were fused with TC and 13 (8,4%) with PBG. In age group III (56-65 years) TC was used in 22 patients (14,2%) and PBG in 15 patients (9,6%). Above 65 years (group IV), 13 patients (8,4%) were fused using TC, while PBG was used in 4 patients (2,6%).
Results
Following TC in group I, neurological results were good or very good in 11%, improved in 70%, unchanged or worse in 19%. After PBG 24% patients in group I showed good of very good results, 52% mentioned improvement and in 24% symptoms remained unchanged. Following TC in group II and III, the proportion of good or very good results was 9-10%, improvements were seen in 53-68% and postoperatively unchanged symptoms remained in 23-37%. After PBG in this two groups good or very good clinical outcome was seen in 23-33%, improved were 47-77% and unchanged 0-20%. In group IV (17 patients) results were good or very good in 3/13 patients following TC and 0/4 patients after PBG. 1/13 after TC and 0/4 remained unchanged, while improvement was seen in 9/13 patients after TC and 4/4 after PBG. Following PBG, pseudarthrosis or non-integration of bone graft was found in 29% in group I, 15% in group II and 20% in group III.
Conclusions
Younger patients (group I) had slightly more clinical improvement after TC compared to PBG. In all other groups, there are only marginal differences between PBG and TC. However, radicular residual symptoms and kyphosis in the following segments, mainly above the fused segment, were more frequently found following TC. To verify these results a higher patients recruitment is necessary.