1. Carbon fibre cage versus autograft for anterior cervical discectomy and inter-body fusion M Taha, J Tapendin, N Alam, A Kemeny, M Radatz Department of neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
Introduction:
Carbon fibre cage devices were introduced in spinal fusion to overcome the shortcoming of autograft, allograft, and other implants.
A small number of studies showed that CFC is safe and efficient in ACDF surgery ( 1,2)
No previous study available to compare CFC with other grafts.
Objective:
we present in this retrospective study our initial experience with CFC for ACDF.
We evaluate the clinical aspect
(surgical morbidity and clinical outcome)
We also compared for the first time the results of CFC patients with autograft patients treated in our unit by the same surgeons
Subjects:
Patients with cervical spondylotic radiculopathy or myelopathy treated with anterior cervical discectomy and inter-body fusion only ( Smith Robinson) between ( 4 years period)
Two neurosurgeons ( AK, MR) performed or supervised the procedures
Methods:
The patients’ records were reviewed to collect their clinical details, and Postal questionnaires were sent to all patients to assess their long term clinical outcome
(a minimum of one year).
Outcome measures:
The incidence of graft-related morbidity in the CFC, and autograft groups.
The clinical outcome was also measured by using the neck disability Index (NDI) and patient’s self-rating regarding arm pain and overall general function.
Results:
1- CFC group:
37 patients with CFC ( 48 cage total)
Mean age 52.2 ( 29-84)
M/F: 23/14
Radiculopathy/ myelopathy/both: 20/11/6
length of stay: 3 ( median)
2- Autograft group:
31 patients had autograft ( 41 graft total)
Mean age 47.32(29-72)
M/F: 18/13
Radiculopathy/myelopathy/both: 18/10/3
Mean length of stay:4 ( median)
Reply to the questionnaires:
CFC: 92%, Autograft: 71%
complication
CFC
Auto
Graft infection
Graft slipping
Graft collapsed 2*
Non-fusion
Bony fracture 1*
Re-operation
* Fracture body of C5 following 2 level ACDF with CFC
Surgical Morbidity(graft-related)
*Same patient developed stenosis
6 months later. Patient re-operated
Overall general function
* Collapsed autograft
Arm pain relief
Neck disability index:
CFC : 16.4 (mean) 10.6 (SD)
Allograft: 20.5 (mean) (SD)
Pain at the donor site ( for autograft)
None (50%) mild (33%) moderate (17%)
Conclusion:
The length of stay is shorter in CFC
No significant difference in morbidity
The long term clinical outcome looks better in CFC, however it is not statistically different.
More than 50% of patients still complain of pain at the donor site( in the auto group)
Although our sample is small we can conclude that CFC for ACDF is safe and efficient
*Same above patient CT.
He was re-operted
References:
Brooke NS, Rorke AW, King AT, : Preliminary experience of carbon fibre cage prosthesis for treatment of cervical spine disorder.Br J Neurosurgery 11: , 1997
Khalil S Georges ER et al: The use of carbon fibre cage in anterior cervical interbody fusion: report of 100 cases. Neurosurg Focus 12: 1-5, 2002