Long term outcome of anterior cervical discectomy and fusion using coral grafts.
BACKGROUND
To determine the long term efficacy of coral grafts in anterior cervical discectomy and fusion.


METHODS
In this prospective longitudinal study, All patients presenting with myelopathy and/or radiculopathy due to discal hernia or cervical spondylosis underwent anterior cervical microdiscectomy, arthrodesis with coral, and stabilization with anterior cervical locking plates. Clinical and radiological post-operative evaluations were performed at 2 days, 3, 6, and 12 months, and then yearly. The visual analogue scale was used for the evaluation of pain. Fusion was defined as the absence of motion on dynamic imaging combined with the disappearance of radio-lucent lines around the graft. The mean follow-up period was 44 months. In 83.3%, 91.2% and 93.7% of patients there was a satisfactory outcome for neck pain, arm pain, and motor deficit, respectively. The overall complication rate was 17.5%, all of which were transient. Additional surgery was required in nine cases. The occurrence of complications is correlated with less satisfactory outcomes for both neck and arm pain. While 95.5% of patients expressed overall satisfaction with their surgery, 70.5% stated that they had returned to their previous activities. The fusion rate was 45%; which was not correlated with clinical outcome and more likely in patients with of cervical spondylosis and one-level arthrodesis.


CONCLUSIONS
Despite satisfactory clinical results and a long follow-up period, coral implants yield low fusion rates, particularly in patients with discal hernia of two-level arthrodesis. The use of coral grafts cannot be recommended when fusion is one of the post-operative endpoints.
Ramzi
Najib
N
Department of Neurosurgery, Cliniques Universitaires St-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, 1200 Brussels, Belgium.
Ribeiro-Vaz
Geraldo
G
Fomekong
Edward
E
Lecouvet
Frédéric E
FE
Raftopoulos
Christian
C
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000818:Animals; D037421:Anthozoa / Q000737:chemistry*; D018786:Bone Substitutes / Q000627:therapeutic use*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000639:trends; D011843:Radiculopathy / Q000209:etiology / Q000473:pathology / Q000601:surgery; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
D018786:Bone Substitutes