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PubMed2001

Significance of CSF area measurements in cervical spondylitic myelopathy.

Mild clinical myelopathy can occur without cord compression, and asymptomatic cord compression seen on MRI is common. The aim of this study was to ascertain the MRI features which best correlate with early clinical myelopathy. The study was conducted on three groups: group A, 20 patients with clinical myelopathy and MRI evidence of cervical spondylosis; group B, 20 patients without myelopathy, but with other clinical and MRI evidence of cervical spondylosis; and group C, 10 normal volunteers with no MRI evidence of spondylosis. The cross-sectional area (CSA) of the spinal cord (SP-CSA), spinal canal (SC-CSA) and CSF space (CSF-CSA) were measured on T1-weighted axial images at the level of the most severe spinal canal stenosis. The severity of myelopathy was assessed using a simple scoring system giving a score from 0 (normal) to 11 (severe). Subjective demonstration of cord compression on sagittal images was an insensitive indicator of clinical myelopathy. All three measures of cross-sectional area were significantly smaller in Group A than in B (p<0.01). The reduction in SP-CSA was the only independent prognosticator for severity of myelopathy (p<0.005) accounting for 63% of the variation in myelopathy score. All three variables showed a significant correlation with the presence of myelopathy (p<0.01); however, logistic regression analysis showed a decrease in CSF-CSA to be the only independent significant prognosticator of the presence of clinical myelopathy (p<0.02). Reduction of the CSF space to less than 0.7 cm2 was associated with a 90% chance of clinical myelopathy (specificity 83%).

Adult↗
PubMed2000

Surgery for cervical spinal cord compression in patients with multiple sclerosis.

OBJECTIVE: The goal of this study was to investigate the clinical and paraclinical features, treatment, and outcomes of patients with multiple sclerosis (MS) and coexisting spinal cord compression secondary to either cervical spondylosis or cervical disc disease. Patients with MS commonly experience neurological disabilities that present as myelopathy associated with bladder dysfunction. For some patients with MS, however, this neurological deterioration may result from coexisting spinal cord compression attributable to either spondylosis or a herniated disc. Overlapping symptoms of the two conditions do not allow clear clinical determination of the underlying cause of worsening. METHODS: Patients with MS who underwent cervical decompression surgery were selected. Medical records were retrospectively reviewed, to collect data on their pre- and postoperative clinical courses. RESULTS: Nine women and five men with definite MS were selected for cervical decompression surgery to treat neurological deterioration considered to be at least partially attributable to spinal cord compression. The most common symptoms were progressive myelopathy (n = 13), neck pain (n = 11), and cervical radiculopathy (n = 10). Bladder dysfunction was notably absent among these patients with MS with moderate disabilities. Surgical intervention was frequently delayed because the neurological deterioration was initially thought to be attributable to MS. The majority of patients experienced either improvement or stabilization of their preoperative symptoms in the immediate postoperative period; three subjects (21%) maintained this improvement after a mean follow-up period of 3.8 years. No MS relapses, permanent neurological worsening, or serious complications resulting from surgery or general anesthesia were noted. CONCLUSION: Carefully selected patients with MS and cervical spinal cord compression secondary to either spondylosis or disc disease may benefit from surgical decompression, with minimal associated morbidity. Clinical features (especially neck pain and cervical radiculopathy) and magnetic resonance imaging may assist clinicians in differentiating between the two conditions and may guide appropriate treatment without undue delay.

Adult↗
PubMed2002

In vitro characteristics of cultured posterior longitudinal ligament tissue.

STUDY DESIGN: To determine the osteogenicity of posterior longitudinal ligament ossification, the posterior longitudinal ligament obtained during anterior cervical surgery from patients with the disorder was analyzed with in vitro cultures. OBJECTIVES: To determine the osteogenicity of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: The osteogenicity of posterior longitudinal ligament ossification in North America requires better documentation. METHODS: The posterior longitudinal ligament obtained during anterior cervical corpectomy with fusion from seven patients, three with ossification of the posterior longitudinal ligament documented by magnetic resonance imaging and computed tomography and four with spondylosis, was blindly submitted for in vitro culture. Explants of the posterior longitudinal ligament were placed in Dulbecco modified Eagle medium with 10% fetal calf serum, antibiotics, 4 mmol/L x L-proline, and 50 mg/L ascorbic acid. After reaching confluency, cells were trypsinized, and first-passage cells were used for all osteocalcin measurements to establish their osteoblastic phenotype. Periosteal cells, previously shown to synthesize osteocalcin, were used as a positive control. The cells were incubated with 1,25(OH)2 vitamin D3 at 10E-8 M for 72 hours in serum-free medium. The supernatants were collected and frozen, after which the quantity of osteocalcin induced by exposure to 1,25(OH)2 vitamin D3 was determined using enzyme-linked immunoassay. Control replicate cultures were measured without incubation using vitamin D3. RESULTS: Ossification of the posterior longitudinal ligament cell lines responded positively with osteocalcin synthesis in the 0.1 to 0.4 ng/M range. The cell line of the patient with spondylosis alone did not respond to vitamin D3 priming. CONCLUSIONS: Posterior longitudinal ligament cells from the three North American white patients with ossification of the posterior longitudinal ligament, when cultured in vitro, synthesized osteocalcin on vitamin D3 priming, confirming their osteoblastic phenotype, whereas posterior longitudinal ligament cells from four white patients with isolated spondylosis did not.

Calcitriol↗
PubMed2003

Spasticity, strength, and gait changes after surgery for cervical spondylotic myelopathy: a case report.

STUDY DESIGN: A case report with repeated measures is presented. OBJECTIVE: To describe an objective method for evaluating changes in upper- and lower-extremity spasticity and strength, as well as temporal and kinematic gait variables, after surgical intervention for cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: Degenerative cervical spinal disease is a common disorder, with some form of spondylosis demonstrated radiographically in more than 80% of those older than 55 years. Normative pre- and postoperative objective data quantifying spasticity, strength, and gait do not exist. METHODS: A 65-year-old woman underwent C2-C3 anterior cervical discectomy and fusion for progressive myelopathy secondary to a spondylosis and disc herniation. The measure for spasticity and strength at the ankles and elbows and a gait analysis were collected before surgery and at 11 days, 3 and 6 months after surgery. Spasticity and strength were assessed using a dynamometer, and a six-camera video system was used to record the gait. RESULTS: Preoperative left elbow flexor spasticity was more than 10 times greater than the values for the able bodies. It was reduced to normal levels after surgery. Substantial presurgery weakness was present in the elbow flexors and extensors bilaterally. Elbow extensor strength was at able-body levels after surgery. Gait speed was 57% of the able-body level before surgery and 78% of the able-body level 6 months after surgery. CONCLUSIONS: This case study demonstrated the role of biomechanics in characterizing impairments associated with cervical spondylosis and its surgical intervention. Measures for spasticity, strength, and gait taken before and after surgery indicated a favorable outcome. This report provides a foundation for the continued use of biomechanical methods to measure changes in function and impairments associated with surgical intervention of cervical spine disorders.

Aged↗
PubMed2006

Adverse effects of fluoroscopically guided interlaminar thoracic epidural steroid injections.

OBJECTIVES: To assess the prevalence of adverse effects or complications from fluoroscopically guided thoracic interlaminar epidural steroid injections. DESIGN: A retrospective study with independent observer review. Patients presenting with thoracic radicular pain, caused by either herniated nucleus pulposus or thoracic spondylosis as confirmed by magnetic resonance imaging, received an interlaminar thoracic epidural steroid injection as part of a conservative-care treatment plan. The study was performed in a multidisciplinary spine care center. All injections were performed over a 5-yr period. An independent observer reviewed medical charts, which included a 24-hr postprocedure standardized questionnaire completed by telephone by an ambulatory surgical center nurse. Ambulatory surgical center operative reports and physician follow up office notes up to 3 mos after the procedures, along with epidurograms, were also reviewed. RESULTS: A total of 21 patients who received 39 injections were reviewed. Adverse effects or complications per injection observed included three with increased pain at injection site (7.7%), two with facial flushing (5.1%), one transient nonpositional headache (2.6%), one episode of insomnia the night of the injection (2.6%), and one episode of fever the night of the procedure (2.6%). Statistical analysis revealed no significant difference based on diagnosis (herniated nucleus pulposus vs. spondylosis, P = 0.9156), and age was not linked to higher prevalence of adverse/effects complications (P = 0.3137). CONCLUSIONS: No major complication arose. Adverse effects did occur with a rate of 20.5%. All adverse effects resolved without morbidity. No statistical difference was observed in the rate of adverse effects in patients with herniated nucleus pulposus or spondylosis.

Age Distribution↗
PubMed1983

Value of x ray examinations of the cervical spine.

The value of x ray examination of the cervical spine was studied. In one district general hospital it has been estimated that such examinations occupy one radiographer and one room for four hours a week. Eighty-five per cent of patients aged 60 or more who had been referred for an x ray examination of the neck in one year were reported as having cervical spondylosis, and there were no unexpected findings of infection or malignancy at any age. The reports of patients referred for x ray examination of the cervical spine were compared with those of control patients who had originally attended for barium studies. There was no significant difference in the prevalence of cervical spondylosis between the two groups, although the severity of the disc changes was greater among cases than controls. There were no consistent relations between symptoms and changes seen on x ray films. It is suggested that x ray examinations should be performed only when there is a clinical suspicion of malignancy or infection, after trauma, or when surgery may be indicated. There is little point in taking x ray films of the neck to diagnose cervical spondylosis.

Adult↗
PubMed1994

Increased concentration of C4d complement protein in CSF in amyotrophic lateral sclerosis.

Plasma and CSF concentrations of C4d and the circulating immune complex to C1q were measured in 27 patients with amyotrophic lateral sclerosis (ALS) or cervical spondylosis. There was no significant difference among groups in plasma C4d or in plasma or CSF concentrations of the circulating immune complex to C1q. The ALS group, however, had a significantly higher CSF concentration of C4d than the group with cervical spondylosis, as well as a higher C4d index (CSF to plasma C4d ratio x serum to CSF albumin ratio). These results suggest that augmented complement activation in the CNS occurs in ALS. Increased CSF concentration of C4d or raised C4d index may serve as a basis for differentiating ALS from cervical spondylosis.

Adult↗
PubMed2005

Do BPH patients have neurogenic detrusor dysfunction? A uro-neurological assessment.

INTRODUCTION: Most men with benign prostatic hyperplasia (BPH) are middle- aged and elderly. Neurogenic detrusor dysfunction (NDD) may also occur in these populations. We made an uro-neurological assessment in such patients in order to investigate the possibility of a concurrent NDD in patients diagnosed with BPH, and to correlate the presence of NDD with treatment outcome. MATERIALS AND METHODS: 28 men, mean age 66.4 years, referred by urologists at the outpatient clinic as BPH (initial diagnosis: BPH alone, 24, BPH and NDD, 4) with regards to digital examination and lower urinary tract symptoms, underwent urodynamic study and neurological examination. MRI scans were performed to confirm the diagnosis. RESULTS: Urodynamic study (except for 2, acontractile detrusor (AD)) showed equivocal obstruction (EO), 6; underactive detrusor (UD), 9 (voiding phase); detrusor overactivity (DO), 12; urethral relaxation, 1, and reduced sensation, 5 (filling phase). EO correlated with the presence of UD (p = 0.03). DO did not correlate with the prostate size or urodynamically-defined outlet obstruction. Reduced sensation was common in patients >65 years of age (p = 0.05). Neurological examination/imaging showed exaggerated reflexes, 1; decreased reflexes, 6; multiple cerebral infarction, 8; cervical spondylosis, 1 (in patients with DO); lumbar spondylosis, 5 (in patients with AD/UD), and the final diagnosis was made: definite BPH, 6; probable BPH, 9; BPH and NDD, 13, and NDD were common in the patients aged >65 years (p = 0.015). Transurethral prostatectomy and alpha-blocker were mostly successful, but the failure rate was reported in definite BPH, none, probable BPH, 29%, and BPH and NDD, 33%. CONCLUSIONS: BPH patients, particularly those >65 years of age, commonly have NDD. Multiple cerebral infarction (upper neuron disorder) and lumbar spondylosis (lower neuron disorder) might contribute to DO and UD, respectively. A uro-neurological assessment is important to select typical BPH patients for maximizing therapeutic benefit.

Aged↗
PubMed1980

Paget's disease of the lumbar spine.

The frequency and extent of lumbar spondylosis is no greater in patients with Paget's disease (osteitis deformans) affecting the lumbar spine than in control groups, whether or not the disease is accompanied by deformity of vertebrae, and we have found no evidence that Paget's disease predisposes to our enhances lumbar spondylosis. The similarity of distribution of the Paget's disease and of degenerative spondylosis raises the possibility that bone stress may be an aetiological factor in the formation of Paget's disease of bone.

Female↗
PubMed2000

Degenerative spinal disease in large felids.

Degenerative spinal disorders, including intervertebral disc disease and spondylosis, seldom occur in domestic cats. In contrast, a retrospective study of 13 lions (Panthera leo), 16 tigers (Panthera tigris), 4 leopards (Panthera pardis), 1 snow leopard (Panthera uncia), and 3 jaguars (Panthera onca) from the Knoxville Zoo that died or were euthanatized from 1976 to 1996 indicated that degenerative spinal disease is an important problem in large nondomestic felids. The medical record, radiographic data, and the necropsy report of each animal were examined for evidence of intervertebral disc disease or spondylosis. Eight (three lions, four tigers, and one leopard) animals were diagnosed with degenerative spinal disease. Clinical signs included progressively decreased activity, moderate to severe rear limb muscle atrophy, chronic intermittent rear limb paresis, and ataxia. The age at onset of clinical signs was 10-19 yr (median = 18 yr). Radiographic evaluation of the spinal column was useful in assessing the severity of spinal lesions, and results were correlated with necropsy findings. Lesions were frequently multifocal, included intervertebral disc mineralization or herniation with collapsed intervertebral disc spaces, and were most common in the lumbar area but also involved cervical and thoracic vertebrae. Marked spondylosis was present in the cats with intervertebral disc disease, presumably subsequent to vertebral instability. Six of the animals' spinal cords were examined histologically, and five had acute or chronic damage to the spinal cord secondary to disc protrusion. Spinal disease should be suspected in geriatric large felids with decreased appetite or activity. Radiographic evaluation of the spinal column is the most useful method to assess the type and severity of spinal lesions.

Age Factors↗
PubMed1999

[Separate measurement of radial trabecular and cortical bone mineral density by peripheral quantitative computed tomography (pQCT) in degenerative joint disease].

Degenerative joint disease and osteoporosis, both of which tend to increase with advance in age, were thought to be essentially different mainly because of the artifactually high lumbar spine bone mineral density (BMD) in the former unlike osteoporosis characterized by persistent decrease of BMD. To clarify the relationship between these two diseases, three-dimensional BMD of the trabecular and cortical bone was measured separately in an area of the radius relatively free of degenerative changes by peripheral computed tomography (pQCT). In addition to radiological assessment of spondylosis deformans, quantification of vertebral deformity was attempted by calculation of standard deviation, coefficient of variation, difference between maximum and minimum density divided by the mean of L1-L4. With advance in age and progress of spondylosis deformans, the standard deviation, coefficient of variation difference between the maximum and minimum density and this difference divided by the mean of L1-L4 increased, but radial trabecular bone density, cortcal density and relative cortical volume decreased, suggesting parallel advance of degenerative joint disease and osteoporosis. Sodium etidronate, an antiresorber commonly used in the treatment of osteoporosis, increased mean lumbar spine BMD and markedly decreased the standard deviation, coefficient of variation, difference between the maximum and minimum density and this difference divided by the mean of L1 and L2 but maintained maximum BMD constant, decreasing vertebral deformity due to spondylosis deformans. It is conceivable that calcium release from bone on increased resorption leads to osteoporosis, and calcium entrance into cartilage, causing its hardening, disappearance and degeneration, direct contact between bones, osteoarthritis and subsequent deformity in a single sequence of events.

Absorptiometry, Photon↗
PubMed1976

Late results of cervical disc surgery.

Late results of cervical disc surgery have been reported and statistically studied in 383 cases: 83% were lateral discs, 13% were central spondylosis discs, and 4% central soft discs. Central spondylosis occured at a higher spinal level, and caused cord compression with or without weakness of the hands, but no pain. A posterior approach was used in all lateral discs, and either an anterior or a posterior approach, with or without fusion, for central discs. Preoperative myelography was always done and is recommended postoperatively in central disc surgery to evaluate the results. Our results were good to excellent in 95% of lateral discs, in 64% of central spondylosis discs, and in an unexpected 91% of 11 cases of central soft discs. There were no recurrences and no serious complications, although 20% developed other cervical or lumbar disc herniations.

Adult↗
PubMed1997

Hyperactive pectoralis reflex as an indicator of upper cervical spinal cord compression. Report of 15 cases.

Myelopathy from cervical spondylosis is often accompanied by hyperreflexia of the upper-extremity deep tendon reflexes (DTRs). Reflexes such as the pectoralis jerk and the deltoid jerk may only be apparent in the context of hyperreflexia. Although the nerve roots involved in the reflex arcs are well described, levels of cervical spinal cord compression that lead to the hyperreflexia are not as clear. This is of particular significance for patients with multilevel cervical spondylosis in determining the levels responsible for their symptoms. The authors examined 15 consecutive patients who presented for treatment of cervical myelopathy. The clinical examination was then correlated with levels of cervical spinal cord compression by cervical magnetic resonance imaging or computerized tomography with intrathecal contrast enhancement. The presence of a prominent pectoralis jerk was seen only in patients with spinal cord compression at the C2-3 and/or C3-4 levels (nine patients). No patient with compression at or below the C4-5 disc space without coexisting compression at a higher level had hyperactive pectoralis reflexes. This association between the C3-4 level and a hyperactive pectoralis reflex was significant (p < 0.004, Fisher's exact test). The deltoid reflex was tested in the last nine consecutive patients. It was present in patients with compression of the upper spinal cord at levels C3-4 and C4-5 (four of five patients) but appeared in only one of four patients with compression below C4-5. This association did not attain statistical significance. The presence of a hyperactive pectoralis reflex is specific for lesions of the upper cervical spinal cord. Examination of upper-extremity DTRs may be helpful in planning the appropriate levels for surgical decompression in patients with multilevel spondylosis and myelopathy.

Humans↗
PubMed2005

Early results after ProDisc-C cervical disc replacement.

OBJECT: Cervical anterior decompression and total-disc replacement is currently being investigated as an alternative treatment in patients with symptomatic intervertebral cervical spondylosis with and without radiculopathy. The authors prospectively investigated the safety and efficacy of using the ProDisc-C disc for cervical arthroplasty in the treatment of symptomatic cervical spondylosis. METHODS: Sixteen patients in whom a diagnosis of symptomatic cervical spondylosis had been established were prospectively treated with complete anterior cervical discectomy and ProDisc-C cervical disc arthroplasty. Overall 12 single- and four two-level procedures were performed (20 prostheses). Patients underwent pre- and multiple postoperative assessments (3 and 6 weeks and 3, 6, and 12 months). The median age of all patients was 50 years (range 32-60 years). Levels of surgery included seven C5-6, six C6-7, and three C4-5. Neck and arm pain as well as disability scores were significantly improved by 3 months and remained significantly improved at 1 year. No additional fusion surgeries were necessary at the affected or unaffected levels. Radiography revealed an affected disc motion from 4 to 12 degrees. No surgery- or device-related complications were documented. CONCLUSIONS: Analysis of preliminary results involving ProDisc-C arthroplasty indicates significant improvement in pain and functional outcome scores. No spontaneous fusions at the level of surgery or at adjacent levels were noted. Long-term follow-up studies will be necessary before more definitive treatment recommendations can be formulated.

Adult↗
PubMed2001

[Development and clinical application of posterior STBtrade mark thoracolumbar transpedicular screw-plate fixation system].

OBJECTIVE: To develop a posterior STBTM thoracolumbar transpedicular screw-plate system and to apply it clinically. METHODS: A posterior STBTM thoracolumbar transpedicular screw-plate system was developed with titanium alloy (TC4, Ti64A14V) and was used, from December 1999 to July 2000, to treat 63 cases with thoracolumbar or lumbar injuries or diseases, including thoracolumbar fracture/dislocation (33 cases), lumbar spondylosis and spondylolisthesis (16 cases), lumbar spondylosis and disk protrusion (6 cases), degenerative lumbar instability (4 cases), kyphosis due to ankylosing spondylitis (2 cases), and tuberculosis of spine (2 cases). RESULTS: The 33 cases with thoracolumbar fracture/dislocation showed perfect reduction and fixation after the operation. The height of injured vertebral bodies returned to normal. One month later, all patients with neurological deficits, except the 6 cases with neurological deficits of Frankel grade A, showed improvement by 1 approximately 3 Frankel grades. The radicular symptoms in the 26 patients with lumbar spondylolisthesis, lumbar spondylosis and disk protrusion, and degenerative lumbar instability disappeared after operation. Among those cases, complete reduction was achieved in the 7 cases with grade I spondylolisthesis and 7 out of the 9 cases with grade II spondylolisthesis, and incomplete reduction (grade I) was seen in the remaining 2 cases with grade II spondylolisthesis. Forty cases were followed up for 5 months or over in out-patient department, no complication was found. CONCLUSION: The posterior STBTM thoracolumbar transpedicular screw-plate system has the advantages of biological stability, excellent reduction capacity, easiness of operation, and positive clinical effectiveness.

Adult↗
PubMedDate not supplied

Cervical myelopathy: a comparison of magnetic resonance and myelography.

Fifty-seven patients with a strong clinical suspicion of cervical myelopathy were studied with body coil magnetic resonance (MR) and conventional myelography or CT myelography. Eight patients were believed to have normal studies with both modalities. There were six patients with syringomyelia; four with an intramedullary tumor; one with an arteriovenous malformation; 19 with cervical spondylosis at multiple levels; eight with cervical spondylosis at a single level; four with extensive rheumatoid arthritis; four with extradural neoplasm; two with trauma; and one patient with an epidural abscess. In this study, body coil MR was the superior examination for the evaluation of an intramedullary process. It was as diagnostic as myelography in one case of an extramedullary intradural lesion. In patients with extradural disease, body coil MR was the superior study in 45%, equivalent to myelography in 37%, and, although still diagnostic, inferior to myelography in 17%. In 8% of the cases, body coil MR was at best equivocal, whereas myelography was diagnostic. It appears that in technically adequate studies, MR is at least equivalent to myelography in its ability to delineate disease. A superior MR study provides a better appraisal of the size and character of the spinal cord as well as the degree of both anterior and posterior defects on the subarachnoid space and neural structures. In addition, MR is as good as conventional myelography for the identification of extrinsic cervical cord lesions producing cervical myelopathy. Finally, an additional small group of 30 patients were studied with a prototype surface coil to determine its advantages relative to body coil imaging. Each patient had correlative myelography. As with body coil MR, imaging with the surface coil was believed to be more informative than conventional myelography in four patients with intramedullary lesions. The remaining 26 patients suffered from cervical spondylosis. Surface coil MR was believed to be more informative than myelography in six cases (23%), equivalent to myelography in 19 (73%), and less diagnostic than myelography in one (4%). The improved spatial resolution with the use of the surface coil was believed to increase the accuracy of MR.

Adolescent↗
PubMed1995

The treatment of degenerative lumbar disorders. A critical review of the literature.

STUDY DESIGN: A literature review. OBJECTIVES: To clarify the surgical indications for spinal fusion in the various lumbar conditions. SUMMARY OF BACKGROUND DATA: This article summarizes the published literature regarding the treatment of lumbar degenerative conditions. Retrospective and prospective studies regarding the treatment of nonspecific low back pain, disc herniation, spinal stenosis, isthmic spondylolisthesis, facet syndrome, discogenic pain, and lumbar spondylosis are reviewed. METHODS: A review of the English Medical Literature regarding the treatment of low back pain, disc herniation, spinal stenosis, spondylolisthesis, discogenic pain, and lumbar spondylosis was performed. RESULTS AND CONCLUSIONS: Past research does not support the use of spinal fusion for nonspecific low back pain. Fusion is rarely indicated for primary disc herniation but may have a role in recurrent herniations. Specific guidelines regarding fusion in spinal stenosis and spondylolisthesis are described based on the literature. Less rigorous data are presented for indications for fusion in facet joint syndrome, discogenic pain, and lumbar spondylosis. Spinal fusion plays an important role in the treatment of degenerative disorders of the lumbar spine, and the indications for this procedure can be refined by reviewing the existing literature.

Humans↗
PubMed1996

Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates.

The purpose of this study was to assess the role of the anterior cervical plate in the treatment of cervical spondylosis. Forty-three patients surgically treated for cervical spondylosis were reviewed. The technique for discectomy and fusion was the same for both groups (Smith-Robinson with autologous iliac crest bone graft). Group I consisted of 25 consecutive patients treated with anterior cervical discectomy, autograft fusion, and anterior cervical plate fixation (Morscher titanium hollow screw plate system). Group II consisted of 18 consecutive patients treated without plate fixation. The overall clinical results in this study were not improved with the use of anterior cervical plate fixation (Fisher's exact test, p > 0.05). The fusion rate of one-level cervical fusions was not improved with anterior cervical plate fixation (Fisher's exact test, p > 0.05). The overall graft complication rate (pseudoarthrosis plus delayed union plus graft collapse) in multilevel fusions was decreased with anterior cervical plate fixation (Fisher's exact test, p < 0.01). The cost effectiveness and risk versus benefit of anterior cervical plate fixation in the surgical treatment of cervical spondylosis require further investigation.

Adult↗