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PubMed1993

Evaluation of intraoperative somatosensory-evoked potential monitoring during 100 cervical operations.

Continuous intraoperative somatosensory-evoked potential monitoring during scoliosis surgery, along with improved instrumentation techniques, has contributed to the reduction of neurologic injury from 4-6.9% to 0-0.7%. To assess whether somatosensory-evoked potential monitoring might play a similar role in cervical surgery, the authors compared the morbidity and mortality rates associated with 218 patients who were not monitored and were operated on between 1985-1989 with those found in 100 consecutive somatosensory-evoked potential monitored procedures done from 1989-1991. The cervical procedures were conducted for disc disease, stenosis, spondylosis, and ossification of the posterior longitudinal ligament. Eight of 218 unmonitored patients became quadriplegic (3.7%) and 1 died (0.5%); no instances of quadriplegia and no deaths were encountered among the 100 monitored patients. The reduction of neurologic deficit was attributed in part to early somatosensory-evoked potential detection of vascular or mechanical compromise of the spinal cord or nerve roots and to the immediate alteration of anesthetic or surgical technique in response to somatosensory-evoked potential changes, i.e., reversal of systemic or "relative" hypotension, adjustment of operative position, release of distraction, and cessation of manipulation. Continuous intraoperative somatosensory-evoked potential monitoring also was a practical tool in monitoring cervical surgery.

Cervical Vertebrae↗

PubMed1993

Dissociated motor loss in the upper extremities. Clinical features and pathophysiology.

Dissociated motor loss occurring in the upper extremities with and without lower extremity myelopathy was evaluated in patients with cervical spondylosis. The presence of dissociated motor loss without attendant myelopathy was correlated with selected compression of the anterior nerve root in the lateral spinal canal, close to the intervertebral foramen. The clinical and radiologic feature differentiating these two dissociative syndromes were reviewed.

Arm↗

PubMed1993

The increased signal intensity at the vertebral body endplates after chemonucleolysis demonstrated by magnetic resonance imaging.

Changes in signal intensity observed by magnetic resonance imaging in the contiguous end plates of injected discs after chemonucleolysis over a period of 2 years in 28 patients were evaluated. These changes appeared to be of two types; a transiently increased signal intensity on T2-weighted images, and a progressively increased signal intensity on T1-weighted images with isointense or hyperintense signal on T2-weighted images. The former appeared within three months and disappeared within 2 years. This change was observed in six patients (21%), whose mean age was higher than that of the other patients. This change correlated with the preinjection state of the affected disc. The latter appeared after 2 years and was accompanied by sclerotic changes on roentgenograms. These changes were observed in five patients (18%). The discs, of which the contiguous end plates showed these changes, did not recover the decreased nuclear signal intensity in four patients. These changes are considered to be a sign of degenerative spondylosis in the treated segment.

Adult↗

PubMed1994

Neuroradiologic and electrophysiologic assessment of cervical spondylotic amyotrophy.

Dissociated motor loss due to cervical spondylosis and disc herniation was evaluated in 10 patients who presented with left deltoid paresis in the absence of sensory deficits or myelopathy. All of these cases underwent cervical anterior decompression. Based on magnetic resonance imaging, computed tomography myelography, and computed tomography discography, patients were divided into two pathologic types: The first showed focal bony spur and disc herniation with axial cord rotation and nerve root compression, and the second demonstrated ventral cord flattening. Electrophysiologic studies included evoked spinal potentials, motor evoked potentials, and evoked muscle action potentials. Motor evoked potentials, recorded epidurally from the ventral aspect of the thecal sac and the nerve root within the anterior discectomy or vertebrectomy sites, proved clinically most useful. Combining the latest available neuroradiologic and electrophysiologic information, 4 types of neural injury associated with deltoid pareses were identified in the 10 patients. The first included isolated C5 nerve root lesions; the second, C6 nerve root lesions; the third, both C5 and C6 nerve root lesions, and finally, intrinsic cord pathology.

Adult↗

PubMed1994

Cervical spine injuries in patients 65 and older.

STUDY DESIGN: This study was a retrospective data-base review of patients with cervical injuries admitted to a regional spinal cord injury center over a 9-year period. OBJECTIVES: Patients < 40 and > or = 65 were analyzed separately to determine differences in etiology, neurologic findings, mortality, and neurologic recovery. SUMMARY OF BACKGROUND DATA: Previous studies of cervical injuries in older patients have found a high percentage of falling as an etiology, a high incidence of injuries to C2, and a high mortality rate with spinal cord injury (SCI). METHODS: Three databases containing information on all SCI patients, SCI patients with 1-2 year follow-up, and neurogically intact spinal injury patients were reviewed retrospectively. RESULTS: A higher percentage of older patients had cervical injuries, and this group did not show the typical male predominance seen in young patients (4:1 vs. 1:1). Neurologic deficits were more common in the younger age group. In the older patients, falls were a much more common etiology, and upper cervical injuries, especially odontoid fractures, predominated. Cervical spondylosis and stenosis were more common in the older patients, and the mortality with associated SCI was 60 times higher than in younger patients. Younger patients more commonly had complete neurologic injuries, but had more early functional motor return in incomplete lesions. The older patients did show late functional return in incomplete deficits. CONCLUSIONS: Cervical spine injury commonly occurs with relatively minor trauma in patients > or = 65, with a mortality rate of approximately 26% with associated SCI. Return of functional motor recovery is delayed in older patients with incomplete deficits, but can be expected. C2 injuries, especially odontoid fractures, must be ruled out in older patients with neck pain after even a minor injury.

Aged↗

PubMed1995

Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography.

STUDY DESIGN: This study analyzed anatomic characteristics of 44 patients with cervical myelopathy. OBJECTIVES: This study was conducted to clarify the patterns of spinal cord expansion after decompression, their relationship to clinical recovery, and the capacity of the compressed spinal cord for restoration. SUMMARY OF BACKGROUND DATA: No previous studies have clearly assessed the relationship between morphological changes of the spinal cord and clinical improvement after posterior decompression in patients with cervical myelopathy using computerized tomography myelography and intraoperative spinal sonography. METHODS: Forty-four patients with cervical myelopathy underwent posterior decompression. The diagnosis was cervical spondylosis in 26 patients and ossification of the posterior longitudinal ligament in 18 patients. The cross-sectional area, sagittal diameter, and frontal diameter of the spinal cord at the level of maximum compression were determined by computerized tomography myelography (performed before and 1 month after decompression) and by intraoperative spinal sonography. RESULTS: Expansion of the spinal cord was defined as immediate or gradual. Of the 44 patients, 20 demonstrated gradual expansion, and their clinical recovery rate was 68.4%. In contrast, the clinical recovery rate of patients without gradual expansion was only 32.6%. Good clinical recovery was significantly related to gradual expansion. The patients were divided into four groups (A-D) based on the clinical recovery rate and compression ratio. Group A (severe compression and poor clinical recovery) showed a significantly smaller cross-sectional area of the spinal cord than Group D (severe compression, but good clinical recovery). CONCLUSIONS: Preservation of the cross-sectional area of the spinal cord, even when it is severely compressed and deformed, is an important factor in a good surgical outcome.

Adult↗

PubMed1995

Distribution of the basic fibroblast growth factor and its receptor gene expression in normal and degenerated rat intervertebral discs.

STUDY DESIGN: Using a rat spondylosis model, the distributions of cells expressing the basic fibroblast growth factor and its receptor were investigated in normal and degenerated intervertebral discs. Cell-proliferating activity in degenerated discs was also assessed. OBJECTIVES: This study was conducted to determine whether basic fibroblast growth factor is related to intervertebral disc degeneration. SUMMARY OF BACKGROUND DATA: Basic fibroblast growth factor stimulates proliferation and matrix synthesis of cultured intervertebral disc cells. METHODS: Immunohistochemistry and in situ hybridization histochemistry were conducted to detect cells with basic fibroblast growth factor-like immunoreactivity and fibroblast growth factor receptor messenger RNA, respectively. Cell-proliferating activity was evaluated by AgNOR staining. RESULTS: In degenerated discs, round chondrocytes with basic fibroblast growth factor-like immunoreactivity and fibroblast growth factor receptor messenger RNA are scattered instead of spindle-shaped cells in the normal anulus (normal anular cells), which are devoid of basic fibroblast growth factor-like immunoreactivity and fibroblast growth factor receptor messenger RNA. The proliferating activity of these chondrocytes is suggested to exceed that of normal anular cells. CONCLUSION: Basic fibroblast growth factor is suggested to promote proliferation of chondrocytes in degenerated discs in an autocrine or paracrine manner. Basic fibroblast growth factor may be related to intervertebral disc degeneration as a proliferation-stimulating factor of chondrocytes that replace normal anular cells during disc degeneration.

Animals↗

PubMed1996

A novel technique for laminoplasty augmentation of spinal canal area using titanium miniplate stabilization. A computerized morphometric analysis.

STUDY DESIGN: Titanium miniplates are used to secure the posterior elements in the open position after expansive open-door laminoplasty. Preoperative and postoperative spinal canal dimensions are measured to assess the effectiveness of this technique. OBJECTIVES: To develop a simple yet effective technique to stabilize the posterior elements after laminoplasty and to compare preoperative and postoperative spinal canal dimensions to accepted normal values. SUMMARY OF BACKGROUND DATA: Expansive open-door laminoplasty has been offered as a simple alternative to laminectomy, which has been associated with postoperative kyphosis. Although the technique of laminoplasty is effective, a simple and reliable method of holding the posterior elements open has not been described. METHODS: Ten myelopathic patients with multilevel cervical canal stenosis secondary to spondylosis or ossification of the posterior longitudinal ligament were treated with an expansive open-door laminoplasty. The posterior elements were stabilized in the open position with titanium miniplates. Computer-assisted morphometric analysis was performed on preoperative and postoperative computed tomography scans to obtain spinal canal dimensions. Plain radiographs were used to monitor construct integrity. RESULTS: The preoperative sagittal canal diameter was 8.2 +/- 0.96 mm, and the canal area was 180.6 +/- 33.7 mm2. These dimensions increased after surgery to 16.6 +/- 1.5 mm and 321.9 +/- 29.7 mm2, respectively. The titanium miniplate constructs did not fail during the follow-up period (mean, 26.4 months), and the decompression was maintained. The single significant complication was transient C5 radiculopathy. CONCLUSIONS: Normal canal dimensions can be reestablished with open-door laminoplasty. Achieving and maintaining an increased sagittal canal diameter is probably the most important change in anatomic parameters to facilitate neurologic recovery. The use of titanium miniplates to stabilize the posterior elements after laminoplasty is a simple, durable, and effective technique to maintain the increased sagittal diameter of the spinal canal.

Adult↗

PubMed1996

Controversy in spine care. Is fusion necessary after anterior cervical discectomy?

Anterior cervical discectomy is an effective and reliable treatment for nerve root or cord compression caused by disc herniation or spondylosis. Although physicians have traditionally included fusion as a part of this procedure, recent experience has suggested that this may not be necessary. Dr. Volker Sonntag and Dr. Peter Klara express opposing views on the need for fusion after discectomy and support their perspectives with clinical experience and a review of the pathoanatomy of disc disease. Dr. Sonntag believes that the majority of patients are well served with discectomy alone, avoiding the complications of graft harvest and potential nonunion. Dr. Klara feels that the interposed graft restores foraminal height and maintains cervical lordosis, both of which are important to a good outcome.

Bone Transplantation↗

PubMed1997

Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies.

STUDY DESIGN: A systematic review of published observational studies. OBJECTIVES: To examine the causal relationship between radiographic findings and nonspecific low back pain. SUMMARY OF BACKGROUND DATA: The causal relationship between radiographic findings and nonspecific low back pain still is controversial. METHODS: Two reviewers independently scored the methodologic quality of all relevant, available studies using a standardized set of criteria. The association between radiographic findings and nonspecific low back pain was expressed as an odds ratio with a corresponding 95% confidence interval. RESULTS: Degeneration, defined by the presence of disc space narrowing, osteophytes, and sclerosis, turned out to be associated with nonspecific low back pain with odds ratios ranging from 1.2 to 3.3. Spondylolysis and spondylolisthesis, spina bifida, transitional vertebrae, spondylosis, and Scheuermann's disease did not appear to be associated with low back pain. The validity scores of the observational studies ranged from 0% to 91% of the maximum score. Only two studies used a prospective design, and most studies lacked control for confounding, an appropriate test for nonspecific low back pain, and blinded assessment of radiographs and low back pain status. CONCLUSIONS: There is no firm evidence for the presence or absence of a causal relationship between radiographic findings and nonspecific low back pain.

Evaluation Studies as Topic↗

PubMed1997

Instantaneous center of rotation and instability of the cervical spine. A clinical study.

STUDY DESIGN: This study was designed to investigate flexion and extension of the cervical spine in patients with "instability" of the cervical spine. OBJECTIVES: To establish a new method of calculating the instantaneous center of rotation (ICR) of the skull relative to the thorax and to compare the differences in the ICR between normal volunteers and patients. SUMMARY OF BACKGROUND DATA: "Instability" of the cervical spine commonly is investigated using functional radiographs, which is an unreliable method. Although the ICR was suggested as an objective parameter in measuring spinal "instability," the ICR of the skull relative to the thorax has not been studied before. METHOD: Three groups of subjects (27 normal volunteers, 28 patients with chronic cervical spondylosis, and 17 patients undergoing fusion for cervical disc degeneration) were measured with a CA-6000 system (OSI, CA). The ICR then were calculated and compared at various angles of flexion and extension. RESULTS: The horizontal component of the ICR in the preoperative group was found to have shifted anteriorly from 5 degrees to 25 degrees of flexion (P < 0.05) and at 5 degrees of extension (P < 0.05), compared with that of the healthy subjects. There also was a significant difference in the vertical component of the ICR at 15 degrees of flexion (P < 0.05). However, there were no significant differences in the horizontal and the vertical components of the ICR between the normal and nonoperative groups. CONCLUSION: The ICR in patients with "instability" of the cervical spine was found to have shifted anteriorly; the method described in this study might be useful for identifying patients who suffer from this condition.

Aged↗

PubMed1997

The biomechanical effect and clinical application of a Ni-Ti shape memory expansion clamp.

STUDY DESIGN: The study involves three phases: a clinical study of 30 patients, a biomechanical study to assess the expansion force of a recovering-shape memory expansion clamp, and a biomechanical study using cadaveric specimens to assess the pullout strength of the shape memory expansion clamp as a function of the shape of the clamp. OBJECTIVE: To evaluate the biomechanical effect and clinical application of the shape memory expansion clamp. SUMMARY OF BACKGROUND DATA: The major complication of anterior cervical decompression and fusion was graft dislodgement and pseudarthrosis. Improvement of the shape of bone graft and fusion technique could not eliminate the problem completely. The authors designed the shape memory expansion clamp by using the characteristic of Ni-Ti shape memory alloy and first applied it in an anterior cervical operation. METHODS: The expansion force of recovering of the shape memory expansion clamp was measured in a biomechanical study. Eight fresh human cadaver cervical spine specimens were used to assess the pullout strength of the shape memory expansion clamp as a function of the shape of the clamp. The shape memory expansion clamp had been used to fix rotated circular grafts in 30 cases with cervical spine injuries or cervical spondylosis after anterior decompression. RESULTS: The expansion force of the shape memory expansion clamp in recovery was 4.65-27.96 N, and the pullout strength was 8.82-20.58 N. Bone fusion was achieved in all 30 cases. Dislocation of bone graft, loosening of clamp, or kyphotic deformity had not occurred. CONCLUSION: The expansion force and the pullout strength of the partially recovered shape memory expansion clamp were determined biomechanically. The clinical study demonstrated that the shape memory expansion clamp is safe and effective.

Adult↗

PubMed1998

Cervical spondylotic amyotrophy. Magnetic resonance imaging demonstration of intrinsic cord pathology.

STUDY DESIGN: Three case reports. OBJECTIVE: To elucidate the pathophysiology of cervical spondylotic amyotrophy. SUMMARY OF BACKGROUND DATA: Cervical spondylotic amyotrophy is the clinical syndrome in cervical spondylosis characterized by severe muscular atrophy in the upper extremities, with an absent or insignificant sensory deficit. Pathophysiology of this particular syndrome has not been well understood. METHODS: Three cases of cervical spondylotic amyotrophy are presented in which magnetic resonance imaging confirmed the intrinsic cord disease as the cause of the syndrome. RESULTS: The patients had segmental muscular atrophy of the proximal upper extremities, with an absent or insignificant sensory deficit. After initial disease progression, the symptoms stabilized for years. Sagittal T2-weighted magnetic resonance images showed multi-segmental linear high-signal intensity within the compressed spinal cord. These high-signal intensity lesions appeared to be located at the anterior horns on axial images. The spinal cord compression was less severe in the neck-neutral position, but spinal canal stenosis increased when the neck was extended. CONCLUSIONS: The results suggest that one pathophysiology of this syndrome may be multisegmental damage to the anterior horns caused by dynamic cord compression, possibly through circulatory insufficiency.

Aged↗

PubMed1998

Imaging of the cervical spine.

The emergence of multiplanar spiral computed tomography and high-resolution magnetic resonance imaging has resulted in the ability to see cervical spine anatomy and pathologic conditions in detail. Appropriately chosen and performed, these imaging studies can provide an anatomic basis for a clinical diagnosis and a therapeutic plan. In the evaluation of cervical spondylosis, magnetic resonance imaging is more commonly performed than computed tomography because of its superior depiction of soft tissue anatomy, including intervertebral discs and spinal cord disease. However, computed tomography still has a role, particularly in the assessment of osseous neural foraminal stenosis. In cervical spine trauma, routine radiography remains the procedure of choice. Computed tomography is performed in patients who have abnormal plain radiographs or in patients in whom there is a strong clinical suspicion of fracture with inconclusive radiographs. In the neurologically compromised patient, magnetic resonance imaging is useful in the diagnosis of cord and nerve root injury. Magnetic resonance imaging is the most sensitive and specific imaging study in the assessment of spinal infection, including osteomyelitis, discitis, and epidural abscess. Magnetic resonance imaging has also supplanted all other imaging methods in the evaluation of primary and secondary tumors of the spinal cord and spinal column. Despite the precise depiction of cervical spine anatomy provided by these imaging methods, the role of the clinician in determining the true cause of a patient's symptoms is in no way diminished. The presence of an imaging study abnormality does not automatically imply causality.

Cervical Vertebrae↗

PubMed1999

Ossification of the posterior longitudinal ligament of the spine. A case-control risk factor study.

STUDY DESIGN: A case-control study. OBJECTIVES: To determine the risk factors for ossification of the posterior longitudinal ligament (OPLL) of the spine. SUMMARY OF BACKGROUND DATA: Previous epidemiologic studies conducted in Japan showed consuming vegetable protein and salt was a risk factor for OPLL. Dietary habits of the Taiwanese and Japanese people are similar. Whether the similar dietary habits play an important role in the high prevalence of OPLL in Taiwan was of interest. METHODS: A case-control study was conducted in a tertiary teaching hospital. The study included 98 consecutive cervical spine patients with OPLL, with 98 age-matched patients with cervical spondylosis serving as control subjects. Radiologic examinations, clinical interviews, physical examinations, and risk factor questionnaires were administered to all the participants. RESULTS: Compared with incidence in the control patients, the frequency of the ossification of the anterior longitudinal ligaments was significantly higher in OPLL patients with OPLL (31% vs. 19%; P = 0.049), but there was no difference in incidence of ossification of the ligamentum flavum (13.3% vs. 16.3%; P = 0.546). More OPLL patients preferred a high-salt diet (OPLL/CS, no:somewhat:yes = 23/38:18/25:57/35;, X2 for trend = 6.3; P = 0.001) and pickled foods (OPLL/CS, no:somewhat:yes = 39/56:11/11:48/31; X2 for trend = 6.7; P = 0.0099). Fewer patients with OPLL consumed meat daily (63% vs. 79%; P = 0.018). High-salt diet (odds ratio = 2.62) and daily meat intake (odds ratio = 0.39) showed persistent association with OPLL in a multivariate logistic regression. CONCLUSIONS: The similar dietary habits, particularly a high-salt and low meat intakes, may partially explain the high prevalence of OPLL in Taiwan and Japan. Modifying dietary habits may help prevent this disease, especially in those high-risk populations.

Aged↗

PubMed1999

Outcome in patients with cervical radiculopathy. Prospective, multicenter study with independent clinical review.

STUDY DESIGN: The Cervical Spine Research Society study is a prospective, nonrandomized, multicenter investigation of patients with cervical spondylosis and disc disease. In this analysis, only patients who had radiculopathy without myelopathy as the predominant symptom were considered. OBJECTIVES: To determine demographics, surgeon treatment practices, and outcomes in patients with symptomatic radiculopathy. SUMMARY OF BACKGROUND DATA: Current data on patient demographics and treatment practices of surgeons do not exist. There are no published prospective studies in which outcomes, including pain, function, neurologic symptoms, and ability to perform activities of daily living, are systematically quantified. METHODS: Patients were recruited by participating Cervical Spine Research Society surgeons. Demographic, symptomologic, and functional patient data were compiled from surveys of patients and physicians completed at the time of initial examination, and outcomes were assessed from surveys of patients completed after treatment. Data were compiled and statistically analyzed by a blinded third party. RESULTS: Of the 503 patients enrolled by 41 CSRS surgeons, 246 (49%) had radiculopathy. Patients had a mean duration of symptoms of 26.7 months (range, 8 weeks to > 352 months) and a mean age of 48.1 +/- 12.42 years; 44.7% were female. Surgery was recommended for 86 (35%) of these patients. Of the 155 patients on whom there were follow-up data, 51 (33%) underwent surgery, whereas 104 (67%) received medical treatment. Surgically treated patients had a significant improvement in pain, neurologic symptoms, functional status, and ability to perform activities of daily living. A significant number of patients who underwent surgery reported persistent excruciating or horrible pain on follow-up (26%). Patients treated medically also had significant improvement in pain and overall functional status. CONCLUSIONS: In summary, this study represents the first in-depth, prospective outcome analysis of patients with cervical spondylotic and discogenic radiculopathy.

Activities of Daily Living↗

PubMed1999

The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part I: An evidence-based analysis of the published literature.

STUDY DESIGN: An evidence-based analysis of published radiologic criteria for assessing spinal canal compromise and cord compression in patients with acute cervical spinal cord injury. OBJECTIVES: This study was conducted to determine whether literature-based guidelines could be established for accurate and objective assessment of spinal canal compromise and spinal cord compression after cervical spinal cord injury. SUMMARY OF BACKGROUND DATA: Before conducting multicenter trials to determine the efficacy of surgical decompression in cervical spinal cord injury, reliable and objective radiographic criteria to define and quantify spinal cord compression must be established. METHODS: A computer-based search of the published English, German, and French language literature from 1966 through 1997 was performed using MEDLINE (U.S. National Library of Medicine database) to identify studies in which cervical spinal canal and cord size were radiographically assessed in a quantitative manner. Thirty-seven references were included for critical analysis. RESULTS: Most studies dealt with degenerative disease, spondylosis, and stenosis; only 13 included patients with acute cervical spinal cord injury. Standard lateral radiographs were the most frequent imaging method used (23 studies). T1- and T2-weighted magnetic resonance imaging were used to assess spinal cord compression in only 7 and 4 studies, respectively. Spinal cord size or compression were not precisely measured in any of the cervical trauma studies. Interobserver or intraobserver reliability of the radiologic measurements was assessed in only 7 (19%) of the 37 studies. CONCLUSIONS: To date, there are few quantitative, reliable radiologic outcome measures for assessing spinal canal compromise or cord compression in patients with acute cervical spinal cord injury.

Cervical Vertebrae↗

PubMed1999

Anterior cervical reconstruction using titanium cages with anterior plating.

STUDY DESIGN: A preliminary outcome assessment study of titanium cage implants with anterior cervical plating in anterior cervical reconstruction. OBJECTIVES: To evaluate the efficacy and safety of using titanium cage implants and anterior plating in cervical reconstruction. SUMMARY OF BACKGROUND DATA: Anterior decompression and interbody fusion is a widely accepted surgical treatment for patients with cervical spondylosis. Tricortical iliac crest autograft has been the gold standard but is associated with morbidity at the bone graft donor site, whereas allograft fibula is associated with pseudarthrosis. Problems such as pseudarthrosis, graft collapse, and extrusion still persist with the accepted method of harvesting and implanting bone autografts. METHODS: Thirty-four patients were treated by channel corpectomy followed by placement of a titanium cage packed with autogenous bone graft from the vertebral bodies to reconstruct the anterior column. An anterior cervical plate was added in 30 of 34 cases that involved decompression of two or more levels. The follow-up period ranged from 24 to 56 months, with an average follow-up period of 32 months, and included examination and radiography. RESULTS: Six months after surgery, there was radiographic evidence of fusion in 97% of the patients. Eighty-eight percent of the patients (30 of 34) did not experience any complications (neither cage dislodgment nor hardware failure). Four patients had complications that included pseudarthrosis (1), extruded cage (1), cage in kyphosis (1), and radiculopathy (1). CONCLUSIONS: Titanium cages provide immediate strong anterior column support with minimum hardware complications and avoid bone graft-site morbidity. Titanium cages, with concomitant use of anterior plating, offer an effective and safe alternative to bone autografts.

Bone Plates↗