Can Recurrent Pain be a Signal of Delayed Autograft Strut Fracture Following Anterior Cervical Surgery? A Radiographic Correlation

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概要

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• Introduction : Seven of 67 patients undergoing plated single level anterior corpectomy and fusion (ACF) utilizing iliac crest autograft were evaluated with plain/dynamic X-ray and 2D-CT studies to assess the etiology of recurrent postoperative pain. Methods : Fixed (10 patients) and more recent dynamic ABC (Aesculap, Tuttlingen, Germany) plates (57 patients) were applied in patients undergoing single level ACF using non-reversed iliac crest autografts. Patients averaged 46 years of age and exhibited moderate preoperative myeloradiculopathy. Plain/dynamic X-rays and 2D-CT-studies performed 3, 6, and selectively up to 15 months postoperatively were utilized to document fusion progression. Cervico-thoracic orthoses (CTO) were worn until fusion was confirmed. Patients were followed an average of 3.0 years. Results : At 3 postoperative months, X-rays documented a 83% and 2D-CT studies confirmed a 50% fusion rate. At 6 postoperative months, X-rays documented 98% while 2D-CT confirmed only 70% fusion. By the 15th postoperative month, X-rays documented fusion in 96% of patients, while only 90% demonstrated 2D-CT evidence of fusion. Seven (10%) of 67 patients who had fused developed delayed autograft fractures between 6 months to 2 years postoperatively. Four sustained X-ray and 2D-CT documented mid-graft fractures, while 3 cephalad/caudad end plate fractures were identified only on 2D-CT examinations. After 6 months of additional CTO bracing, 3 patients with end plate fractures fused spontaneously, while 4 patients with mid-graft fractures required secondary posterior arthrodesis with ultimate fusion. Discussion : Few series report on recurrent pain associated with delayed strut fractures following single level ACF, as they are typically reliant on X-ray studies alone. Conclusions : Recurrent cervical pain signaled delayed autograft strut fractures in 7 (10.4%) of 67 patients undergoing plated single level ACF. Two-dimensional CT and X-ray studies identified 4 mid-strut fractures, while only 2D-CT studies identified 3 fractures occurring at the extreme cephalad or caudad end plates.

• 日本脊髄外科学会の論文
• 2002-11-30

著者

• Dickerman Rob

  Department Of Neurosurgery The North Shore-long Island Jewish Health Care System Manhasset Ny And Ne

• Dickerman Rob

  Department Of Neurosurgery North Shore University-long Island Jewish Health System

• Epstein Nancy

  Clinical Professor Of Neurological Surgery The Albert Einstein College Of Medicine : Neurosurgical E

• Epstein Nancy

  Clinical Professor Of Neurological Surgery The Albert Einstein College Of Medicine Bronx Ny And Atte

関連論文

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• Single Level Anterior Corpectomy and Fusion for Five Morbidly Obese Patients; Is Simultaneous Posterior Fusion and Halo Fixation Necessary?
• Letters
• Can Recurrent Pain be a Signal of Delayed Autograft Strut Fracture Following Anterior Cervical Surgery? A Radiographic Correlation

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