The Effects of Mono- and Bi-Segmental Cervical Discectomy with Interbody Replacement: A Prospective One-Year´s Study

Česká verzia

Authors: M. Häckel ¹; I. Štětkářová ²; J. Chrobok J ³; D. Hořínek ¹; L. Stejskal ¹; S. Ostrý ¹
Authors place of work: Neurochirurgická klinika 1. LF UK a IPVZ Ústřední vojenská nemocnice, Praha ¹; Neurologické oddělení Nemocnice Na Homolce ²; Neurochirurgické oddělení Nemocnice Na Homolce ³
Published in the journal: Cesk Slov Neurol N 2007; 70/103(3): 253-258
Category: Original Paper

Práce byla podpořena grantem IGA MZ ČR NR 7773-3

Summary

The Aim:
To compare mono- and bi-segmental decompressions of neural structures by means of discectomy with interbody replacement in patients with radiculopathy at a degenerative disease of the cervical spine using two types of subjective scales, clinical and electrophysiological investigations.

Material and Methods:
Surgical interventions were used in 78 patients (38 men, 40 women). The fixation after mono-segmental (52 patients) and bi-segmental (26 patients) operations was carried out using three different methods of mediating the bone fusion, i.e. by an autologous graft, autologous graft fixed with a splint, and a titanium cage filled with spongious bone without the splint fixation. Patients were followed up prospectively before an intervention, 3, 6, and 12 months after an operation. Results were evaluated together and separately after mono-segmental (group 1) and bi-segmental (group 2) interventions irrespective of the type of post-operative fixation. There were processed statistically the subjective assessment using NDI (neck disability index) and 5 items of perceived intensity of pain (head, neck, between scapulae, shoulder and arms of the affected extremity) of visual analogue scale (VAS).

The results obtained from the two scales used have shown statistically significant improvement after the intervention carried out in both groups of patients in all the post-operative check-ups. The comparison of electrophysiological findings in patients before and after surgery has shown no significant difference. The differences between the therapeutical results after mono-segmental and bi-segmental interventions were not singificant in the selected items of VAS, however, the assessment with NDI provided significant difference to disadvantage of bi-segmental surgery during check-ups carried out 6 months and one year after operation.

Conclusion:
The results obtained by means of chosen subjective scales have demonstrated statistically significant improvement of patients’ health conditions checked up after the intervention – discectomy with interbody replacement – in all the post-operative investigations, i.e. they support both mono- and bi-segmental discectomies with interbody replacement as a method of choice of surgical therapy for neurological complications of degenerative disorders of the cervical spine. The results obtained with NDI 6 and 12 months after surgery are significantly worse after bi-segmental interventions if compared with mono-segmental surgery, i.e. the value of intermediate results of NDI is negatively affected by the extent of the cervical spine desis.

Key words degenerative disorders of cervical spine – anterior cervical discectomy with fusion – VAS – NDI

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