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Shenlong Howng - One of the best experts on this subject based on the ideXlab platform.
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anterior corpectomy with iliac bone fusion or discectomy with interbody Titanium Cage fusion for multilevel cervical degenerated disc disease
Journal of Spinal Disorders & Techniques, 2007Co-Authors: Shiuhlin Hwang, Shenlong Howng, Yufeng Su, Annshung Lieu, Yanfeng HwangAbstract:Study DesignClinical and radiologic study evaluating the outcome after anterior corpectomy with iliac bone fusion compared with discectomy with interbody Titanium Cage fusion for multilevel cervical degenerated disc disease.ObjectivesTo investigate the safety and effectiveness of interbody Titanium
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outcome analyses of interbody Titanium Cage fusion used in the anterior discectomy for cervical degenerative disc disease
Journal of Spinal Disorders & Techniques, 2005Co-Authors: Shiuhlin Hwang, Yufeng Su, Annshung Lieu, Yanfen Hwang, Shenlong HowngAbstract:: Anterior discectomy and fusion to treat cervical degenerative disc disease is the preferred procedure for many spine surgeons. The ideal device for structural reconstruction of the anterior cervical spine remains controversial. The purpose of this prospective study was to investigate the effectiveness of a non-threaded Titanium Cage in performing anterior spinal fusion for cervical degenerative disc disease. The clinical and radiologic data of 78 consecutive patients were reviewed. Neurologic outcome was assessed using Odom's criteria. Neck pain was graded using a 10-point visual analog scale. The cervical spinal curvature, the height of foramina, and fusion status were evaluated on preoperative and postoperative radiographs. Mean follow-up was 24.9 (range 18-35) months. An excellent or good result was found in 92% of the patients with radiculopathy, 69% of those with myelopathy, and 73% of those with myeloradiculopathy. Statistical analyses also showed improvement of cervical pain after surgery (P < 0.001) and a significant increase in foraminal height (P = 0.035). Cervical kyphosis was present in 27 (34%) patients before surgery; it was corrected to lordosis in 9. The fusion rate at 12 months and 24 months was 91% and 95%, respectively. No surgery or Cage-related complication occurred in these patients. Non-threaded interbody Cage fusion in this study achieved a high fusion rate and had a good neurologic outcome. These results suggest that non-threaded Cage fusion is a safe and effective method for anterior cervical discectomy.
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three level and four level anterior cervical discectomies and Titanium Cage augmented fusion with and without plate fixation
Journal of Neurosurgery, 2004Co-Authors: Shiuhlin Hwang, Yufeng Su, Annshung Lieu, Yanfen Hwang, Shenlong HowngAbstract:OBJECT: Cage-assisted anterior cervical discectomy and fusion (ACDF) has proven to be a safe and effective procedure for the treatment of one- and two-level degenerative disc disease (DDD). To the authors' knowledge, clinical results after three- and four-level interbody Cage-augmented ACDF have not been reported in the literature. The authors investigated the safety and effectiveness of Titanium Cages used in such procedures and evaluated the results in cases with or without plate fixation. METHODS: Fifty-six patients suffering from cervical DDD were divided into two groups. Group 1 included 32 patients who underwent Titanium Cage-assisted ACDF; Group 2 included 24 patients who underwent the same procedure, supplemented with plate fixation. The cervical DDD was confirmed by radiography and magnetic resonance imaging. The patients underwent radiographic evaluation to assess cervical lordosis, segmental height of cervical spine, the height of the foramina, and spinal stability. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) scores. Neck pain was graded using a 10-point visual analog scale (VAS). The follow-up period ranged from 13 to 28 months (mean 17.2 months). In both Groups 1 and 2 significant increase (p < 0.001) was demonstrated in the JOA scores (preoperatively 10.7 +/- 2.4 and 11.1 +/- 2, postoperatively 13.9 +/- 2.2 and 14.1 +/- 2.3, respectively) and VAS pain scores (preoperatively 8.8 +/- 0.9 and 8.5 +/- 1, postoperatively 3.1 +/- 2.1 and 2.8 +/- 1.8, respectively); however, there was no significant intergroup difference. A significant increase in the cervical lordosis, foraminal height, and segmental height was observed in both groups. Good stability of Cage fusion was obtained in both groups 12 months postoperatively (90.6% in Group 1 and 91.7% in Group 2); however, there were no statistically significant intergroup differences. The complication rate in Group 2 was higher than that in Group 1. The hospital length of stay in Group 1 was significantly lower than in Group 2 (p < 0.001). CONCLUSIONS: Analysis of these findings demonstrated that Titanium Cage-assisted ACDF provided long-term stabilization, increased lordosis, increased segmental height, and increased foraminal height. In both groups good neurological outcomes were achieved and donor site morbidity was avoided. The lower complication rate and shorter hospital stay, however, make the Cage-assisted fusion without plate fixation better than with plate fixation.
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Three-level and four-level anterior cervical discectomies and Titanium Cage-augmented fusion with and without plate fixation.
Journal of neurosurgery. Spine, 2004Co-Authors: Shiuhlin Hwang, Annshung Lieu, Yanfen Hwang, Chih-lung Lin, Kung-shing Lee, Tai-hung Kuo, Shenlong HowngAbstract:Object. Cage-assisted anterior cervical discectomy and fusion (ACDF) has proven to be a safe and effective procedure for the treatment of one- and two-level degenerative disc disease (DDD). To the authors' knowledge, clinical results after three- and four-level interbody Cage—augmented ACDF have not been reported in the literature. The authors investigated the safety and effectiveness of Titanium Cages used in such procedures and evaluated the results in cases with or without plate fixation. Methods. Fifty-six patients suffering from cervical DDD were divided into two groups. Group 1 included 32 patients who underwent Titanium Cage—assisted ACDF; Group 2 included 24 patients who underwent the same procedure, supplemented with plate fixation. The cervical DDD was confirmed by radiography and magnetic resonance imaging. The patients underwent radiographic evaluation to assess cervical lordosis, segmental height of cervical spine, the height of the foramina, and spinal stability. Neurological outcomes were a...
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preliminary experience with anterior interbody Titanium Cage fusion for treatment of cervical disc disease
Kaohsiung Journal of Medical Sciences, 2003Co-Authors: Yuchuan Wu, Naiphon Wang, Shenlong HowngAbstract:This study evaluated the efficacy and safety of Titanium Cage implants in cervical reconstruction to treat cervical spondylosis. Surgical data covered a 4-year period from January 1999 to December 2002 and included 34 consecutive patients, 20 men and 14 women, with ages ranging from 27 to 84 years (mean, 57 years). Patients underwent anterior cervical microdiscectomy followed by interbody fusion with a Titanium Cage implant (rather than an autogenous iliac crest bone graft) at a single level ranging from C3 to C7. Twenty-one patients had a herniated intervertebral disc, nine had degenerative disc disease, and four had previous failed autograft fusion surgery that required revision. At clinical presentation, 26 patients had neck pain, 23 had radiculopathy, and nine had myelopathy. Diagnostic imaging studies included spinal dynamic roentgenography, computerized tomography, and magnetic resonance imaging. Lesions were located at C3-4 in seven cases, C4-5 in 14 cases, C5-6 in nine cases, and C6-7 in four cases. The follow-up period ranged from 7 to 48 months (mean, 26 months). Results revealed that the procedure was technically feasible. There were no intra- or postoperative complications. The most commonly used Cage was 9 mm high. Imaging studies showed no Cage instability, migration, or pseudarthrosis. Although mild subsidence (
M Payer - One of the best experts on this subject based on the ideXlab platform.
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unstable burst fractures of the thoraco lumbar junction treatment by posterior bisegmental correction fixation and staged anterior corpectomy and Titanium Cage implantation
Acta Neurochirurgica, 2006Co-Authors: M PayerAbstract:Background. Controversy exists about the best treatment of unstable thoraco-lumbar (TL) burst fractures. Kyphosis correction and canal decompression in case of a neurological deficit are recognized treatment objectives, and various conservative and surgical strategies have been proposed. This prospective observational study evaluates the benefits and risks of a posterior bisegmental transpedicular correction/fixation and staged anterior corpectomy and Titanium Cage implantation in unstable TL junction burst fractures.
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Clinical Article Implantation of a distractible Titanium Cage after cervical corpectomy: technical experience in 20 consecutive cases
2006Co-Authors: M PayerAbstract:Summary Background. This prospective observational study was undertaken to investigate the advantages, the safety, and the drawbacks of reconstructing a cervical corpectomy with a distractible corpectomy Cage. According to the author’s literature search, this is the second clinical report on a distractible cervical corpectomy Cage. Method. 20 consecutive patients underwent a single- or multi-level cervical corpectomy for spondylotic myelopathy, traumatic fracture, or tumor. The corpectomy defect was reconstructed by means of a distractible Titanium Cage, and local bone from the corpectomy was layed around the Cage for fusion. An anterior cervical plate and=or a posterior lateral mass or pedicle screw fixation was added in all patients. The average follow-up was 14 months, and all patients had at least 12 months of follow-up. Findings. No hardware failure occurred in any of the patients. Construct stability was achieved in 19 out of 20 patients (95%) at 12 months postoperatively. The mean regional lordosis was 1 � preoperatively, 9 � postoperatively, and 7 � at the follow-up. Mean neck pain on a VAS was 3.9 preoperatively, and 2.6 at 12 months. There were three perioperative complications: transient neurological worsening in one patient, one transient vocal cord paralysis, and persistent dysphagia in one patient. Conclusion. A single- or multi-level cervical corpectomy can be safely and effectively reconstructed by a distractible Titanium Cage and local bone graft in combination with anterior cervical plating and=or posterior lateral mass=pedicle screw fixation. Potential advantages of this technique are an unforced Cage insertion in its non-distracted position, press-fitting the Cage into the corpectomy defect through Cage distraction, correction of kyphosis or preservation of local lordosis through Cage distraction, and the absence of donor site morbidity. However, the stability rate in the current series did not exceed the fusion rates of auto- or allografts.
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Unstable burst fractures of the thoraco-lumbar junction: treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and Titanium Cage implantation.
Acta neurochirurgica, 2005Co-Authors: M PayerAbstract:Background. Controversy exists about the best treatment of unstable thoraco-lumbar (TL) burst fractures. Kyphosis correction and canal decompression in case of a neurological deficit are recognized treatment objectives, and various conservative and surgical strategies have been proposed. This prospective observational study evaluates the benefits and risks of a posterior bisegmental transpedicular correction/fixation and staged anterior corpectomy and Titanium Cage implantation in unstable TL junction burst fractures.
John Pournaras - One of the best experts on this subject based on the ideXlab platform.
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Treatment of tuberculous spondylitis with anterior stabilization and Titanium Cage.
Clinical orthopaedics and related research, 2006Co-Authors: Anastasios Christodoulou, Panagiotis Givissis, Dimitrios Karataglis, Panagiotis Symeonidis, John PournarasAbstract:UNLABELLED We retrospectively reviewed 12 patients with spinal tuberculosis of the thoracic and lumbar spine who had radical debridement, anterior decompression, interbody arthrodesis with an anterior interbody Titanium Cage, and autologous bone grafts, combined with a standardized perioperative antituberculous regimen. Their mean age was 55.1 years and they were observed for a mean of 65.3 months. Indications for surgery included epidural abscess, structural destruction with instability, progressive kyphosis, and/or neurologic deterioration. Kyphotic deformity was corrected from a mean of 24.6 degrees (range, 15 degrees-32 degrees) to a mean of 10 degrees (range, 4 degrees-18 degrees). Tuberculous infection was controlled and bony fusion was achieved in all patients. No recurrence of infection or construct failure was recorded. All patients were safely mobilized within the first postoperative week; back pain fully resolved in eight patients and improved in the remaining four. We conclude that radical debridement followed by anterior stabilization with a Titanium Cage and bone grafting is a reasonable alternative for tuberculous spondylitis requiring surgical treatment. It enables accurate and lasting deformity correction and provides adequate stability to allow early mobilization. The presence of a Titanium Cage in an area of mycobacterial infection did not preclude infection control or lead to recurrence. LEVEL OF EVIDENCE Therapeutic study. Level IV (case series). Please see Guidelines for Authors for a complete description of levels of evidence.
Amir Aziz - One of the best experts on this subject based on the ideXlab platform.
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efficacy of anterior column reconstruction in tuberculosis of the cervical spine with stand alone Titanium Cage without anterior plating
HAMDAN MEDICAL JOURNAL, 2017Co-Authors: Qazi Muhammad Amin, Ashfaq Ahmed, Muhammad Imran, Farrukh Bashir, Atiq Uz Zaman, Shahzad Javed, Amir AzizAbstract:Tuberculosis (TB) is a common disease, especially in underdeveloped countries. TB of the vertebral column constitutes nearly 50% of all lesions of osteoarticular TB. The most common site for the disease is the peridiscal region. The primary treatment option is usually anti-TB chemotherapy, but in some patients with severe pain and neural involvement, instability and a large abscess, surgery is recommended. To our knowledge there are no publications describing the use of a stand-alone Titanium Cage and bone graft without anterior plating in the treatment of tuberculous spondylitis (TBS). The aim of this study is to evaluate the efficacy of stand-alone Titanium mesh Cages in TB of the cervical spine. A retrospective study of 47 patients with cervical TBS was carried out at Ghurki Trust Teaching Hospital, Lahore, Pakistan, of whom 61.6% were aged 3–35 years and 28.4% were aged 36–70 years. Twenty-six were male and 21 were female. Preoperative spinal function was categorized as Frankel grade E in 26 patients, Frankel grade D in four patients, Frankel grade C in 10 patients, Frankel grade B in two patients and Frankel grade A in five patients. Following surgery, one patient categorized as Frankel grade A remained the same while the remaining four improved to grade C at follow-up. The rest of the patients improved to grade E at the 2-year follow-up. The mean preoperative Cobb angle was 39.06°[standard deviation (SD) 10.92°], which improved to –5.51°(SD 77°) (P<0.05). When comparing the visual analogue scores, there was also a statistically significant difference in pain improvement. All patients underwent single-stage radical debridement, decompression and instrumentation. Anterior column reconstruction was performed in all patients using a stand-alone Titanium Cage. The use of Titanium Cages effectively corrects sagittal deformity in the TB-affected spine with no donor site morbidity.
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Efficacy of anterior column reconstruction in tuberculosis of the cervical spine with stand-alone Titanium Cage without anterior plating
Hamdan Medical Journal, 2017Co-Authors: Qazi Muhammad Amin, Ashfaq Ahmed, Muhammad Imran, Farrukh Bashir, Atiq Uz Zaman, Shahzad Javed, Amir AzizAbstract:Tuberculosis (TB) is a common disease, especially in underdeveloped countries. TB of the vertebral column constitutes nearly 50% of all lesions of osteoarticular TB. The most common site for the disease is the peridiscal region. The primary treatment option is usually anti-TB chemotherapy, but in some patients with severe pain and neural involvement, instability and a large abscess, surgery is recommended. To our knowledge there are no publications describing the use of a stand-alone Titanium Cage and bone graft without anterior plating in the treatment of tuberculous spondylitis (TBS). The aim of this study is to evaluate the efficacy of stand-alone Titanium mesh Cages in TB of the cervical spine. A retrospective study of 47 patients with cervical TBS was carried out at Ghurki Trust Teaching Hospital, Lahore, Pakistan, of whom 61.6% were aged 3–35 years and 28.4% were aged 36–70 years. Twenty-six were male and 21 were female. Preoperative spinal function was categorized as Frankel grade E in 26 patients, Frankel grade D in four patients, Frankel grade C in 10 patients, Frankel grade B in two patients and Frankel grade A in five patients. Following surgery, one patient categorized as Frankel grade A remained the same while the remaining four improved to grade C at follow-up. The rest of the patients improved to grade E at the 2-year follow-up. The mean preoperative Cobb angle was 39.06°[standard deviation (SD) 10.92°], which improved to –5.51°(SD 77°) (P
Kirsten Schmieder - One of the best experts on this subject based on the ideXlab platform.
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Anterior Cervical Discectomy and Titanium Cage Fusion - 7-year Follow-up
Central European Neurosurgery, 2009Co-Authors: Simone M Rohe, Martin Engelhardt, Albrecht Harders, Kirsten SchmiederAbstract:BACKGROUND AND STUDY AIMS The purpose of this study was to prospectively evaluate long-term results after anterior cervical discectomy and Titanium Cage fusion (ACDF) and Titanium Cage fusion. Special focus was on the adjacent levels. METHODS 54 patients (age: 48+/-10 years; one level operation in 44 patients and two level operation in 10 patients) entered the study. Re-evaluation consisted of a clinical out patient investigation and was possible in 33 patients. VAS, PROLO and Oswestry scores were used. Lateral radiographs were taken and changes in the operated and adjacent segments were measured and compared to radiographs directly after surgery. Clinical patient data was compared with the data prior to surgery. RESULTS The mean follow-up time of the 33 patients was 7.26 +/- 0.22 years. One patient needed re-surgery of the cervical spine above the fused segment. PROLO results showed a significant improvement (PROLO F 1.52+/-0.67 to 3.79+/-1.17 p
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Anterior cervical discectomy and Titanium Cage fusion - 7-year follow-up.
Central European neurosurgery, 2009Co-Authors: Simone M Rohe, Martin Engelhardt, Albrecht Harders, Kirsten SchmiederAbstract:The purpose of this study was to prospectively evaluate long-term results after anterior cervical discectomy and Titanium Cage fusion (ACDF) and Titanium Cage fusion. Special focus was on the adjacent levels. 54 patients (age: 48+/-10 years; one level operation in 44 patients and two level operation in 10 patients) entered the study. Re-evaluation consisted of a clinical out patient investigation and was possible in 33 patients. VAS, PROLO and Oswestry scores were used. Lateral radiographs were taken and changes in the operated and adjacent segments were measured and compared to radiographs directly after surgery. Clinical patient data was compared with the data prior to surgery. The mean follow-up time of the 33 patients was 7.26 +/- 0.22 years. One patient needed re-surgery of the cervical spine above the fused segment. PROLO results showed a significant improvement (PROLO F 1.52+/-0.67 to 3.79+/-1.17 p<0.01; PROLO E 1.52+/-0.5 to 3.55+/-1.42 p<0.01). Mean VAS at the time of investigation was 3.2+/-2.5. Oswestry score was 16.4+/-9.5. The alignment of the whole cervical spine was stable lordotic (Katsuura 10.9+/-9.0 degrees to 11.5+/-7.8 degrees ; p=0.76). Total segmental height had reduced from 36.6+/-4.6 mm to 34.6+/-3.9 mm (p=0.04). No significant reduction of disc space height of adjacent levels was detectable (superior: 5.8+/-1.6 mm to 5.2+/-1.6 mm; inferior: 6.0+/-1.7 mm to 5.3+/-1.9 mm). One adjacent superior level showed spontaneous fusion. Ventral and dorsal osteophytes in the superior and inferior adjacent levels increased in number and increased significantly in degree. Patients with bi-segmental fusion (n=7) showed similar results. ACDF with Titanium Cages has good clinical long-term results. A significant progression of degenerative changes can be observed on radiographs without clinical consequences for the patients. A comparison with patients without surgery and conservative therapy is needed to allow a better interpretation of the radiological results. Georg Thieme Verlag KG Stuttgart * New York.
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anterior cervical discectomy and Titanium Cage fusion 7 year follow up
Central European Neurosurgery, 2009Co-Authors: Simone M Rohe, Martin Engelhardt, Albrecht Harders, Kirsten SchmiederAbstract:BACKGROUND AND STUDY AIMS The purpose of this study was to prospectively evaluate long-term results after anterior cervical discectomy and Titanium Cage fusion (ACDF) and Titanium Cage fusion. Special focus was on the adjacent levels. METHODS 54 patients (age: 48+/-10 years; one level operation in 44 patients and two level operation in 10 patients) entered the study. Re-evaluation consisted of a clinical out patient investigation and was possible in 33 patients. VAS, PROLO and Oswestry scores were used. Lateral radiographs were taken and changes in the operated and adjacent segments were measured and compared to radiographs directly after surgery. Clinical patient data was compared with the data prior to surgery. RESULTS The mean follow-up time of the 33 patients was 7.26 +/- 0.22 years. One patient needed re-surgery of the cervical spine above the fused segment. PROLO results showed a significant improvement (PROLO F 1.52+/-0.67 to 3.79+/-1.17 p<0.01; PROLO E 1.52+/-0.5 to 3.55+/-1.42 p<0.01). Mean VAS at the time of investigation was 3.2+/-2.5. Oswestry score was 16.4+/-9.5. The alignment of the whole cervical spine was stable lordotic (Katsuura 10.9+/-9.0 degrees to 11.5+/-7.8 degrees ; p=0.76). Total segmental height had reduced from 36.6+/-4.6 mm to 34.6+/-3.9 mm (p=0.04). No significant reduction of disc space height of adjacent levels was detectable (superior: 5.8+/-1.6 mm to 5.2+/-1.6 mm; inferior: 6.0+/-1.7 mm to 5.3+/-1.9 mm). One adjacent superior level showed spontaneous fusion. Ventral and dorsal osteophytes in the superior and inferior adjacent levels increased in number and increased significantly in degree. Patients with bi-segmental fusion (n=7) showed similar results. CONCLUSION ACDF with Titanium Cages has good clinical long-term results. A significant progression of degenerative changes can be observed on radiographs without clinical consequences for the patients. A comparison with patients without surgery and conservative therapy is needed to allow a better interpretation of the radiological results.
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Subsidence of the Wing Titanium Cage after anterior cervical interbody fusion: 2-year follow-up study
Journal of neurosurgery. Spine, 2006Co-Authors: Kirsten Schmieder, Martin Engelhardt, Markus Wolzik-grossmann, I. Pechlivanis, Martin Scholz, Albrecht HardersAbstract:Object Cage subsidence occurs after anterior cervical discectomy and fusion (ACDF). The aim of this prospective study was to evaluate subsidence and total segmental height after implantation of a newly designed Wing Titanium Cage. Furthermore, alignment of the entire cervical spine was analyzed 2 years after surgery. Methods Fifty-four patients (26 women and 28 men) whose mean age was 48.3 years underwent ACDF. Follow-up examinations were performed at discharge and 6, 12, and 24 months postoperatively by an independent investigator. The clinical course was evaluated using the visual analog pain scale and the Prolo scales. Measurements of subsidence and total segmental height were conducted, and the alignment of the entire cervical spine was classified using two methods. In 54 patients 64 levels were fused. The patients noted a significant reduction of pain, and scores on both Prolo scales were significantly improved. At the 2-year follow-up examination, subsidence was present in 30 of the 67 fused segment...
