Cervical monosegmental interbody fusion using titanium implants in degenerative, intervertebral disc disease

Over a period of 12 months at the Klinik für Neurochirurgie (belonging to the Städtischen Klinikums Fulda) 54 patients were operated upon after presenting with cervical radiculopathy or myelopathy in single vertebral segments with intravertebral disc involvement and/or osteochondrosis. The surgical intervention of all patients was carried out microsurgically by the author using a vental approach in accordance with the operative procedure and technique as described by Smith and Robinson [59]. In no patient was an additional bone plating necessary. Intraoperative data together with postoperative clinical, neurological, and radiological progress controls at 6 weeks and 3 months were, in the frame of a clinical perspective, non-random study, analysed and evaluated. There were no complications during the operative procedure or postoperatively, and of note, in no case was there any implant dislocation or neurological deterioration. Radicular pain was relieved in 98% of patients. Non-radicular pain--neck and shoulder pain--was eradicated in 42 patients (78%), improvement achieved in 8 patients (15%) and 4 patients (7%) still complained of neck pain 3 months postoperatively. Motor radicular deficit was completely relieved in 34 of 38 patients (89%) and in 3 patients (8%) there was a considerable improvement. Similar figures were obtained with relation to radicular sensory deficit. Of 5 patients who presented preoperatively with cervical myelopathy, 3 improved considerably and 2 remained unchanged. For all 50 patients fine layer, computer tomographic examination of the cervical region with 3-dimensional reconstruction was performed immediately postoperatively and at 3 months. All patients showed a correct positioning of the implant and either a complete or convincing bony ingrowth between the operated vertebrae. To summarise, the presented clinical and radiological study shows the cancellous bone tissue filled, titanium implant to be a meaningful and useable alternative to conventional methods of spinal fusion. Essential advantages: (i) Negation of "bone procedure" complications at the iliac crest and neck combined with a simple and safe surgical procedure. (ii) Reduced hospitalisation time and subsequent treatment costs. (iii) The good biocompatibility of titanium combined with a solid stability at the fusion site. Despite the excellent initial operative results the absence of long term results must be born in mind.