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Vol. 12. Issue 2.
Pages 143-151 (January 2001)
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Vol. 12. Issue 2.
Pages 143-151 (January 2001)
Fusión cervical postdiscectomía. Estudio clínico-radiológico comparando el injerto óseo de cresta iliaca, placa cervical anterior con injerto óseo y placa-caja GD
Postdiscectomy cervical fusion. Clinico-radiological study comparing iliac crest bone graft, anterior cervical plate with bone graft and cage-plate GD
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J.M. González-Darder, J.V. Pesudo Martínez, R. Feliu Tatay
Servicio de Neurocirugía. Hospital General de Castellón. Castellón
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Resumen
Objetivo

Comparar clínica y radiológicamente tres tipos de artrodesis cervical por vía anterior tras discectomía de un solo nivel por patología discal no traumática.

Material y Métodos

Se han constituido tres grupos homogéneos estudiados retrospectivamente, donde sólo variaba la técnica de artrodesis postdiscectomia. En el grupo 1 (20 pacientes) se colocaba un injerto tricortical autólogo de cresta ilíaca. En el grupo 2 (10 pacientes) se asociaba al injerto óseo una placa cervical anterior (Stryker). En el grupo 3 (10 pacientes) se utilizaba una placa-caja (placa-caja GD) rellena de esponjosa de cresta ilíaca. Los parámetros clínicos y radiológicos se estudiaron en el preoperatorio y entre 6–9 meses en el postoperatorio.

Resultados

Hubo una mejoría significativa de la cervicobraquialgia con las tres técnicas, con similares complicaciones y estancia hospitalaria. No hubo fallos del material de osteosíntesis. Hay un significativo aumento de la altura discal en el grupo 3 respecto al 1 y de la corrección de la cifosis en el grupo 3 respecto a los grupos 1 y 2. Hay un significativo aumento de la estabilidad radiológica postoperatoria y del tiempo operatorio en los grupos 2 y 3 en relación al grupo 1.

Conclusiones

La discectomía asociada a artrodesis es un método efectivo en el tratamiento de la cervicobra-quialgia. La artrodesis con osteosíntesis obtiene mejores resultados que la conseguida con injerto óseo. La placa-caja GD minimiza los problemas quirúrgicos y clínicos debidos a la asociación de un injerto con una placa anterior y consigue los mejores resultados radiológicos.

Palabras clave:
Artrodesis cervical
Discectomía cervical
Fijación interna
Summary
Objective

To compare clinical and radiologically three methods of cervical arthrodesis after anterolateral one-level discectomy for non-traumatic disk disease.

Materials and Methods

Three groups of patients were studied retrospectively. In group 1 (20 patients) a tricortical autologous iliac crest bone interbody graft was used. In group 2 (10 patients) the bone graft was associated to an anterior cervical plate (Stryker). In group 3 (10 patients) a cage-plate filled with iliac crest trabecular bone was implanted (plate-cage GD). Clinical and radiological parameters were recorded preoperatively and 6–9 months postoperatively.

Results

There was a significant clinical improvement in all three groups, with similar complications and hospitalization time. There were not hardware failures. There was a significant increase in the disc height in group 3 when compared with group 1 and a significant correction of the preoperative kyphosis in group 3 in relation to both group 1 and 2: There was a significant increase in postoperative radiological stability rate and also in the operative time in groups 2 and 3 when compared with group 1.

Conclusions

Cervical arthrodesis after discectomy is an usefull method for treatment of cervicobrachialgia. Arthrodesis with internal fixation achieves best clinical and radiological results and it has some other advantages in relation to bone graft artrhodesis. GD cage-plate minimizes the surgical and clinical problems associated with use of bone graft and cervical plate and reaches the best radiological perfomances.

Key words:
Cervical discectomy
Cervical arthrodesis
Internal fixation

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