Surgeon's Toolbox: New Hardware for Neck Surgery
If you have a degenerative neck condition, your doctor may recommend surgery. In most cases, the surgeon removes a damaged intervertebral disc and replaces it with a chunk of bone. Think of the results as a bone sandwich, with the new bone--or graft--as the filling. The hope is that the graft will attach to the other bones, fusing solidly.
Unfortunately, neck surgery doesn't always have the desired outcome. If the graft doesn't take, problems arise. Grafts can collapse, stick out, or be absorbed. Special devices (instrumentation) have been created to hold grafts in place and stabilize the surrounding bones while the graft heals. These devices are implanted during surgery and remain in the spinal column. Though they often have good results, many of these devices have proven to be faulty or result in complications.
In this article, the authors report on a new instrumentation system. The device they used was developed in France. Like other devices of its kind, this one--called the PCB--is made of titanium. Its simple design consists of a "cage" where chips of bone graft are held. The cage keeps the graft material (mentioned above) from falling out and improves the chances the graft will begin fusing the two neck bones together.
The PCB is specially angled to restore the natural curve of the neck. The screws that hold it in place are simple to fit and insert. And the device is designed to work on more than one vertebral level when multilevel fusion is performed. The procedure to implant the PCB creates enough stability in the neck that patients don't need to wear neck collars after surgery.
The PCB was tried out on 29 patients. The patients were mostly male. Their average age was 49. Most of them had surgery at one level (or location) in their neck. Seven had surgery at two levels, and two had surgery at three levels.
The authors followed up five months to two years after surgery. They took X-rays to see whether the bones had fused successfully. In 27 cases, there was noticeable improvement. One patient had gotten worse, and one patient had no change.
There were no complications or infections from surgery. The PCB stayed solidly positioned, with none of the screw breakage that sometimes happens with other types of instrumentation. None of the patients had abnormally high levels of pain after surgery.
These early results were very positive. The PCB seemed to reduce neck pain by immediately stabilizing the bones in the neck. What's more, the device was successful in maintaining the space between vertebrae and correcting the curve of the neck. The authors would like to see more research on this device. They are especially interested in a new version of the PCB that shows up more clearly on X-rays.
George Samandouras, MC, FRCS, et al. A New Anterior Cervical Instrumentation System Combining an Intradiscal Cage With an Integrated Plate. In Spine. May 15, 2001. Vol. 26. No. 10. Pp. 1188-1192.
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