Comparison of three techniques of anterior fusion in single-level cervical disc herniation

Abstract

This study compared the clinical and radiographic outcome of three techniques of anterior fusion for cervical disc herniation: Cloward fusion with autograft, Cloward fusion with freeze-dried bone, and BAK-C device fusion. In a cohort of 84 consecutive patients, 34 were treated by classic autograft Cloward's technique, in 26 patients freeze-dried xenograft Surgibone was used and in the last 24 patients a BAK-C titanium device was implanted. The mean follow-up period of this last group was 14.6 months. All patients were operated by the same surgeon at the same hospital and all underwent single-level surgery. Results were evaluated on the basis of patient satisfaction and postoperative capacity to work. There was no significant difference between the three groups related to the preoperative assessment. The analysis revealed that BAK-C patients had significantly shorter hospital stays. No postoperative cervical collar was worn by BAK-C patients and they had the highest percentage of excellent clinical results. Concerning radiographic evaluation, BAK-C achieved a more stable fixation of the involved segment without complications in contrast with the two others, which presented a significant incidence of extrusion, collapse, kyphosis and pseudarthrosis. Measurement of the progressive kyphosis grade shows statistically significant differences between the three groups. BAK-C patients had the lowest kyphosis grade at the end of the follow-up. There is an important correlation between collapse, collapse with kyphosis and pseudarthrosis with bad clinical results. In conclusion, the BAK-C device showed significant advantages, including higher patient satisfaction, unnecessary postoperative collar, early rehabilitation and a lower rate of complications. Furthermore, BAK-C is cost effective because of it shortens postoperative hospital stay and allows an earlier return to work.