Today's News

Friday, February 23, 1996

Internal fixation lowers complications rate in spine fusion

Anterior cervical spine fusion with rigid internal fixation (plates, screws) increases the incidence of fusion and lowers the complication rate, according to a study presented Friday in scientific paper 97.

Orthopaedic researchers at Boston University Medical Center reviewed the medical records of 171 anterior cervical spine fusion patients, 66 females and 105 males, and then followed-up an average of 11 years after surgery.

The procedure - performed with or without internal fixation - fuses two spinal segments together with bone graft (from the iliac crest) to relieve spinal instability or nerve root irritation resulting from osteoarthritis.

Sixty patients had no internal fixation and wore a cervical collar for three months; the 111 patients with internal fixation wore an external immobilizer for one month. Average age of patients was 36 (range: 18-72 years).

"Patients without internal fixation had a high rate of nonunion coupled by loss of position of the graft," said co-author Isadore G. Yablon, MD, professor and chairman, department of orthopaedic surgery, Boston University School of Medicine. This group had nine cases of nonunion and 12 cases that required reoperation due to graft loosening or resorption.

In contrast, the fixation group had only two instances of nonunion and no graft failure.

"Internal fixation enabled burst fracture cases to start active rehabilitation four weeks earlier than those without internal fixation," said Dr. Yablon. "Nine of the 42 burst fracture patients with internal fixation and one of the 19 without (internal fixation) showed two or more levels of improvement."

Quadriplegic patients with internal fixation showed a higher rate of functional return than quadriplegic patients without internal fixation. "Presumably, the rigid fixation permitted a more complete resolution of cord edema and contusion," said Dr. Yablon.

Wearing a cervical orthosis less than three months was especially advantageous in the burst fracture cases, all of which were quadriplegics.

Among all patients, 61 had sustained a burst fracture; 41 had spinal stenosis caused by either an osteophyte or disc protrusion; 31 had a single level discectomy followed by an interbody fusion; and 36 had a two-level discectomy with an interbody fusion.

Co-authors of the study with Dr. Yablon are Edward Spatz, MD, professor and chairman, department of neurological surgery; Joe Ordia, MD, associate professor of neurosurgery; James Reed, MD, assistant professor of neurosurgery; Shapur Ameri, MD, clinical assistant professor of neurosurgery; Krishna Nirmel, MD, assistant professor of neurosurgery; and Sin Choo, MD, assistant clinical professor of neurosurgery; all at Boston University School of Medicine.

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