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. 2011 Jun 28:12:140.
doi: 10.1186/1471-2474-12-140.

Polymethylmethacrylate-assisted ventral discectomy: rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years

Mario Cabraja  1 , Daniel Koeppen, Wolfgang R Lanksch, Klaus Maier-Hauff, Stefan Kroppenstedt
Affiliations

Polymethylmethacrylate-assisted ventral discectomy: rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years

Mario Cabraja et al. BMC Musculoskelet Disord. .

Abstract

Background: Polymethylmethacrylate (PMMA) assisted ventral discectomy has been criticized for high rates of graft migration and pseudarthrosis when compared with various other fusion procedures for the treatment of cervical degenerative disc disease (DDD), therefore rendering it not the preferred choice of treatment today. Recently however spine surgery has been developing towards preservation rather than restriction of motion, indicating that fusion might not be necessary for clinical success. This study presents a long term comparison of clinical and radiological data from patients with pseudarthrosis and solid arthrodesis after PMMA assisted ventral discectomy was performed.

Methods: From 1986 to 2004 416 patients underwent ventral discectomy and PMMA interposition for DDD. The clinical and radiological outcome was assessed for 50 of 127 eligible patients after a mean of 8.1 years. Based on postoperative radiographs the patients were dichotomized in those with a pseudarthrosis (group A) and those with solid arthrodesis (group B).

Results: Pseudarthrosis with movement of more than 2 of the operated segment was noted in 17 cases (group A). In 33 cases no movement of the vertebral segment could be detected (group B). The analysis of the clinical data assessed through the neck disability index (NDI), the visual analogue scale (VAS) of neck and arm pain and Odom's criteria did not show any significant differences between the groups.Patients from group B showed a trend to higher adjacent segment degeneration (ASD) than group A (p = 0.06). This correlated with the age of the patients.

Conclusions: PMMA assisted discectomy shows a high rate of pseudarthrosis. But the clinical long-term success does not seem to be negatively affected by this.

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Figures

Figure 1
Figure 1
Patient flow.
Figure 2
Figure 2
Exemplary plain (A), extension (B) and flexion (C) radiographs of a 67 years old patient with achieved fusion and ASD 7 years after surgery at level C5/6. In figure 1 a multisegmental degeneration can be seen.
Figure 3
Figure 3
Exemplary plain (A), extension (B) and flexion (C) radiographs of a 57 year old patient with pseudarthrosis of the operated level and without signs of ASD 7 years after surgery. The operated pseudarthrotic level C5/6 is indexed, and the spheric form of the graft material has the aim to prevent migration (A).
See this image and copyright information in PMC

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