Donald Corenman, MD, DCModeratorSeptember 5, 2012 at 10:46 pmPost count: 8460
There are two different questions that you raise. One is what construct works the best for a fusion and the other is what is the best way to preserve the disc above.
I’ll address the last one first. Unfortunately, genetics plays a very large role in the future of the disc above. It is my opinion that you personally have more brittle collagen making up the annulus of the disc (see degenerative disc disease under cervical spine on website) which is more likely to tear.
That being said, activities that produce potential impact and large, quick rotational and flexion/extension motions puts the disc at more risk of tearing. These would be skiing, tennis, contact sports, water skiing, horseback riding (falls) among others. Keeping the neck muscles strong should help to ameliorate these injuries.
The second question is the type of construct you should consider to for a fusion surgery. This however begs the question of an artificial disc or even a posterior foraminotomy. If this disc space of the herniated disc level is in reasonable shape (the disc is less than 50% of normal height loss, the endplates are still intact, the facets are not degenerative and neck pain itself is a minor issue), then an artificial disc can be considered. There are risks and benefits of an artificial disc in the neck that can be reviewed on the website under “Treatments”/”Surgical”/Artificial disc replacement cervical”.
If the herniation is the only problem (no neck pain, facets are intact (no degenerative spondylolisthesis- see website) and the herniation is not positioned under the cord (surgical manipulation of the hernation could put the cord in jeopardy), then a posterior foraminotomy could be considered. Look for the video of this procedure on my website.
Finally, if an ACDF is considered, there are three potential surgical grafts that can be considered along with the plate; autograft (your own bone from the hip), allograft (cadaver bone) and allograft ground up bone along with a cage (made of plastic called PEEK).
See the website section under “Pre and Post-op”/”Preparation for spine surgery”/”Fusion bone graft choices” to gain a better understanding of your graft choices. I can tell you that these PEEK cages are used frequently in the neck but I am not a fan of them for the cervical spine. I do use PEEK cages extensively for the lumbar spine, but that is because there is so much more surface area to work with in the lumbar spine.
In the cervical spine, there is very little surface area for fusion so the idea is to use a graft that is 100% biologically active. The PEEK cage, being made of plastic, reduces the active surface area by 30-50% which means greater time to fusion and a higher percentage of non-fusion (pseudoarthrosis).
This leaves autograft (your own bone) and allograft (an iliac crest graft that originates from a donor) as choices. The section I referred to earlier is a good discussion of those choices.
In my opinion, the plate is a necessity as it secures the graft, increases the fusion rate and allows the patient to discontinue the neck brace early (or not use it at all).
Hope that covers your choices for you.
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