ANTERIOR CERVICAL DISKECTOMY WITH OR WITHOUT FUSION WITH ACRYLATE - ARANDOMIZED TRIAL

Study Design. A prospective randomized trial with assessment of treatm ent results by an independent observer and by patient questionnaire. O bjectives. This study evaluated whether implantation of polymethylmeth acrylate after anterior cervical discectomy improved clinical results and whether polymethylmethacrylate provided a solid bony union with pr eservation of anatomical relations of the cervical spine. Summary of B ackground Data. Discectomy without fusion disturbs anatomical relation s of the cervical spine. Use of an autologous bone graft frequently ca uses donor-site complications. Therefore, synthetic materials such as polymethylmethacrylate have been used instead of bone to obtain spinal fusion. Whether these implants improve the clinical results of anteri or discectomy is unknown. In addition, the radiological follow-up of d iscectomy with polymethylmethacrylate has hardly been investigated. Me thods. Between April, 1986, and April, 1990, all patients with radiolo gically proven cervical disc pathology and a radicular syndrome were e ligible for this study. The primary endpoint of the study was the clin ical result after 2 years. Assessment of the result was rated both by an independent observer using Odom's criteria and by the patient using a written questionnaire. Before surgery and during follow-up, radiogr aphs were obtained. Results. Two patients died during follow-up. A goo d result was obtained in 28 of 42 patients (70%) treated with polymeth ylmethacrylate and in 30 of 39 patients (77%) of patients treated with discectomy only. Pre-operative neck pain subsided earlier if polymeth ylmethacrylate was used, but the difference was temporary and clinical ly insignificant. The use of polymethylmethacrylate resulted in a sign ificant lower bony union rate. Polymethylmethacrylate frequently migra ted into adjacent vertebrae. Conclusions. No relevant clinical differe nces between treatments were found. The radiological results of anteri or discectomy with polymethylmethacrylate were inferior to those of di scectomy only. Based on these results, the use of polymethylmethacryla te to obtain fusion after anterior discectomy is not recommended.