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Microinjuries During Cervical Spine Fusion

Posted on: 10/25/2007
In this study, researchers use sheep to study the effects of surgery on the cervical spine (neck). They looked at structural and cellular changes at the facet joints of the spine. All sheep were treated with anterior cervical discectomy and fusion (ACDF).

There are risks whenever spinal surgery is performed. During the anterior approach to cervical fusion, things can go wrong with screw placement, retraction of the soft tissues, and surgical removal of the disc. Placement of a titanium cage between the vertebrae can also result in patient complaints of pain and neurologic symptoms.

Only one surgeon performed the operations. The procedures were all the same. The disc was removed at the C5-6 cervical spine level. This step is called a discectomy. In ten of the 15 sheep, a rigid device called a cage was inserted in the empty disc space.

X-rays were taken of the cervical spine before and after the operation. Tissue samples from the joints and vertebral endplates were examined. The endplates are located on either side of the disc between the disc and the vertebral bone. They are made up of fibrocartilage.

The facet joints were studied using special light microscopy. Changes suggesting trauma were seen in both the joints and the endplates. This was true for the level operated on as well as the next (adjacent) segment. Degeneration and death of the cartilage cells was observed.

Other signs of injury in these two areas included edema (swelling) and microhemorrhages. There were no observable changes in the vertebral bodies. There were no problems with the position of the implants.

The authors conclude that joint injury does occur during surgery to place stabilizing screws in the sheep spine. If that's the case, then it's likely that similar problems occur in humans. The human spine and sheep spine are very comparable.

This could be the explanation for problems that develop weeks to months after surgery in humans. Neck and or arm pain and loss of motor and sensory function occur when there's no evidence of any apparent injury.

More study is needed to see if the effects of surgery go away after the operation. It's possible that microinjuries can be avoided with changes and improvements in surgical technique. Further study of this area is also needed.

Parmenion Ph. Tsitsopoulos, MD, et al. Intraoperative Facet Joint Injury During Anterior Cervical Discectomy and Fusion: An Experimental Study. In Journal of Neurosurgery: Spine. October 2007. Vol. 7. No. 4. Pp. 429-435.

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