PRESERVATION OF SEGMENTAL MOTION PRESERVATION OF SEGMENTAL MOTION WITH ANTERIOR CONTRALATERAL WITH ANTERIOR CONTRALATERAL CERVICAL MICRODISKECTOMY AND CERVICAL MICRODISKECTOMY AND

INTERBODY FAT GRAFT: INTERBODY FAT GRAFT: PROSPECTIVE PROSPECTIVE STUDYSTUDY

CLINIC OF NEUROSURGERY, CLINIC OF NEUROSURGERY,

ŞİŞLİ ETFAL TEACHING & ŞİŞLİ ETFAL TEACHING &

RESEARCH HOSPITALRESEARCH HOSPITAL

İSTANBUL, TURKEYİSTANBUL, TURKEY

Yunus AYDIN, MD

Halit ÇAVUŞOĞLU, MD

Cengiz TUNCER, MD

Osman TÜRKMENOĞLU, MD

Ahmet Murat MÜSLÜMAN, MD

MATERIAL & METHOD

• with cervical paramedian disc herniation

• who underwent one or two-level anterior contralateral

simple microdiskectomy (without fusion)

• Interbody fat graft raplacement were performed on 91 of

330 patients

• between 1992 and 2009.

The mean follow-up time: 10 years (range 1 to 16 years).

at conventional right side

procedures, the left foramina can be

approached easier from the right

side!.

• Technique based on opening the

opposite of the brachialgia which

supports the better visualization of

the foraminal area.

SIMPLY THE BEST !

CONTRALATERAL APPROACH

SURGICAL TECHNIQUE

• Performed at the contralateral side of the radiculopathy,

• 2 cm. transvers skin incision,

• Only 10 mm. wide mini-size Zenker hand retractor, no spreader,

• The longus colli muscles are not stripped,

• Narrow opening through ALL,

• No bone and cartilage removal,

• The disc material is removed with bayonet microcurettes and

punches down to the PLL,

Zenker hand retractors & Bayonet Kambin microcurettes

SURGICAL TECHNIQUE

• Lateral parts of annulus fibrosus

not shaved extensively!

• Removal of all posterior & lateral

osteophytes,

• Opening of PLL,

• Transuncal foraminotomy,

• Interbody fat graft replacement

is performed.

FOLLOW-UP

• All patients were followed-up regularly at intervals of 1,

3, 6, 12 months, and were followed up annually

thereafter.

• Routine radiological investigations, including periodic

dynamic x-ray

Clinical outcomes were assessed using

the

Neck Disability Index (NDI) and

Short Form-36 (SF-36).

OUTCOME MEASUREMENT

In group 1 (without fat graft):

Despite fusion procedures were not performed, spontaneous

radiological fusion signs were obtained in 12% of group 1

patients.

RESULTS

In group 2 (with fat graft):

Follow-up radiological studies revealed healing without fusion in

group 2 patients.

RESULTS Cont’d.

• Despite the kyphosis seen at the treated levels, the

overall alignment between C2 and C7 did not change

significantly in group 1 (without fat graft)

• The kyphosis were not seen at the treated levels in

group 2 (with fat graft)

• The ROM increased significantly in group 2 (with fat

graft) (p < 0,05).

RESULTS Cont’d.

Neck Disability Index

Scores decreased

significantly in both early

and late follow-up

evaluations.

(t = -1.789, p = 0.077)

RESULTS Cont’d.

Short Form 36

Physical Function (F = 199, P < .0001), Physical Role (F= 402,264 P < .0001), Bodily Pain (F = 242, P < .0001), General Health (F = 685, P < .0001), Vitality/Energy (F= 356,266 P < .0001), Social Function (F= 139, P < .0001), Emotional Role (F = 135, P < .0001), Mental Health (F= 125,P < .0001)

Scores demonstrated significant improvement in long-term

follow-up results in the all areas

RESULTS Cont’d.

16 years succesfull history shows that:

Our really minimal invasive technique provides

• better and direct exposure of the pathology,

• preservation of motion segment (NO functional loss),

• going back to work in shorter time with short hospital stay,

• esthetic result,

• lower cost..

CONCLUSION

16 years succesfull history shows that:

Contralateral approach & intervertebral fat graft prevents

• adjacent segment disease,

• serious complications of the instrumentation,

• long term side effects of the foreign materials in body..

CONCLUSION Cont’d.

DISCUSSIONThe advantages of preserving the mobile segment are widely

accepted.

•Advocates of disc replacements base their arguments on this

thesis. If disc replacements could have actually achieved the

desired results, it would have been great.

•Our technique is the less costly approach with less

complications that achieves the results intended with disc

replacements.

DISCUSSION

The fat graft plays an important role in achieving the desired

results by preventing unintended spontaneous bone

fusions.

Already acknowledged multi-potent transformation ability of

fat cell raises great curiosity about its long-term

transformations in intervertebral space.

7 - 10 Years7 - 10 Years

Case SamplesCase Samples

(2(2 levels levels))

Pre-Pre-op.op.

Post-Post-op.op.

Pre-Pre-opop

Post-Post-opop

Pre-Pre-op.op.

Post-Post-op.op.

7 - 10 Years7 - 10 Years

Case SamplesCase Samples

(1(1 level level))

Pre-op.

Post-op.

*with fat graft

Pre-Pre-op.op.

Post-Post-op.op.

Pre-Pre-op.op.

Post-Post-op.op.

Pre-Pre-op.op.

Post-Post-op.op.

Pre-Pre-op.op.

Post-Post-op.op.

Pre-Pre-op.op.

Post-Post-op.op.

Pre-Pre-op.op.

Post-Post-op.op.

Pre-Pre-op.op.

Post-Post-op.op.

THANK YOUQ & A