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STUDY DESIGN: A preliminary assessment of anterior cervical fusion performed with interbody cage and DOC plate.

OBJECTIVES: To describe and evaluate the efficacy and safety of the "Chattanooga Procedure", a modified technique in achieving anterior cervical fusion.

SUMMARY OF BACKGROUND DATA: Anterior cervical fusion with interbody bone graft and anterior plating is connnonly performed. Unfortunately, the plate has been reported to shield the graft from loading thus reducing fusion rates. The use of interbody fusion cages has been effective in the lumbar spine and has gained acceptance in the cervical spine.

METHODS:. Twenty-five patients received "The Chattanooga Procedure" between 7/24/98 and 4/8/99. All patients had anterior discectomies and carpectomies, placement of a Harms cage packed with carpectomy bone, and application ofDePuy-Acromed DOC. Fusion was defined by radiographic evidence of trabecular bone bridging across the Harms cage. CT scans were performed on twelve randomly chosen patients to verify fusion. No external bracing was used except a soft collar as needed. Pre- and post-operative pain and functional capacity data were collected and statistically analyzed using paired t-tests.

RESULTS: There were no cases of pseudoarthrosis, major neurological, vascular, or wound complications. Only one case of unresolved dysphasia was noted. The average operative time (11 0 minutes) was comparable to standard instrumented multi-level anterior cervical fusion surgeries. The average estimated blood loss was 113 ml (range, 50-750 ml). Both visual analog pain scale and Oswestry functional capacity data were significantly improved post-operatively (p< 0.01).

DISCUSSION: Advantages of the "Chattanooga Procedure" include immediate stability, support, elimination of donor site pain to iliac crest bone autograft, and a decrease in pseudoarthrosis by dividing the fusion surfaces by half. Concerns regarding this technique include an increased risk for dysphasia due to the DOC's high profile. Pseudoarthrosis or instrumentation migration could also become problematic since the removal of the Harms cage could be difficult if necessary.

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