J Korean Neurosurg Soc.  2013 Dec;54(6):496-500. 10.3340/jkns.2013.54.6.496.

The Impact of Menopause on Bone Fusion after the Single-Level Anterior Cervical Discectomy and Fusion

• Park SB
• Chung CK
• Lee SH
• Yang HJ
• Son YJ
• Chung YS

• KMID: 2190945
• DOI: http://doi.org/10.3340/jkns.2013.54.6.496

Abstract

OBJECTIVE
To evaluate the successful fusion rate in postmenopausal women with single-level anterior cervical discectomy and successful fusion (ACDF) and identify the significant factors related to bone successful fusion in pre- and postmenopausal women.
METHODS
From July 2004 to December 2010, 108 consecutive patients who underwent single-level ACDF were prospectively selected as candidates. Among these, the charts and radiological data of 39 women were reviewed retrospectively. These 39 women were divided into two groups : a premenopausal group (n=11) and a postmenopausal group (n=28). To evaluate the significant factors affecting the successful fusion rate, the following were analyzed : the presence of successful fusion, successful fusion type, age, operated level, bone mineral density, graft materials, stand-alone cage or plating with autologous iliac bone, subsidence, adjacent segment degeneration, smoking, diabetes mellitus, and renal disease.
RESULTS
The successful fusion rates of the pre- and postmenopausal groups were 90.9% and 89.2%, respectively. There was no significant difference in the successful fusion rate or successful fusion type between the two groups. In the postmenopausal group, three patients (10.8%) had successful fusion failure. In the postmenopausal group, age and subsidence significantly affected the successful fusion rate (p=0.016 and 0.011, respectively), and the incidence of subsidence in patients with a cage was higher than that in patients with a plate (p=0.030).
CONCLUSION
Menopausal status did not significantly affect bone successful fusion in patients with single-level ACDF. However, in older women with single-level ACDF, the combination of use of a cage and subsidence may unfavorably affect successful fusion.

Keyword

Menopause; Cervical; Discectomy; Successful fusion; Bone mineral density

MeSH Terms

Bone Density
Diabetes Mellitus
Diskectomy*
Female
Humans
Incidence
Menopause*
Prospective Studies
Retrospective Studies
Smoke
Smoking
Transplants
Smoke

Figure

• 

  Fig. 1 Plain X-rays show the examples of successful fusion in different site after ACDF. A : Successful fusion with a bridging bone in disc space. B : Successful fusion with a bridging bone in posterior corner. C : Successful fusion with bridging bones in disc space and posterior corner. ACDF : anterior cervical discectomy and successful fusion.

• 

  Fig. 2 Plain X-rays show the examples of adjacent segment degeneration and subsidence after ACDF. A : Immediate postoperative X-ray. B : Increased body spur at superior adjacent level at 12 month after surgery. C : Subsidence is shown at the fused segment using cage. ACDF : anterior cervical discectomy and successful fusion.

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