Cervical Anterior Fusion with the Williams-Isu Method: Clinical Review

Department of Neurosurgery, Graduate School of Medicine, Nippon Medical School, Chiba, Japan.
Journal of Nippon Medical School (Impact Factor: 0.58). 02/2012; 79(1):37-45. DOI: 10.1272/jnms.79.37
Source: PubMed


Anterior decompression and fusion of the cervical spine is a widely accepted treatment for cervical canal disease. The Williams-Isu method involves cervical anterior fusion with autologous bone grafts from cervical vertebral bodies. Its advantages are a wide operative field, excellent graft fusion, the absence of problems related to the iliac donor site, and direct visualization of the nerve root. For detailed decompression of the cervical root, an ultrasonic bone curette (SONOPET, Stryker Japan K.K., Tokyo) may be useful. To prevent graft extrusion, bioabsorbable screws featuring a head are placed in 4 corners of the bone graft and are fixed with a tap on a part of the graft. The screws are visualized on postoperative X-ray, computed tomography, and magnetic resonance imaging studies. In 69 patients reported elsewhere there were no complications attributable to screw insertion, screw or graft extrusion, or surgery-related infections. When adequate bone cannot be harvested, a piece of ceramic hydroxyapatite is placed between the bone grafts. This sandwich method reinforces the graft, and radiological evidence suggests that it yields better results with respect to the angle and height of the fused segment. For the surgical treatment of cervical ossification of the posterior longitudinal ligament, a large vertebral bone window and a large bone graft are needed; this may result in postoperative radiological worsening. Radiological studies have shown that cervical ossification of the posterior longitudinal ligament can, as can cervical spondylosis, be addressed with the Williams-Isu method. Detailed radiological studies in patients treated with the Williams-Isu method have demonstrated that the range of motion and the disc height of the fused segment must be considered to prevent worsening in that segment after anterior fusion. The Williams-Isu method cannot completely correct cervical alignment, and great caution must be exercised in patients with preoperative malalignment. To reduce the levels to be fused in patients with multilevel lesions due to cervical disease, the Williams-Isu method can be combined with the transvertebral approach. The transvertebral approach facilitated by the wide Williams-Isu window allows the root bifurcation area to be confirmed during the early stage of surgery and possible decompression along the root. Radiological examination has shown that the combination of the Williams-Isu method and transvertebral approach does not affect the fusion level compared with the Williams-Isu method alone and produces better results than does the transvertebral approach alone.

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Available from: Kyongsong Kim, Jan 04, 2014
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    ABSTRACT: Anterior cervical fixation with autologous bone transplantation-without the need for harvesting bone from other sites, such as the ilium-was developed by Williams and modified by Isu et al. In recent intervertebral fusion procedures, after harvesting the cuboid bone from vertebral bodies, a hydroxyapatite block is placed between two harvested vertebral bones in the same way as in the sandwich method for intervertebral fixation. According to previous studies, this procedure has the following disadvantages: (i) as the corrective force for cervical kyphosis is insufficient, it could not be adapted for patients with preoperative kyphosis; (ii) special devices, including a microsurgical saw, are required for harvesting vertebral bones. In our modified method, we used a conventional high-speed drill instead of a microsurgical saw. Nevertheless, the results show that the operated spine can be stabilized to a greater extent by decreasing the height of the grafted bone, and this might help in reducing postoperative kyphosis.
    Full-text · Article · Mar 2015 · Journal of Nippon Medical School
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    ABSTRACT: Anterior cervical discectomy and fusion (ACDF) has become a common procedure for cervical spine surgeries, since it is safe and effective in most patients. However, some patients develop life-threatening problems such as respiratory obstruction arising from rare postoperative hematoma and edema, although intraoperative bleeding caused by the connective tissue splitting procedure or bleeding caused by postoperative insertion of a suction tube has rarely been reported. Investigation of the requirement for indwelling drains in patients who undergo cervical spine surgery is necessary because of the pain, anxiety, and discomfort caused despite the use of high-quality materials. Enrolled in the study were 43 patients who underwent one-level anterior cervical fixation surgery, including 23 (randomly selected) who received an indwelling drain (group A, mean age: 57.78±14.46 years, range: 39-82 years, male/female: 13/10), and 20 who received no indwelling drain (group B, mean age: 57.00±13.99 years, range: 29-81 years, male/female: 12/8). Intraoperative bleeding amounts, lateral views of plain cervical spine radiographs, prevertebral space (PVS) changes on plain radiographs and computed tomography (CT) images, wound inspections, and pain assessments on the Numeric Rating Scale (NRS) were compared between groups. In addition, a history of risk factors for bleeding, such as hypertension, diabetes, and cerebrovascular diseases which require antiplatelet therapy, was determined. Hepatic failure was observed in none of the patients. Postoperative CT images obtained the day following surgery showed no densities indicating the presence of postoperative hematoma in any of the 43 patients. The maximum amount of intraoperative bleeding was 10 mL, with no significant difference between groups. No patients reported an obvious pain level on NRS, but the pain was significantly milder in group B (A: 1.326±0.911, B: 0.555±0.556, p=0.0037). The postoperative PVS increment on plain radiographs was comparable between groups (A: 1.778±0.992, B: 1.730±0.966, p=0.8728). Given the negligible intraoperative and postoperative bleeding observed in both groups, and the lack of difference in PVS increments between the groups, our results suggested that indwelling drains are not required for patients undergoing typical anterior cervical fixation surgery. However, it is important to take care of major vessels such as the superior and inferior thyroid arteries and the external jugular vein as well as the prevertebral venous plexus during surgery.
    Preview · Article · Jul 2015 · Journal of Nippon Medical School