Minim Invasive Neurosurg 2011; 54(04): 172-178
DOI: 10.1055/s-0031-1284399
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Use of Nitinol Shape Memory Alloy Staples (Niti Clips) after Cervical Discoidectomy: Minimally Invasive Instrumentation and Long-Term Results

D. Singh
1   Department of Neurosurgery, G B Pant Hospital, New Delhi, India
,
S. Sinha
1   Department of Neurosurgery, G B Pant Hospital, New Delhi, India
,
H. Singh
1   Department of Neurosurgery, G B Pant Hospital, New Delhi, India
,
A. Jagetia
1   Department of Neurosurgery, G B Pant Hospital, New Delhi, India
,
S. Gupta
1   Department of Neurosurgery, G B Pant Hospital, New Delhi, India
,
P. Gangoo
2   Department of Anaesthesia, G B Pant Hospital, New Delhi, India
,
M. Tandon
2   Department of Anaesthesia, G B Pant Hospital, New Delhi, India
› Author Affiliations
Further Information

Publication History

Publication Date:
15 September 2011 (online)

Abstract

Background:

Anterior cervical discoidectomy with or without fusion is a well established surgical remedy for cervical prolapsed intervertebral disc (PIVD) disease. If fusion is done by an iliac bone graft then internal fixation is commonly used to keep the graft in position. This study was conducted to determine the efficacy and tolerability of shape memory alloys, especially NiTi (nickel titanium) clips in the stabilization of grafts following anterior cervical discoidectomy.

Methods:

133 NiTi clips were applied in 119 patients between January 2002 and December 2008. The patients age ranged from 38–60 years. There were 66 male and 53 females. Various indications for fixation of the spine included degenerated cervical spondylosis with single level PIVD (105) and two level PIVD in 14 patients. The cine mode fluoroscopy confirmed the perioperative correct placement of grafts and clips in all the patients. Follow-up ranged from 2 to 8 years (mean: 4.6 years).

Results:

Single level discoidectomy was performed in 105 patients and two level disc removal was done in 14 patients. A single NiTi clip was applied in all the cases except for 14 cases of two level PIVD. No procedural complication or adverse reaction to the clip was noted. There was no movement at the operated level in dynamic lateral view X-ray of cervical spine at the 1st postoperative day as well as on follow-up. Graft extrusion was seen in one patient on the 2nd day after surgery and was reoperated. Bony fusion occurred in all patients after 9 − 12 months of surgery. There was no incidence of breakage or dislodgement of the clip from the site where it was inserted. No artifact was noted in cervical MRI done in 33 patients.

Conclusion:

NiTi clips are a simple alternative for cervical spine stabilization after discoidectomy. Their insertion is simple, minimally invasive, does not require any special set of instruments and they are much more economical than other established methods of treatment. These clips are accepted well by human tissue and do not interfere with MRI.

 
  • References

  • 1 Connolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion: outcome analysis of patients fused with or without anterior cervical plates. J Spinal Disord 1996; 9: 202-206
  • 2 Chuang Tic, Cho DY, Chang CS et al. Efficacy and safety of the titanium mesh cage and anterior cervical plate for interbody fusion after anterior cervical corpectomy. Surg Neurol 2006; 65: 464-471
  • 3 Narottam PK, Panley SM, Mc Ginn GJ. Titanium mesh for cervical spine stabilization after corpectomy: a clinical and radiological study. J Neurosurg 2003; 99: 172-180
  • 4 Siddiqui AA, Jackowski A. Cage versus tricorticate graft for cervical interbody fusion: A prospective randomized study. J Bone Joint Surg (Br) 2003; 85: 1019-1025
  • 5 Floyd D, Ohnmeiss D. A meta-analysis of autograft versus allograft in anterior cervical fusion. Eur Spine J 2000; 9: 398-403
  • 6 BenDebba M, Heller J, Ducker TB et al. Cervical spine outcomes questionnaire: its development and psychometric properties. Spine 2002; 27: 2116-2124
  • 7 Samartzis D, Shen FH, Lyon C et al. Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion?. Spine J 2004; 4: 636-643
  • 8 Padua R, Padua L, Ceccarelli E et al. Cross-cultural adaptation of the lumbar North American Spine Society questionnaire for Italian-speaking patients with lumbar spinal disease. Spine 2001; 26: 344-347
  • 9 Molloy RD. The use of NiTi shape memory staples in the fixation of pediatric mandibular fractures. J Trauma 2009; 66: 963-965
  • 10 Ryhänen J, Kallioinen M, Serlo W et al. Bone healing and mineralization, implant corrosion, and trace metals after nickel-titanium shape memo­ry metal intramedullary fixation. J Biomed Mater Res 1999; 47: 472-480
  • 11 Es-Souni M, Es-Souni M, Fischer-Brandies H. Assessing the biocompatibility of NiTi shape memory alloys used for medical applications. Anal Bioanal Chem 2005; 381: 557-567
  • 12 Veldhuizen AG, Sanders MM, Cool JC. A scoliosis correction device based on memory metal. Med Eng Phys 1997; 19: 171-179
  • 13 Bolesta MJ, Rechtine GR, Chrin AM. One- and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine 2002; 2: 197-203
  • 14 Nohra G, Abi-Lahoud G, Jabbour P et al. Anterior cervical discectomy with or without bone graft placement in the treatment of cervical radiculopathy. Long-term results. Neurochirurgie 2003; 49: 571-578
  • 15 Russell SM, Benjamin V. The anterior surgical approach to the cervical spine for intervertebral disc disease. Neurosurgery 2004; 54: 1144-1149
  • 16 Thorell W, Cooper J, Hellbusch L et al. The long-term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement. Neurosurgery 1998; 43: 268-274
  • 17 Sonntag VKH, Klara P. Controversy in spine care. Is fusion necessary after anterior cervical discectomy?. Spine 1996; 21: 1111-1113
  • 18 Kao FC, Niu CC, Chen LH et al. Maintenance of interbody space in one- and two-level anterior cervical interbody fusion: comparison of the effectiveness of autograft, allograft, and cage. Clin Orthop Relat Res 2005; 430: 108-116
  • 19 Boden SD, Schimandle JH, Hutton WC et al. The use of an osteoinductive growth factor for lumbar spinal fusion. Part I. The biology of spinal fusion. Spine 1995; 20: 2626-2632
  • 20 Schimandle JH, Boden SD, Hutton WC. Experimental spinal fusion with recombinant human bone morphogenetic protein-2. Spine 1995; 20: 1326-1337
  • 21 Jenis LG, An HS, Simpson JM. A prospective comparison of the stan­dard and reverse Robinson cervical grafting techniques: radiographic and clinical analyses. J Spinal Disord 2000; 13: 369-373
  • 22 Spiegel DA, Cunningham BW, Oda I et al. Anterior vertebral screw strain with and without solid interspace support. Spine 2000; 25: 2755-2761
  • 23 Craven TG, Carson WL, Asher MA et al. The effect of implant stiffness on the bypassed bone mineral density and facet fusion stiffness of the canine spine. Spine 1994; 19: 1664-1673
  • 24 McAfee PC, Farey ID, Sutterlin CE et al. Volvo Award in basic science. Device-related osteoporosis with spinal instrumentation. Spine 1989; 14: 919-926
  • 25 Mantovani D. Shape memory alloys: Properties and biomedical applications. J Minerals, Metals Materials Soc 2000; 52: 36-44
  • 26 Shabalovskaya SA. Surface, corrosion and biocompatibility aspects of Nitinol as an implant material. Biomed Mater Eng 2002; 12: 69-109
  • 27 Bansiddhi A, Sargeant TD, Stupp SI et al. Porous NiTi for bone implants: a review. Acta Biomater 2008; 4: 773-782
  • 28 Dai KR, Hou XK, Sun YH et al. Treatment of intra-articular fractures with shape memory compression staples. Injury 1993; 24: 651-655
  • 29 Musialek J, Filip P, Nieslanik J. Titanium-nickel shape memory clamps in small bone surgery. Arch Orthop Trauma Surg 1998; 117: 341-344
  • 30 Baumgart F, Bensmann G, Haasters J. Memory alloys − new material for implantation in orthopedic surgery. In: Uthof HK. ed. Current concepts of internal fixation of fractures: 122-127. . Springer; Berlin: 1980
  • 31 Riccioni ME, Shah SK, Tringali A et al. Endoscopic palliation of unresectable malignant oesophageal strictures with self-expanding metal stents: comparing Ultraflex and Esophacoil stents. Dig Liver Dis 2002; 34: 356-363
  • 32 Ryhänen J, Kallioinen M, Tuukkanen J et al. In vivo biocompatibility evaluation of nickel-titanium shape memory metal alloy: muscle and perineural tissue responses and encapsule membrane thickness. J Biomed Mater Res 1998; 41: 481-488