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Sample records for anterior cervical discectomy

  1. Experience with titanium cages in anterior cervical discectomy and fusion

    International Nuclear Information System (INIS)

    Junaid, M.; Afsheen, A.; Bukhari, S.S.; Rashid, M.U.; Kalsoom, A.

    2016-01-01

    Background: Anterior cervical discectomy is a common procedure for treating patients for cervical disc prolapse. This study was conducted to study the surgical outcome and demographic characteristics of patients who were treated for anterior cervical disc prolapse. Methods: Study was conducted in the combined military hospital (CMH) Peshawar. Study interval was 3 years from 1st September, 2011 to 31st August, 2014. Total number of patients were 84. Males were 54 (64.28 percentage) and females were 30 (35.71 percentage). All the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium cages (ACDF). All the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse. Results: Total 84 patients were operated. In the patients who complained of brachialgia, 100 percentage improvement was seen after the operation. Three (3.5 percentage) of the patients, who presented with axial neck pain, continued to complain of pain and 2 (2.5 percentage) of the patients complained of pain at the donor site after the operation. One of the patient had dural tear which resulted in subcutaneous cerebrospinal fluid (CSF) accumulation and was treated conservatively with repeated aspiration. Fusion rate was 100 percentage with titanium cages used for fusion after anterior cervical discectomy. No complications were noted after the surgery at 1 year of interval. Conclusion: Results with titanium cages are expectedly good. Symptoms resolved and fusion rate was 100 percentage at 1 year follow up. (author)

  2. Bilateral vocal cord injury following anterior cervical discectomy ...

    African Journals Online (AJOL)

    We present a rare case of bilateral vocal cord injury (BVCI) following anterior cervical discectomy with fusion (ACD/F) in a 47 year old man. The patient experienced postextubation stridor and whispering voice in the recovery room. Clinical assessment led to the diagnosis of BVCI. The patient was treated by tracheostomy ...

  3. Anterior cervical discectomy and fusion for noncontiguous cervical spondylotic myelopathy

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    Sun Qizhi

    2016-01-01

    Full Text Available Background: Noncontiguous cervical spondylotic myelopathy (CSM is a special degenerative disease because of the intermediate normal level or levels between supra and infraabnormal levels. Some controversy exists over the optimal procedure for two noncontiguous levels of CSM. The study was to evaluate the outcomes of the anterior cervical discectomy and fusion (ACDF with zero-profile devices for two noncontiguous levels of CSM. Materials and Methods: 17 consecutive patients with two noncontiguous levels of CSM operated between December 2009 and August 2012 were included in the study. There were 12 men and 5 women with a mean age of 60.7 years (range 45-75 years. Involved disc levels were C3/4 and C5/6 in 11 patients and C4/5 and C6/7 in six patients. Preoperative plain radiographs, computed tomography (CT with 3-D reconstruction and magnetic resonance imaging (MRI of the cervical spine were taken in all patients. All radiographs were independently evaluated by 2 spine surgeons and 1 radiologist. The outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA score, improvement rate, neck dysfunction index (NDI, swallowing quality of life (SWAL-QOL score, the cervical lordosis and complications. Results: The mean followup was 48.59 months (range 24-56 months. The average operative time and blood loss was 105.29 min and 136.47 ml, respectively. The preoperative JOA score was 8.35, which significantly increased to 13.7 at the final followup ( P 0.05. Cerebrospinal fluid leak, dysphagia and radiological adjacent segment degeneration occurred in one patient, respectively. Conclusion: The ACDF with zero-profile devices is generally effective and safe in treating two noncontiguous levels of CSM.

  4. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: a systematic review.

    Science.gov (United States)

    Jiang, Sheng-Dan; Jiang, Lei-Sheng; Dai, Li-Yang

    2012-02-01

    There is considerable controversy as to which technique is best option for reconstruction after multilevel anterior decompression for cervical spondylosis. The aim of this study was to compare the clinical and radiographic results and complications of anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) in the treatment of multi-level cervical spondylosis. We reviewed and analyzed papers published from Jan 1969 to Dec 2010 regarding the comparison of ACDF and ACCF for multilevel cervical spondylosis. Statistical comparisons were made when appropriate. Twelve studies were included in this systematic review. Blood loss was greater for ACCF compared with ACDF. Similarly, the rate of graft dislodgement in ACCF was higher than that in ACDF. Nonunion rates were 18.4% for 2-level ACDF and 37.3% for 3-level ACDF, whereas nonfusion rates were 5.1% for single-level ACCF and 15.2% for 2-level ACCF. In addition, nonunion rates for three disc levels fused were much higher than that for two disc levels fused, regardless of discectomy or corpectomy. Clinical outcome was compared between ACDF and ACCF in nine studies. Of these, similar outcome was found between ACDF and ACCF in six studies, whereas three studies reported better outcome in ACCF compared with ACDF. Nonunion rates of ACDF are higher than those of ACCF for multilevel cervical spondylosis. Sometimes, clinical outcome of ACCF was better than ACDF for multilevel cervical spondylosis.

  5. Late Results of Anterior Cervical Discectomy and Fusion with Interbody Cages

    OpenAIRE

    Da?l?, Murat; Er, Uygur; ?im?ek, Serkan; Bavbek, Murad

    2013-01-01

    Study Design Retrospective analysis. Purpose To evaluate the effectiveness of anterior cervical discectomy with fusion for degenerative cervical disc disease. Overview of Literature Anterior spinal surgery originated in the mid-1950s and graft for fusion was also employed. Currently anterior cervical microdiscectomy and fusion with an intervertebral cage is a widely accepted procedure for treatment of cervical disc hernia. Artificial grafts and cages for fusion are preferred because of their ...

  6. Treatment of cervical radiculopathy by anterior cervical discectomy and cage fusion

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    Osman A Mohamed

    2012-01-01

    Full Text Available Introduction: Since the pioneering days of the anterior cervical approach introduced by Cloward et al. in the early 1950s, anterior cervical discectomy and fusion (ACDF has been the standard procedure for most discogenic and degenerative cervical spinal lesions. Although traditional interbody fusion using iliac bone can maintain the patency of the neuroforamen and ensure solid fusion, selection of patients, and of surgical procedure for ACDF is a continuous challenge. Aim: The aim of this study was to assess the results of cervical discectomy and fusion with cervical cages in treatment of cervical radiculopathy clinically and radiologically. Materials and Methods: Eighteen patients suffering from cervical radiculopathy were operated upon using this technique. They were 15 males and 3 females. Clinical and radiological assessment, visual analog scale (VAS for neck and arm and modified Oswestery neck disability index (NDI were done preoperatively and at 4 weeks, 3, 6, and 12 months postoperatively. Polyetheretherketone (Peek cages filled with iliac bone graft were used after cervical discectomy. The levels operated upon were C 5-6 in 16 patients and C4-5 in 2 patients. Results: Marked clinical improvement as regard arm and neck pain, and NDI was observed. The pre and post operative mean and standard deviations (SD of the various scores were as follows. VAS for pain in arm reduced from mean of 8 (SD 1.76 to mean 0.4 (SD 0.4, VAS for neck pain reduced from mean of 3.5 (SD 1.58 to mean of 0.8 (SD 0.47, and NDI from mean of 20.2 (SD 0.89 to 2.1(SD 1.05. Fusion occurred in all patients. Subjectively 79% of the patients reported marked improvement in neck pain, and 95% reported marked reduction in arm pain. Conclusion: Anterior cervical discectomy and cage fusion resulted in high fusion rate with minimal preservation of lordosis.

  7. Multilevel cervical disc replacement versus multilevel anterior discectomy and fusion

    Science.gov (United States)

    Wu, Ting-kui; Wang, Bei-yu; Meng, Yang; Ding, Chen; Yang, Yi; Lou, Ji-gang; Liu, Hao

    2017-01-01

    Abstract Background: Cervical disc replacement (CDR) has been developed as an alternative surgical procedure to anterior cervical discectomy and fusion (ACDF) for the treatment of single-level cervical degenerative disc disease. However, patients with multilevel cervical degenerative disc disease (MCDDD) are common in our clinic. Multilevel CDR is less established compared with multilevel ACDF. This study aims to compare the outcomes and evaluate safety and efficacy of CDR versus ACDF for the treatment of MCDDD. Methods: A meta-analysis was performed for articles published up until August 2016. Randomized controlled trials (RCTs) and prospective comparative studies associated with the use of CDR versus ACDF for the treatment of MCDDD were included in the current study. Two reviewers independently screened the articles and data following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Results: Seven studies with 702 enrolled patients suffering from MCDDD were retrieved. Patients who underwent CDR had similar operative times, blood loss, Neck Disability Index (NDI) scores, and Visual Analog Scale (VAS) scores compared to patients who underwent ACDF. Patients who underwent CDR had greater overall motion of the cervical spine and the operated levels than patients who underwent ACDF. Patients who underwent CDR also had lower rates of adjacent segment degeneration (ASD). The rate of adverse events was significantly lower in the CDR group. Conclusion: CDR may be a safe and effective surgical strategy for the treatment of MCDDD. However, there is insufficient evidence to draw a strong conclusion due to relatively low-quality evidence. Future long-term, multicenter, randomized, and controlled studies are needed to validate the safety and efficacy of multilevel CDR. PMID:28422837

  8. Symptomatic Adjacent Segment Disease After Anterior Cervical Discectomy for Single-level Degenerative Disk Disease.

    Science.gov (United States)

    Donk, Roland D; Verhagen, Wim I M; Hosman, Allard J F; Verbeek, Andre; Bartels, Ronald H M A

    2018-02-01

    A prospective cohort of 142 patients underwent either anterior cervical discectomy alone, anterior cervical discectomy with fusion by cage stand-alone, or anterior cervical discectomy with arthroplasty. We then followed up on their condition for a mean of 9.1±1.9 years (5.6-12.2 y) later. We aimed to evaluate the annual rate of clinically symptomatic adjacent segment disease (ASD) and to analyze predictive factors. Until recent, ASD has been predominantly evaluated radiologically. It is not known whether all patients had complaints. A frequent cited annual rate of ASD is 2.9%, but a growing number of studies report a lower annual rate. Furthermore, maintaining motion to prevent ASD is one reason for implanting a cervical disk prosthesis. However, the results of studies contradict one another. Participants took part in a randomized controlled trial that ended prematurely because of the publication of evidence that did not justify continuation of the trial. The patients were randomly allocated to 3 groups, each of which received one of the abovementioned treatments. We defined symptomatic ASD as signs and symptoms caused by degeneration of an intervertebral disk adjacent to a level of previous anterior cervical disk surgery. At the last follow-up, we were able to ascertain whether clinically symptomatic ASD was present in any of the participants. The overall annual rate of symptomatic ASD was 0.7%. We found no statistically significant correlations between any of the investigated factors and symptomatic ASD except for the surgical method used. Symptomatic ASD was seen less often in anterior cervical discectomy solely or anterior cervical discectomy with arthroplasty than in anterior cervical discectomy with fusion by plate fixation. The annual rate of symptomatic ASD after an anterior cervical discectomy procedure was estimated to be 0.7%. This seems to be related to the procedure, although firm conclusions cannot be drawn. Level 2-prospective cohort.

  9. Minimally Invasive Anterior Cervical Discectomy Without Fusion to Treat Cervical Disc Herniations in Patients with Previous Cervical Fusions

    Science.gov (United States)

    Granville, Michelle; Berti, Aldo

    2017-01-01

    Adjacent level cervical disc disease and secondarily progressive disc space degeneration that develops years after previously successful anterior cervical fusion at one or more levels is a common, but potentially complex problem to manage. The patient is faced with the option of further open surgery which involves adding another level of disc removal with fusion, posterior decompression, and stabilization, or possibly replacing the degenerated disc with an artificial disc construct. These three cases demonstrate that some patients, especially after minor trauma, may have small herniated discs as the cause for their new symptoms rather than progressive segmental degeneration. Each patient became symptomatic after minor trauma three to six years after the original fusion and had no or minimal radiologic changes of narrowing of the disc or spur formation commonly seen in adjacent level disease, but rather had magnetic resonance imaging (MRI) findings typical of small herniated discs. After failing multiple months of conservative treatment they were offered surgery as an option. Subsequently, all three were successfully treated with minimal anterior discectomy without fusion. There are no reports in the literature of using minimal anterior cervical discectomy without fusion in previous fused patients. This report reviews the background of adjacent level cervical disease, the various biomechanical explanations for developing a new disc herniation rather than progressive segmental degeneration, and how anterior cervical discectomy without fusion can be an option in these patients. PMID:28473949

  10. Are External Cervical Orthoses Necessary after Anterior Cervical Discectomy and Fusion: A Review of the Literature.

    Science.gov (United States)

    Camara, Richard; Ajayi, Olaide O; Asgarzadie, Farbod

    2016-07-14

    The use of external cervical orthosis (ECO) after anterior cervical discectomy and fusion (ACDF) varies from physician to physician due to an absence of clear guidelines. Our purpose is to evaluate and present evidence answering the question, "Does ECO after ACDF improve fusion rates?" through a literature review of current evidence for and against ECO after ACDF.  A PubMed database search was conducted using specific ECO and ACDF related keywords. Our search yielded a total of 1,267 abstracts and seven relevant articles. In summary, one study provided low quality of evidence results supporting the conclusion that external bracing is not associated with improved fusion rates after ACDF.  The remaining six studies provide very low quality of evidence results; two studies concluded that external bracing after cervical procedures is not associated with improved fusion rates, one study concluded that external bracing after cervical procedures is associated with improved fusion rates, and the remaining three studies lacked sufficient evidence to draw an association between external bracing after ACDF and improved fusion rates. We recommend against the routine use of ECO after ACDF due to a lack of improved fusion rates associated with external bracing after surgery.

  11. Reoperation Rates After Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Radiculopathy and Myelopathy: A National Population-based Study.

    Science.gov (United States)

    Park, Moon Soo; Ju, Young-Su; Moon, Seong-Hwan; Kim, Tae-Hwan; Oh, Jae Keun; Makhni, Melvin C; Riew, K Daniel

    2016-10-15

    National population-based cohort study. To compare the reoperation rates between cervical spondylotic radiculopathy and myelopathy in a national population of patients. There is an inherently low incidence of reoperation after surgery for cervical degenerative disease. Therefore, it is difficult to sufficiently power studies to detect differences between reoperation rates of different cervical diagnoses. National population-based databases provide large, longitudinally followed cohorts that may help overcome this challenge. We used the Korean Health Insurance Review and Assessment Service national database to select our study population. We included patients with the diagnosis of cervical spondylotic radiculopathy or myelopathy who underwent anterior cervical discectomy and fusion from January 2009 to June 2014. We separated patients into two groups based on diagnosis codes: cervical spondylotic radiculopathy or cervical spondylotic myelopathy. Age, sex, presence of diabetes, osteoporosis, associated comorbidities, number of operated cervical disc levels, and hospital types were considered potential confounding factors. The overall reoperation rate was 2.45%. The reoperation rate was significantly higher in patients with cervical spondylotic myelopathy than in patients with cervical radiculopathy (myelopathy: P = 0.0293, hazard ratio = 1.433, 95% confidence interval 1.037-1.981). Male sex, presence of diabetes or associated comorbidities, and hospital type were noted to be risk factors for reoperation. The reoperation rate after anterior cervical discectomy and fusion was higher for cervical spondylotic myelopathy than for cervical spondylotic radiculopathy in a national population of patients. 3.

  12. Retrospective analysis of arthrodesis from various options after anterior cervical discectomy

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    Vinaysagar Sharma

    2018-01-01

    Full Text Available Introduction: Anterior cervical discectomy is a surgical procedure performed to treat a herniated/degenerated disc in the cervical region. There have been various studies comparing arthrodesis rates among various procedures. Our patients belonged to varied socioeconomic background and underwent anterior cervical microdiscectomy without/with instrumentation. Aim: The present study was performed to study and compare the arthrodesis rates in the patients operated for anterior cervical microdiscectomy with and without fusion/instrumentation procedures at our institution. Materials and Methods: This is a retrospective study performed at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. Pre- and post-operative X-rays were assessed in 96 patients who had undergone anterior cervical discectomy with/without fusion from June 2012 to June 2015. Radiographic arthrodesis was assessed in all patients. An arbitrary grading was designed by us and categorized into Grade I to IV. The criteria considered for adequate arthrodesis in this study were: (a <2° movement on dynamic X-rays, (b restored disc space height (±2 mm accepted, and (c evidence of solid bone mass around disc space. Arthrodesis was categorized as Grade I if all the above 3 criteria on X-rays was fulfilled, Grade II if any 2 of the criteria was fulfilled, Grade III if any 1 of the criteria was fulfilled, and Grade IV when pseudoarthrosis/none of the criteria was fulfilled. Grade I arthrodesis was noted in about 79 patients (82.2%, Grade II in 14 patients, and only 3 patients had Grade III arthrodesis. There were no patients with absent arthrodesis/pseudoarthrosis. Results: Satisfactory arthrodesis was noted in 82% of the total patients, with patients undergoing fusion ± instrumentation procedure having better results. Conclusions: Arthrodesis by an interbody graft/implant with/without plating increases chances of success as compared to anterior cervical discectomy alone

  13. Anterior cervical discectomy and fusion to treat cervical spondylosis with sympathetic symptoms.

    Science.gov (United States)

    Hong, Liu; Kawaguchi, Yoshiharu

    2011-02-01

    Retrospective study. To investigate the clinical effectiveness of polytheretherketone (PEEK) cages-assisted anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis with sympathetic symptoms. The diagnosis and treatment of cervical spondylosis with sympathetic symptoms has remained controversial. To date, few reports have focused on the surgical efficacy of cervical spondylosis with sympathetic symptoms. Retrospective analysis was undertaken for 39 patients who were diagnosed as cervical spondylosis with sympathetic symptoms and underwent ACDF with PEEK cages. They were followed up for at least 1 year. The mean follow-up was 15.6 months. Radiographs obtained before surgery, after surgery, and at the final follow-up were assessed for quality of fusion. The sympathetic symptoms including vertigo, headache, tinnitus, nausea and vomiting, heart throb, hypomnesia, and gastroenterologic discomfort were scored by 20-point system preoperatively, 2 months postoperatively, and at the final follow-up. The recovery rate and clinical satisfaction rate were also evaluated. Surgical complications were also assessed. Radiographs of the cervical spine at the last follow-up revealed a solid fusion with no signs of a pseudoarthrosis in 36 cases. In 2 patients delayed union and bony fusion were achieved at 9 and 11 months. Pseudoarthrosis was found in 1 case but the patient had no symptoms. The sympathetic symptoms improved in all patients and the score was significantly improved after surgery. There was one patient who had cerebral spinal fluid leakage but he recovered 1 week after surgery. Two patients felt a mild swallowing discomfort, but it disappeared within 1 month after surgery. Subcutaneous hematoma occurred in one patient due to obstructed drainage. It was cleared 2 days after surgery. Cervical spondylosis patients with sympathetic symptoms may be managed successfully with ACDF using PEEK cages. Successful clinical results regarding symptom improvement

  14. ANTERIOR PERCUTANEOUS CERVICAL DISCECTOMY. TWO-YEAR FOLLOW-UP OF A BLUNT TECHNIQUE PROCEDURE

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    Jorge Felipe Ramírez León

    Full Text Available ABSTRACT Objective: To report the outcomes of non-endoscopic percutaneous cervical discectomy by anterior blunt approach for the treatment of degenerative disc disease. Methods: A review of the medical records of patients with axial cervical pain resulting from degenerative disc disease and treated with discectomy and percutaneous nucleoplasty by anterior blunt approach with radiofrequency source was carried out. The data were evaluated according to modified MacNab and pre- and postoperative VAS criteria at 3, 12 and 24 months. Results: Sixty-two procedures were performed in 48 patients between 2008 and 2014. The mean age of the population was 52.4 years. MacNab results were 84.6%, 92.3%, and 89.2% improvement (excellent and good results at 3, 12 and 24 months, respectively. The VAS changed from 7.4 to 2.3 two years after the procedure, showing a statistically significant difference (p=0.000. There were no major complications or re-interventions related to the technique. Conclusions: Anterior non-endoscopic discectomy and nucleoplasty for the treatment of discogenic axial cervical pain may be an effective alternative to open surgery. In the two-year follow-up, our blunt technique proved to be a safe procedure with no approach-related complications, and provided outcomes comparable to those reported using the original needle technique.

  15. Adjacent Segment Degeneration Following Anterior Cervical Discectomy and Fusion Versus the Bryan Cervical Disc Arthroplasty.

    Science.gov (United States)

    Yan, Suo-Zhou; Di, Jun; Shen, Yong

    2017-06-02

    BACKGROUND Anterior cervical discectomy and fusion (ACDF) is an established treatment for degenerative disease of the cervical disc, but adjacent segment degeneration or instability may develop long term. The aim of this study was to investigate the risk factors for adjacent segment degeneration following ACDF compared with the use of the Bryan artificial disc for cervical disc arthroplasty (CDA). MATERIAL AND METHODS A prospective comparative study included 93 patients who underwent ACDF or CDA with the Bryan artificial cervical disc between 2002 and 2004, and who had more than eight years of follow-up. There were 29 cases in the CDA group and 39 cases in ACDF group, with a follow-up rate of 73.12%. Clinical results and imaging data were assessed before and after surgery. RESULTS There was no significant difference between the two groups in radiographic parameters at each follow-up time point. There were 19 cases of adjacent segment degeneration (48.72%) in the ACDF group, and 13 cases of adjacent segment degeneration (44.83%) in the CDA group, with no statistically significant difference (P>0.05). Univariate analysis showed that advanced age (OR 1.271, 95% CI 1.005-1.607), low preoperative overall lordosis (OR 0.858, 95% CI 0.786-0.936) and low preoperative segmental lordosis (OR 1.185, 95% CI 1.086-1.193) were significantly correlated with adjacent segment degeneration. CONCLUSIONS Equally good clinical outcomes were achieved with both the ACDF and the Bryan CDA. Increasing patient age was associated with adjacent segment degeneration in both patient groups.

  16. Adjacent Segment Degeneration Following Anterior Cervical Discectomy and Fusion Versus the Bryan Cervical Disc Arthroplasty

    Science.gov (United States)

    Yan, Suo-Zhou; Di, Jun; Shen, Yong

    2017-01-01

    Background Anterior cervical discectomy and fusion (ACDF) is an established treatment for degenerative disease of the cervical disc, but adjacent segment degeneration or instability may develop long term. The aim of this study was to investigate the risk factors for adjacent segment degeneration following ACDF compared with the use of the Bryan artificial disc for cervical disc arthroplasty (CDA). Material/Methods A prospective comparative study included 93 patients who underwent ACDF or CDA with the Bryan artificial cervical disc between 2002 and 2004, and who had more than eight years of follow-up. There were 29 cases in the CDA group and 39 cases in ACDF group, with a follow-up rate of 73.12%. Clinical results and imaging data were assessed before and after surgery. Results There was no significant difference between the two groups in radiographic parameters at each follow-up time point. There were 19 cases of adjacent segment degeneration (48.72%) in the ACDF group, and 13 cases of adjacent segment degeneration (44.83%) in the CDA group, with no statistically significant difference (P>0.05). Univariate analysis showed that advanced age (OR 1.271, 95% CI 1.005–1.607), low preoperative overall lordosis (OR 0.858, 95% CI 0.786–0.936) and low preoperative segmental lordosis (OR 1.185, 95% CI 1.086–1.193) were significantly correlated with adjacent segment degeneration. Conclusions Equally good clinical outcomes were achieved with both the ACDF and the Bryan CDA. Increasing patient age was associated with adjacent segment degeneration in both patient groups. PMID:28574978

  17. Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy.

    Science.gov (United States)

    Ghori, Ahmer; Konopka, Joseph F; Makanji, Heeren; Cha, Thomas D; Bono, Christopher M

    2016-01-01

    Current literature suggests that anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) have comparable clinical outcomes for the treatment of cervical radiculopathy. Given similar outcomes, an understanding of differences in long-term societal costs can help guide resource utilization. The purpose of this study was to compare the relative long-term societal costs of anterior cervical discectomy and fusion (ACDF) to cervical disc arthroplasty (CDA) for the treatment of single level cervical disc disease by considering upfront surgical costs, lost productivity, and risk of subsequent revision surgery. We completed an economic and decision analysis using a Markov model to evaluate the long-term societal costs of ACDF and CDA in a theoretical cohort of 45-65 year old patients with single level cervical disc disease who have failed nonoperative treatment. The long-term societal costs for a 45-year old patient undergoing ACDF are $31,178 while long-term costs for CDA are $24,119. Long-term costs for CDA remain less expensive throughout the modeled age range of 45 to 65 years old. Sensitivity analysis demonstrated that CDA remains less expensive than ACDF as long as annual reoperation rate remains below 10.5% annually. Based on current data, CDA has lower long-term societal costs than ACDF for patients 45-65 years old by a substantial margin. Given reported reoperation rates of 2.5% for CDA, it is the preferred treatment for cervical radiculopathy from an economic perspective.

  18. Thoracic spinal subdural hematoma complicating anterior cervical discectomy and fusion: case report.

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    Protzman, Nicole M; Kapun, Jennifer; Wagener, Christopher

    2015-10-13

    A spinal subdural hematoma is a rare clinical entity with considerable consequences without prompt diagnosis and treatment. Throughout the literature, there are limited accounts of spinal subdural hematoma formation following spinal surgery. This report is the first to describe the formation of a spinal subdural hematoma in the thoracic spine following surgery at the cervical level. A 53-year-old woman developed significant paraparesis several hours after anterior cervical discectomy and fusion of C5-6. Expeditious return to operating room for anterior cervical revision decompression was performed, and the epidural hematoma was evacuated without difficulty. Postoperative imaging demonstrated a subdural hematoma confined to the thoracic level, and the patient was returned to the operating room for a third surgical procedure. Decompression of T1-3, with evacuation of the subdural hematoma was performed. Postprocedure, the patient's sensory and motor deficits were restored, and, with rehabilitation, the patient gained functional mobility. Spinal subdural hematomas should be considered as a rare but potential complication of cervical discectomy and fusion. With early diagnosis and treatment, favorable outcomes may be achieved.

  19. Changes in Swallowing after Anterior Cervical Discectomy and Fusion with Instrumentation: A Presurgical versus Postsurgical Videofluoroscopic Comparison

    Science.gov (United States)

    Muss, Lydia; Wilmskoetter, Janina; Richter, Kerstin; Fix, Constanze; Stanschus, Soenke; Pitzen, Tobias; Drumm, Joerg; Molfenter, Sonja

    2017-01-01

    Purpose: The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method: We retrospectively analyzed both functional measures (penetration-aspiration, residue) and…

  20. Multi-channel motor evoked potential monitoring during anterior cervical discectomy and fusion

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    Dong-Gun Kim

    Full Text Available Objectives: Anterior cervical discectomy and fusion (ACDF surgery is the most common surgical procedure for the cervical spine with low complication rate. Despite the potential prognostic benefit, intraoperative neurophysiological monitoring (IONM, a method for detecting impending neurological compromise, is not routinely used in ACDF surgery. The present study aimed to identify the potential benefits of monitoring multi-channel motor evoked potentials (MEPs during ACDF surgery. Methods: We retrospectively reviewed 200 consecutive patients who received IONM with multi-channel MEPs and somatosensory evoked potentials (SSEPs. On average, 9.2 muscles per patient were evaluated under MEP monitoring. Results: The rate of MEP change during surgery in the multi-level ACDF group was significantly higher than the single-level group. Two patients from the single-level ACDF group (1.7% and four patients from the multi-level ACDF group (4.9% experienced post-operative motor deficits. Multi-channel MEPs monitoring during single and multi-level ACDF surgery demonstrated higher sensitivity, specificity, positive predictive and negative predictive value than SSEP monitoring. Conclusions: Multi-channel MEP monitoring might be beneficial for the detection of segmental injury as well as long tract injury during single- and multi-level ACDF surgery. Significance: This is first large scale study to identify the usefulness of multi-channel MEPs in monitoring ACDF surgery. Keywords: Disc disease, Somatosensory evoked potentials, Intraoperative neurophysiological monitoring, Motor evoked potentials, Anterior cervical discectomy and fusion

  1. Comparison of polyetheretherketone (PEEK) cage and cervical disc prostheses used in anterior cervical microscopic discectomy operations

    OpenAIRE

    Bahadir Alkan; Murat Cosar; Mustafa Guven; Adem Bozkurt Aras; Tarik Akman

    2017-01-01

    Objective: The aim of this study was to radiologically and clinically compare the polyetheretherketone (PEEK) cage and cervical disc prostheses used in anterior cervical microdiscectomy operations during the postoperative period. Methods: The study evaluated 25 cervical disc hernia patients. The cervical disc prosthesis group (Group A) comprised 10 patients while the PEEK cage group (Group B) comprised 15 patients. Before and after the operation, the cervical graphics from radiological mon...

  2. The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; A double-blind randomised multicenter study

    NARCIS (Netherlands)

    M.P. Arts (Mark); R. Brand (René); B.W. Koes (Bart); W.C. Peul (Wilco); M.E. van den Akker-van Marle (Elske)

    2010-01-01

    textabstractBackground. Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is

  3. Outcome of single level anterior cervical discectomy and fusion using nano-hydroxyapatite/polyamide-66 cage

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    Xi Yang

    2014-01-01

    Full Text Available Background: Cages have been widely used for the anterior reconstruction and fusion of cervical spine. Nonmetal cages have become popular due to prominent stress shielding and high rate of subsidence of metallic cages. This study aims to assess fusion with n-HA/PA66 cage following one level anterior cervical discectomy. Materials and Methods: Forty seven consecutive patients with radiculopathy or myelopathy underwent single level ACDF using n-HA/PA66 cage. We measured the segmental lordosis and intervertebral disc height on preoperative radiographs and then calculated the loss of segmental lordosis correction and cage subsidence over followup. Fusion status was evaluated on CT scans. Odom criteria, Japanese Orthopedic Association (JOA and Visual Analog Pain Scales (VAS scores were used to assess the clinical results. Statistically quantitative data were analyzed while Categorical data by χ2 test. Results: Mean correction of segmental lordosis from surgery was 6.9 ± 3.0° with a mean loss of correction of 1.7 ± 1.9°. Mean cage subsidence was 1.2 ± 0.6 mm and the rate of cage subsidence (>2 mm was 2%. The rate of fusion success was 100%. No significant difference was found on clinical or radiographic outcomes between the patients (n=27 who were fused by n-HA/PA66 cage with pure local bone and the ones (n=20 with hybrid bone (local bone associating with bone from iliac crest. Conclusions: The n-HA/PA66 cage is a satisfactory reconstructing implant after anterior cervical discectomy, which can effectively promote bone graft fusion and prevent cage subsidence.

  4. Anterior cervical discectomy with or without fusion with ray titanium cage: a prospective randomized clinical study

    DEFF Research Database (Denmark)

    Hauerberg, J.; Kosteljanetz, M.; Bøge-Rasmussen, Torben

    2008-01-01

    adjacent disc degeneration or spondylosis were the same in both groups. CONCLUSION: This study showed no statistically significant difference between simple discectomy and discectomy followed by interbody fusion with a titanium cage in the surgical treatment of cervical radiculopathy caused by disc...

  5. Anterior cervical discectomy with or without fusion with ray titanium cage: a prospective randomized clinical study

    DEFF Research Database (Denmark)

    Hauerberg, J.; Kosteljanetz, M.; Bøge-Rasmussen, Torben

    2008-01-01

    STUDY DESIGN: A prospective randomized clinical study. OBJECTIVE: To compare 2 surgical methods in the treatment of cervical radiculopathy caused by hard or soft disc herniation; namely, simple discectomy versus discectomy with an additional interbody fusion with a Ray titanium cage. SUMMARY...... of the nervous elements have been performed. To date, no randomized studies have compared simple discectomy with discectomy followed by an interbody fusion with a titanium cage. METHODS: Eighty-six patients with symptoms of nerve root compression at 1 level were randomly allocated to either discectomy followed...... by fusion with a Ray titanium cage (40 patients) or to discectomy alone (46 patients). Clinical and radiologic follow-up was performed 3, 12, and 24 months after surgery. RESULTS: There was no statistically significant difference between the 2 groups concerning self-reported satisfaction or severity of pain...

  6. Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review.

    Science.gov (United States)

    Liu, Wei-Jun; Hu, Ling; Chou, Po-Hsin; Wang, Jun-Wen; Kan, Wu-Sheng

    2016-11-01

    Controversy remains over whether anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is superior for the treatment of cervical radiculopathy. We therefore performed a systematic review including three prospective randomized controlled trails (RCT) and seven retrospective comparative studies (RCoS) by searching PubMed and EMBASE. These studies were assessed on risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and level of recommendation were evaluated according to the GRADE approach. Clinical outcomes, complications, reoperation rates, radiological parameters, and cost/cost-utility were evaluated. The mean complication rate was 7% in the ACDF group and 4% in the PCF group, and the mean reoperation rate was 4% in the ACDF group and 6% in the PCF group within 2 years of the initial surgery. There was a strong level of recommendation that no difference existed in clinical outcome, complication rate and reoperation rate between the ACDF and the PCF group. There was conflicting evidence that the ACDF group had better clinical outcomes than the PCF group (one study with weak level of recommendation). PCF could preserve the range of motion (ROM) of the operated segment but did not increase the ROM of the adjacent segment (weak level of recommendation). Meanwhile, the average cost or cost-utility of the PCF group was significantly lower than that of the ACDF group (weak level of recommendation). In conclusion, the PCF was just as safe and effective as the ACDF in the treatment of cervical radiculopathy. Meanwhile, PCF might have lower medical cost than ACDF and decrease the incidence of adjacent segment disease. Based on the available evidence, PCF appears to be another good surgical approach in the treatment of cervical radiculopathy. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  7. Anterior cervical discectomy and fusion versus cervical arthroplasty for the management of cervical spondylosis: a meta-analysis.

    Science.gov (United States)

    Ma, Zhuo; Ma, Xun; Yang, Huilin; Guan, Xiaoming; Li, Xiang

    2017-04-01

    The aim of this study was to compare the efficacy and safety of anterior cervical discectomy and fusion (ACDF) and cervical arthroplasty for patients with cervical spondylosis. PubMed, Embase, and Cochrane Library were used to search for relevant articles published prior to April 2016 to identify studies comparing ACDF and cervical arthroplasty involving patients with cervical spondylosis. Relative risks (RR) and mean differences (MD) were used to measure the efficacy and safety of ACDF and cervical arthroplasty using the random effects model. The meta-analysis of 17 studies involved 3122 patients diagnosed with cervical spondylosis. Patients undergoing ACDF showed lower overall success rate (RR 0.84; 95 % CI 0.77-0.92; P < 0.001), higher VAS score (MD 0.36; 95 % CI 0.08-0.64; P = 0.011), and shorter mean surgical duration (MD -1.62; 95 % CI -2.80 to -0.44; P = 0.007) when compared with cervical arthroplasty. However, the association between ACDF therapy and the risk of mean blood loss (MD -0.16; 95 % CI -0.34 to 0.02; P = 0.082), mean hospitalization (MD 0.02; 95 % CI -0.31 to 0.36; P = 0.901), patient satisfaction (RR 0.96; 95 % CI 0.92-1.00; P = 0.066), neck disability index (MD 0.20; 95 % CI -0.05 to 0.44; P = 0.113), reoperation (RR 1.25; 95 % CI 0.64-2.41; P = 0.514), or complication (RR 1.17; 95 % CI 0.90-1.52; P = 0.242) was not statistically significant. Patients undergoing ACDF therapy tended to exhibit lower overall success rate, higher VAS score, and decreased mean surgical duration when compared with patients treated with cervical arthroplasty.

  8. Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis.

    Science.gov (United States)

    Fallah, Aria; Akl, Elie A; Ebrahim, Shanil; Ibrahim, George M; Mansouri, Alireza; Foote, Clary J; Zhang, Yuqing; Fehlings, Michael G

    2012-01-01

    To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis. Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS), archives of spine meetings and bibliographies of relevant articles. We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate. We used random-effects model to pool data using mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome. Of 2804 citations, 9 articles reporting on 9 trials (1778 participants) were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004) and improvement in the Neck pain visual analogue scale (VAS) (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID) = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia. There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single level

  9. Long term outcome of anterior cervical discectomy and fusion using coral grafts.

    Science.gov (United States)

    Ramzi, Najib; Ribeiro-Vaz, Geraldo; Fomekong, Edward; Lecouvet, Frédéric E; Raftopoulos, Christian

    2008-12-01

    To determine the long term efficacy of coral grafts in anterior cervical discectomy and fusion. In this prospective longitudinal study, All patients presenting with myelopathy and/or radiculopathy due to discal hernia or cervical spondylosis underwent anterior cervical microdiscectomy, arthrodesis with coral, and stabilization with anterior cervical locking plates. Clinical and radiological post-operative evaluations were performed at 2 days, 3, 6, and 12 months, and then yearly. The visual analogue scale was used for the evaluation of pain. Fusion was defined as the absence of motion on dynamic imaging combined with the disappearance of radio-lucent lines around the graft. The mean follow-up period was 44 months. In 83.3%, 91.2% and 93.7% of patients there was a satisfactory outcome for neck pain, arm pain, and motor deficit, respectively. The overall complication rate was 17.5%, all of which were transient. Additional surgery was required in nine cases. The occurrence of complications is correlated with less satisfactory outcomes for both neck and arm pain. While 95.5% of patients expressed overall satisfaction with their surgery, 70.5% stated that they had returned to their previous activities. The fusion rate was 45%; which was not correlated with clinical outcome and more likely in patients with of cervical spondylosis and one-level arthrodesis. Despite satisfactory clinical results and a long follow-up period, coral implants yield low fusion rates, particularly in patients with discal hernia of two-level arthrodesis. The use of coral grafts cannot be recommended when fusion is one of the post-operative endpoints.

  10. Preoperative Radiographic Parameters to Predict a Higher Pseudarthrosis Rate After Anterior Cervical Discectomy and Fusion.

    Science.gov (United States)

    Choi, Sung H; Cho, Jae H; Hwang, Chang J; Lee, Choon S; Gwak, Hyun W; Lee, Dong-Ho

    2017-12-01

    Retrospective study. To determine whether postoperative pseudarthrosis can be predicted from specific preoperative radiograph measurements. Various factors reportedly influence the occurrence of pseudarthrosis after anterior cervical discectomy and fusion (ACDF). However, to our knowledge, there are no reports on the relationships between preoperative radiographic parameters and pseudarthrosis. We analyzed 84 consecutive patients (45 males, 39 females, mean age, 58.9 ± 11.2 yrs) who underwent ACDF. In all patients, allografts filled with local chip bone were inserted after discectomy and anterior plating was performed. On preoperative plain radiographs, we analyzed C2-C7 sagittal vertical axis, T1 sagittal slope, segmental motion, global cervical motion, and location of fusion segments. Pseudarthrosis was diagnosed as interspinous motion >1 mm with superjacent interspinous motion ≥4 mm on magnified dynamic lateral radiographs. Multivariate logistic regression was used to analyze the risk factors for pseudarthrosis and the receiver operating characteristic (ROC) curve was used to define a cutoff value. One hundred and twenty-five segments from 84 patients were included. The pseudarthrosis rate was 29% based on number of patients (24/84) and 20% based on number of segments (25/125). Multilevel surgery and segments at the lowest levels showed higher pseudarthrosis rates (P = 0.01). Per multivariate logistic regression analysis, greater preoperative segmental motion, greater preoperative T1 sagittal slope, and C6-7 segments were associated with a higher risk of pseudarthrosis (all P preoperative segmental motion, greater preoperative T1 sagittal slope, and lower fusion levels could be risk factors for pseudarthrosis following ACDF. Preoperative segmental motion >12° is likely to be an important indicator of the development of pseudarthrosis. 3.

  11. Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery.

    Science.gov (United States)

    Miller, Larry E; Block, Jon E

    2011-11-15

    Systematic review. The primary aim of this review was to evaluate clinical and radiographic outcomes in studies of anterior cervical discectomy and fusion (ACDF) using allograft versus ACDF with autograft, ACDF with cage devices, and cervical disc arthroplasty for the treatment of symptomatic cervical disc disease. ACDF remains the standard of care for patients with cervical radiculopathy who are unresponsive to conservative medical care. However, no known study has compared patient outcomes after ACDF with allograft, ACDF with autograft, ACDF with cage, and disc arthroplasty. After applying strict inclusion criteria, 21 comparisons from 20 studies formed the basis for this review. Patient outcomes included neck and arm pain, neck disability index (NDI), physical component summary (PCS), and mental component summary (MCS) scores from the SF-36, radiographic fusion rate, and select adverse events (e.g., wound infection, dysphagia, and adjacent segment degeneration). The four treatment groups included ACDF with allograft (allograft, n = 1341), ACDF with autograft (autograft, n = 568), ACDF with cage (cage, n = 87), and cervical disc arthroplasty (arthroplasty, n = 603). Neck pain was reduced similarly by 63% to 69% in all groups. Comparable improvements were realized in arm pain after ACDF with allograft (75%) or arthroplasty (73%) that were greater than other treatment groups (62-68%). There was notable improvement in neck disability (61-65%) with allograft and arthroplasty after treatment. PCS scores improved with allograft (42%) and arthroplasty (44%). MCS scores improved modestly (16-21%) with allograft and arthroplasty. Fusion rates were 91% for allograft and autograft and 97% for cage. Adverse events were uncommon in all groups. ACDF with allograft, ACDF with autograft, ACDF with cage, and cervical disc arthroplasty show similar improvements in pain, function, and quality of life with correspondingly low adverse event rates. All ACDF procedures result in high

  12. Post-operative complications in patients undergoing anterior cervical discectomy and fusion: A retrospective review

    Directory of Open Access Journals (Sweden)

    Rahul Yadav

    2017-01-01

    Full Text Available Background: Anterior cervical discectomy and fusion (ACDF is a surgical procedure used to manage various cervical spine disorders including spondylosis, prolapsed intervertebral disc, trauma and degenerative disc disease. However, this procedure may be associated with significant post-operative complications. In this study, we aimed to analyse the prevalence of post-operative complications following ACDF. Methods: Perioperative data of 128 patients who underwent ACDF surgery at our institute over a 3-year period was analysed. Patients who underwent previous neck surgeries were excluded. Results: Single level ACDF without cervical plating was observed to be the most commonly performed surgical procedure (53%. Dysphagia was the most common (16.4% post-operative complaint, followed by neurological deterioration (7.9%. One patient suffered pharyngeal perforation and presented postoperatively with subcutaneous emphysema and haemoptysis. Conclusions: Post-operative dyphagia and worsening of pre-existing myelopathy were the most common complications following ACDF, and multilevel surgery was identified as the most significant risk factor. The early detection and prompt management may help reduce mortality and morbidity in such patients.

  13. Degenerative changes following anterior cervical discectomy and fusion evaluated by fast spin-echo MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wu, W. [Univ. Hospital, Linkoeping (Sweden). Dept. of Diagnostic Radiology]|[The China-Japan Friendship Hospital, Beijing (China); Thuomas, K.Aa. [Univ. Hospital, Linkoeping (Sweden). Dept. of Diagnostic Radiology; Hedlund, R. [Univ. Hospital, Linkoeping (Sweden). Dept. of Spinal Surgery; Leszniewski, W. [Univ. Hospital, Linkoeping (Sweden). Dept. of Spinal Surgery; Vavruch, L. [Univ. Hospital, Linkoeping (Sweden). Dept. of Spinal Surgery

    1996-09-01

    Purpose: To review pre- and postoperative fast spin-echo (FSE) MR images of disc herniation and spondylosis in patients after spinal cervical surgery. Material and Methods: Data were reviewed of 68 patients after anterior discectomy and fusion (ADF) operations using the Cloward technique with solid single level (C5-C6 or C6-C7) or 2-level fusions (C5-C7). The average interval from surgery to review was 37 months. Age- and sex-matched controls without neck problems were examined. Results: Preoperatively, the fusion groups had a higher incidence of protruded disc, and anterior and posterior osteophytes at the levels to be fused than the controls. Postoperatively, there was a significantly higher incidence of posterior osteophytes at the fused levels compared with the controls. Furthermore, the disc herniations and anterior osteophytes at the levels above and below the operated segments were more frequent in the fusion group. Conclusion: ADF causes acceleration of the degenerative changes at the fused level and at the levels below and above the fused segments. (orig.).

  14. Economic burden of routine hematologic tests and intensive care unit observation for elective anterior cervical discectomy and fusion

    OpenAIRE

    Ching-Kuo Lin; Chih-Lung Lin; Yu-Tung Feng; Yu-Wa Lau; Cheng-Ying Chian; Yi-Tai Wu; Shiuh-Lin Hwang; King-Teh Lee

    2014-01-01

    Background: Anterior cervical discectomy and fusion is one of the most common surgical interventions performed by spine surgeons. As efforts are made to control healthcare spending because of the limited or capped resources offered by the National Health Insurance, surgeons are faced with the challenge of offering high-level patient care while minimizing associated healthcare expenditures. Routine ordering of postoperative hematologic tests and observational intensive care unit (ICU) stay mig...

  15. Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Aria Fallah

    Full Text Available To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA compared to anterior cervical discectomy with fusion (ACDF for patient-important outcomes for single-level cervical spondylosis.Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS, archives of spine meetings and bibliographies of relevant articles.We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD, reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate.We used random-effects model to pool data using mean difference (MD for continuous outcomes and relative risk (RR for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome.Of 2804 citations, 9 articles reporting on 9 trials (1778 participants were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004 and improvement in the Neck pain visual analogue scale (VAS (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia.There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single

  16. Effect of Anterior Cervical Discectomy and Fusion on Patients with Atypical Symptoms Related to Cervical Spondylosis.

    Science.gov (United States)

    Muheremu, Aikeremujiang; Sun, Yuqing; Yan, Kai; Yu, Jie; Zheng, Shan; Tian, Wei

    2016-09-01

    Background A considerable number of patients with cervical spondylosis complain about one or multiple atypical symptoms such as vertigo, palpitations, headache, blurred vision, hypomnesia, and/or nausea. It remains unclear whether surgical intervention for cervical spondylosis can also effectively alleviate those symptoms. The current study was performed to see if anterior cervical diskectomy and fusion (ACDF) offers such an extra benefit for patients with cervical spondylosis. Objective To investigate if patients who received ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy can also achieve alleviation of certain atypical symptoms associated with cervical spondylosis after the surgery in the long run. Methods Sixty-seven patients who underwent ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy were involved in this study. All these patients also complained about various associated atypical symptoms. They were followed up for 26 to 145 months after the surgery. Severity and frequency scores of the atypical symptoms before the surgery and at last follow-up were compared by paired t tests. Results Most patients reported significantly alleviated symptoms at the last follow-up compared with before the surgery. The severity of vertigo, headache, nausea, and palpitations were significantly alleviated at the last follow-up (with p values of p < 0.001, p = 0.001, p = 0.022, p = 0.004, respectively). There were no significant changes in the severity of tinnitus (p = 0.182), blurred vision (p = 0.260), and hypomnesia (p = 0.821). Conclusion ACDF can significantly alleviate vertigo, headache, nausea, and palpitations in most patients with cervical spondylotic myelopathy and/or radiculopathy, but it is not effective in alleviating symptoms such as tinnitus, blurred vision, and hypomnesia. It can be considered for alleviating atypical symptoms when other treatment options prove

  17. Noninfectious prevertebral soft-tissue inflammation and hematoma eliciting swelling after anterior cervical discectomy and fusion.

    Science.gov (United States)

    Yagi, Kenji; Nakagawa, Hiroshi; Okazaki, Toshiyuki; Irie, Shinsuke; Inagaki, Toru; Saito, Osamu; Nagahiro, Shinji; Saito, Koji

    2017-04-01

    OBJECTIVE Anterior cervical discectomy and fusion (ACDF) procedures are performed to treat patients with cervical myelopathy or radiculopathy. Dysphagia is a post-ACDF complication. When it coincides with prevertebral space enlargement and inflammation, surgical site infection and pharyngoesophageal perforation must be considered. The association between dysphagia and prevertebral inflammation has not been reported. The authors investigated factors eliciting severe dysphagia and its relationship with prevertebral inflammation in patients who had undergone ACDF. MATERIALS The clinical data of 299 patients who underwent 307 ACDF procedures for cervical radiculopathy or myelopathy at Kushiro Kojinkai Memorial Hospital and Kushiro Neurosurgical Hospital between December 2007 and August 2014 were reviewed. RESULTS After 7 ACDF procedures (2.3%), 7 patients suffered severe prolonged and/or delayed dysphagia and odynophagia that prevented ingestion. In all 7 patients the prevertebral space was enlarged. In 5 (1.6%) the symptom was thought to be associated with prevertebral soft-tissue edema; in all 5 an inflammatory response, hyperthermia, and an increase in the white blood cell count and in C-reactive protein level was observed. After 2 procedures (0.7%), we noted prevertebral hematoma without an inflammatory response. None of the patients who had undergone 307 ACDF procedures manifested pharyngoesophageal perforation or surgical site infection. CONCLUSIONS Severe dysphagia and odynophagia are post-ACDF complications. In most instances they are attributable to prevertebral soft-tissue edema accompanied by inflammatory responses such as fever and an increase in the white blood cell count and in C-reactive protein. In other cases these anomalies are elicited by hematoma not associated with inflammation.

  18. Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion

    Science.gov (United States)

    Liao, Jen-Chung; Chen, Wen-Jer; Chen, Lih-Huei

    2007-01-01

    From July 2004 to June 2005, 19 patients with 25 discs underwent anterior cervical discectomy and interbody fusion (ACDF) in which polyetheretherketone (PEEK) cages were filled with freeze-dried cancellous allograft bone. This kind of bone graft was made from femoral condyle that was harvested during total knee arthroplasty. Patient age at surgery was 52.9 (28–68) years. All patients were followed up at least 1 year. We measured the height of the disc and segmental sagittal angulation by pre-operative and post-operative radiographs. CT scan of the cervical spine at 1 year was used to evaluate fusion rates. Odom's criteria were used to assess the clinical outcome. All interbody disc spaces achieved successful union at 1-year follow-up. The use of a PEEK cage was found to increase the height of the disc immediately after surgery (5.0 mm pre-operatively, 7.3 mm immediately post-operatively). The final disc height was 6.2 mm, and the collapse of the disc height was 1.1 mm. The segmental lordosis also increased after surgery (2.0° pre-operatively, 6.6° immediately post-operatively), but the mean loss of lordosis correction was 3.3° at final follow-up. Seventy-four percent of patients (14/19) exhibited excellent/good clinical outcomes. Analysis of the results indicated the cancellous allograft bone-filled PEEK cage used in ACDF is a good choice for patients with cervical disc disease, and avoids the complications of harvesting iliac autograft. PMID:17639386

  19. [Clinical outcome of mid-term follow-up of anterior cervical non-fusion surgery versus anterior cervical discectomy and fusion for cervical spondylosis].

    Science.gov (United States)

    Guan, L; Wang, W L; Hai, Y; Liu, Y Z; Chen, X L; Chen, L

    2016-07-05

    To evaluate the clinical and radiological outcomes of artificial cervical disc replacement (Prodisc-C), dynamic cervical implant and anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylosis. From May 2011 to May 2013, a total of 44 cervical spondylosis patients that received cervical disc arthroplasty (Prodisc-C), dynamic cervical implant (DCI) or ACDF were retrospectively reviewed in Orthopedics Department, Beijing Chaoyang Hospital, Capital Medical University.The patients were divided into three groups by surgical methods.Parameters as gender, age, the operation time, blood loss and average hospital stay of three groups were compared.The patients were followed 3 months, 6 months, 12 months and 24 months postoperatively.Neck disability index (NDI), Japanese Orthopaedic Association (JOA) Score and Visual Analogue Scale (VAS) were used to evaluate the clinical outcomes of the three groups.We also measured the cervical lordosis, range of motion of surgical segment and adjacent segment and height of disc at pre-op and post-op. All the patients were got at least 24 months follow-up.The differences between postoperative JOA, NDI and VAS scores and preoperative scores were of statistical significance (P0.05) among three groups.But the operative time and intraoperative blood loss were statistically different (P0.05). There was no statistically significant difference between pre-and postoperative ROM of upper and lower levels among three groups (P>0.05), but had statistically difference in operative levels [(7.0±1.0) mm, (9.2±1.5) mm, (6.8±1.4) mm, Pfusion surgery and ACDF have received good clinical effects in the treatment of spondylotic myelopathy or radicular spondylosis.The artificial cervical disc replacement and dynamic cervical implant can not only recover cervical lordosis and keep the range of motion and stability of the surgical segment, but also reduce the incidence of compensatory motion at adjacent segments and will prevent

  20. Improvements in Neck and Arm Pain Following an Anterior Cervical Discectomy and Fusion.

    Science.gov (United States)

    Massel, Dustin H; Mayo, Benjamin C; Bohl, Daniel D; Narain, Ankur S; Hijji, Fady Y; Fineberg, Steven J; Louie, Philip K; Basques, Bryce A; Long, William W; Modi, Krishna D; Singh, Kern

    2017-07-15

    A retrospective analysis. The aim of this study was to quantify improvements in Visual Analogue Scale (VAS) neck and arm pain, Neck Disability Index (NDI), and Short Form-12 (SF-12) Mental (MCS) and Physical (PCS) Composite scores following an anterior cervical discectomy and fusion (ACDF). ACDF is evaluated with patient-reported outcomes. However, the extent to which these outcomes improve following ACDF remains poorly defined. A surgical registry of patients who underwent primary, one- or two-level ACDF during 2013 to 2015 was reviewed. Comparisons of VAS neck and arm, NDI, and SF-12 MCS and PCS scores were performed using paired t tests from preoperative to each postoperative time point. Analysis of variance (ANOVA) was used to estimate the reduction in neck and arm pain over the first postoperative year. Subgroup analyses were performed for patients with predominant neck (pNP) or arm (pAP) pain, as well as for one- versus two-level ACDF. Eighty-nine patients were identified. VAS neck and arm, NDI, and SF-12 PCS improved from preoperative scores at all postoperative time points (P arm pain (P arm pain over the first 6 months and 12 weeks postoperatively, respectively (P arm pain over the first postoperative year (P arm, respectively (P arm pain following ACDF regardless of presenting symptom. In addition, patients undergoing one-level ACDF report greater reductions in neck and arm pain than patients undergoing two-level fusion. 4.

  1. A Comprehensive Meta-Analysis of the Adjacent Segment Parameters in Cervical Disk Arthroplasty Versus Anterior Cervical Discectomy and Fusion.

    Science.gov (United States)

    Dong, Liang; Wang, Dongqi; Chen, Xiujin; Liu, Tuanjing; Xu, Zhengwei; Tan, Mingsheng; Hao, Dingjun

    2017-06-15

    This is a meta-analysis of controlled trials. To assess the overall condition of adjacent segment of cervical disk arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF). With the increase in CDA and ACDF, surgeons are taking more attention to adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). There are more and more meta-analyses comparing the efficacy of CDA with ACDF, however, there are few meta-analyses referring to adjacent segment parameters, and investigators are still unable to arrive at the same conclusion. Several important databases were searched for controlled trials comparing CDA and ACDF before February 2016 according to PRISMA guidelines. The analysis parameters included follow-up time, operative segments, cervical range of motion (ROM), adjacent segment motion, ASDeg, ASDis and adjacent segment reoperation. The risk of bias scale and Newcastle-Ottawa Scale were used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity. Forty-one controlled trials fulfilled the inclusion criteria, including 36 English papers and 5 Chinese. The average follow-up time of all included patients was 39 months. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (P0.05). CDA provided a greater cervical ROM than did ACDF (Padjacent segment ROM and the rate of ASDis in CDA compared with ACDF (Padjacent segment reoperation and adjacent segment motion; and higher cervical ROM. However, there was no statistical difference between upper and lower adjacent segment ROM/ASDeg using the same surgery.

  2. Cage subsidence after anterior cervical discectomy and fusion using a cage alone or combined with anterior plate fixation.

    Science.gov (United States)

    Pinder, E M; Sharp, D J

    2016-04-01

    To compare the extent of cage subsidence after anterior cervical discectomy and fusion (ACDF) using a cage alone or combined with anterior plate fixation, and to assess the effect of end plate removal on cage subsidence. Records of 23 men and 13 women aged 32 to 82 (mean, 54) years who underwent ACDF for 61 levels using the Solis cage alone (n=46) or combined with anterior plate fixation (n=15) were reviewed. The extent of cage subsidence was determined by comparing immediately postoperative (within one week) with final follow-up radiographs. Cage subsidence was defined as the sum subsidence of the superior and inferior part of the cage into the vertebral body. Mild and major cage subsidence was defined as ≤2 mm and >2 mm, respectively. Patients who underwent ACDF using a cage alone or combined with anterior plate fixation were comparable in terms of age, gender, follow-up duration, and number of levels decompressed. Cage subsidence occurred in 33 (54%) of the 61 levels decompressed. In the cage alone group, the extent of cage subsidence was greater (1.68 vs. 0.57 mm, p=0.039) and the rate of major cage subsidence was higher (28% vs. 7%, p=0.08). The inferior part of the cage was more vulnerable to subsidence compared with the superior part (median subsidence: 3.0 vs. 1.4 mm, psubsidence occurred more often when the end plate was removed rather than preserved (58% vs. 18%, psubsidence was greater after ACDF with cage alone. Cage subsidence occurred more often when the end plate was removed. Additional anterior plate fixation is recommended when the end plate is removed.

  3. The Effect of Uncinate Process Resection on Subsidence Following Anterior Cervical Discectomy and Fusion.

    Science.gov (United States)

    Lee, Su Hun; Lee, Jun Seok; Sung, Soon Ki; Son, Dong Wuk; Lee, Sang Weon; Song, Geun Sung

    2017-09-01

    Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micro-motion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula: subsidence=1.522+2.7×sum pUPR (R2=0.133, p=0.007). Receiver-operating characteristic analysis determined that sum pUPR≥0.38 could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ≥38%, the possibility of subsidence increased.

  4. Influence of cervical bone mineral density on cage subsidence in patients following stand-alone anterior cervical discectomy and fusion.

    Science.gov (United States)

    Brenke, Christopher; Dostal, Martin; Scharf, Johann; Weiß, Christel; Schmieder, Kirsten; Barth, Martin

    2015-12-01

    Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical degenerative diseases. However, cage subsidence remains a frequent problem. We therefore investigated if cage design and site-specific bone mineral density (BMD) contribute to the rate and direction of subsidence following ACDF. Patients were prospectively included and received two different cages (groups 1 and 2) using minimization randomization. The degree and direction of cage subsidence were determined using plain radiographs. Neck pain intensity on the visual analogue scale (VAS), the neck disability index (NDI), and the patient satisfaction index were recorded up to 12 months after surgery. 88 patients were analysed with a mean age of 53.7 ± 11.8 years. BMD values decreased in craniocaudal direction from 302.0 ± 62.2 to 235.5 ± 38.9 mg/cm(3). Both groups showed significant height gain after the operation (both p  0.05). Both groups showed improvement of VAS neck pain intensity (both p subsidence was similar, no correlations were found between cage subsidence and BMD or various clinical parameters. Implant geometry of both cages and variations of the operative procedure promoted a relatively high degree of cage subsidence. Further studies are necessary to identify a relation of BMD and subsidence using optimized implant geometry and by controlling additional intraoperative variables.

  5. Outpatient anterior cervical discectomy and fusion for cervical disk disease: a prospective consecutive series of 96 patients.

    Science.gov (United States)

    Lied, B; Rønning, P A; Halvorsen, C M; Ekseth, K; Helseth, E

    2013-01-01

    To evaluate surgical complications and clinical outcome in a consecutive series of 96 patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical disk degeneration (CDD) in an outpatient setting. Pre-, per-, and postoperative data on patients undergoing single- or two-level outpatient ACDF at the private Oslofjord Clinic were prospectively collected. This study includes 96 consecutive patients with a mean age of 49.1 years. 36/96 had a two-level ACDF. Mean postoperative observation time before discharge was 350 min, and 95/96 were successfully discharged either to their home or to a hotel on the day of surgery. The surgical mortality was 0%, while the surgical morbidity rate was 5.2%. Two (2.1%) patients developed postoperative hematoma, 2 (2.1%) patients experienced postoperative dysphagia, and 1 (1%) experienced deterioration of neurological function. Radicular pain, neck pain, and headache decreased significantly after surgery. 91% of patients were satisfied with the surgery, according to the NASSQ. ACDF in carefully selected patients with CDD appears to be safe in the outpatient setting, provided a sufficient postoperative observation period. The clinical outcome and patient satisfaction of outpatients are comparable to that of inpatients. © 2012 John Wiley & Sons A/S.

  6. Impact of subsidence on clinical outcomes and radiographic fusion rates in anterior cervical discectomy and fusion: a systematic review.

    Science.gov (United States)

    Karikari, Isaac O; Jain, Deeptee; Owens, Timothy Ryan; Gottfried, Oren; Hodges, Tiffany R; Nimjee, Shahid M; Bagley, Carlos A

    2014-02-01

    Systematic review. To provide a systematic review of published literature on the impact of subsidence on clinical outcomes and radiographic fusion rates after anterior cervical discectomy and fusion with plates or without plates. Subsidence of interbody implants is common after anterior cervical spine fusions. The impact of subsidence on fusion rates and clinical outcomes is unknown. Systematic literature review on published articles on anterior cervical discectomy and fusion, which objectively measured graft subsidence, radiographic fusion rates, and clinical outcomes between April 1966 and December 2010. A total of 35 articles that measured subsidence and provided fusion rates and/or clinical outcomes were selected for inclusion. The mean subsidence rate ranged from 19.3% to 42.5%. The rate of subsidence based on the type of implant ranged from 22.8% to 35.9%. The incidence of subsidence was not impacted by the type of implant (P=0.98). The overall fusion rate of the combined studies was 92.8% and was not impacted by subsidence irrespective of subsidence definition or the measurement technique used (P=0.19). Clinical outcomes were evaluated in 27 of 35 studies with all studies reporting an improvement in patient outcomes postoperatively. Subsidence irrespective of the measurement technique or definition does not appear to have an impact on successful fusion and/or clinical outcomes. A validated definition and standard measurement technique for subsidence is needed to determine the actual incidence of subsidence and its impact on radiographic and clinical outcomes.

  7. Symptomatic adjacent segment disease after single-lever anterior cervical discectomy and fusion

    Science.gov (United States)

    Wang, Feng; Hou, Hong-Tao; Wang, Peng; Zhang, Jing-Tao; Shen, Yong

    2017-01-01

    Abstract The purpose of this study was to determine the incidence and risk factors of symptomatic adjacent segment disease (ASD) following single-lever anterior cervical discectomy and fusion (ACDF) for cervical degenerative diseases. From January 2000 to December 2010, a total of 582 patients with cervical radiculopathy and myelopathy who had undergone single-lever ACDF surgery in the authors’ institution were reviewed retrospectively. Patients who had a revision surgery for symptomatic ASD were selected for this study. The authors analyzed the incidence for ASD after single-lever ACDF. And univariate analysis and logistic regression analysis were performed to identify the risk factors of ASD. Among the 582 patients, 36 patients received subsequent surgical management for ASD after initial single-lever ACDF for an overall prevalence of 6.2%. The average onset time of ASD was 8.5 (2–15) years. The univariate analysis showed that there were no significant differences in sex, duration of disease, BMI, DM, smoking, operative levels, and follow-up period (P > .05) between the 2 groups with and without ASD. There were statistically significant differences in age at the time of operation (χ2 = 4.361, P = .037), and developmental canal stenosis (χ2 = 4.181, P = .041) between patients with and without ASD. The variables of age at the time of operation and developmental canal stenosis were included in a logistic regression model. The logistic regression analysis revealed that age at the time of operation ≤50 years (P = .045, OR = 3.015, 95% CI = 1.024–8.882) and developmental canal stenosis (P = .042, OR = 2.797, 95% CI = 1.039–7.527) were the risk factors for ASD after single-lever ACDF. In the present study, the incidence of symptomatic ASD after single-lever ACDF was 6.2%. And the age at the time of operation ≤50 years and developmental canal stenosis were the risk factors for ASD. The patients ≤50 years old at

  8. Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: a systematic review.

    Science.gov (United States)

    Noordhoek, Iris; Koning, Marvyn T; Jacobs, Wilco C H; Vleggeert-Lankamp, Carmen L A

    2018-04-01

    The placement of intervertebral cages in anterior cervical discectomy (ACDF) supposedly maintains foraminal height. The most commonly reported cage-related complication is subsidence, although it is unknown whether a correlation between subsidence and clinical outcome exists. To assess the incidence and relevance of subsidence. Literature searches were performed in PubMed, MEDLINE, Embase, Web of Science, COCHRANE, and CENTRAL. The inclusion criteria were as follows: ≥ 20 patients, ADCF with cage, subsidence assessed, and primary data. Risk of bias was assessed using adjusted Cochrane checklists. Seventy-one studies, comprising 4784 patients, were included. Subsidence was generally defined as ≥ 3-mm loss of height comparing postoperative intervertebral heights with heights at last follow-up. Mean incidence of subsidence was 21% (range 0-83%). Of all patients, 46% of patients received polyether-ether-ketone (PEEK) cages, 31% received titanium cages, 18% received cage-screw-combinations, and 5% received polymethyl-methacrylate (PMMA) cages. Patients treated with cage-screw-combinations had significantly less subsidence than patients treated with PEEK, titanium, or PMMA cages (15.1% vs. 23.5% vs. 24.9% vs. 30.2%; p subsidence; the majority did not find a significant correlation. Only four studies correlated subsidence to cage size and/or height; no correlation was established. Subsidence in ACDF with cages occurs in 21% of patients. The risk for subsidence seems lower using PEEK or titanium cages or adding screws. Whether subsidence affects clinical outcome is not satisfactorily evaluated in the available literature. Future studies on this correlation are warranted in order to establish the additional value of the interposition of a cage in ACDF.

  9. The NEtherlands Cervical Kinematics (NECK Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study

    Directory of Open Access Journals (Sweden)

    van den Akker Elske

    2010-06-01

    Full Text Available Abstract Background Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation. Methods/Design Patients (age 18-65 years presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years. Discussion Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial

  10. Surgical management of C-type subaxial cervical fractures using cervical traction followed by anterior cervical discectomy and fusion within 12 h after the trauma.

    Science.gov (United States)

    Donnarumma, Pasquale; Bozzini, Vincenzo; Rizzi, Gaetano; Berardi, Arturo; Merlicco, Gaetano

    2017-01-01

    This was a retrospective cohort study. To report our 10-year experience of closed reduction using Crutchfield traction followed by anterior cervical discectomy and fusion within 12 h from injury for C-type subaxial cervical fractures (according to the AOSpine classification system). Clinical records and neuroimaging were retrospectively reviewed. Surgical details were provided. A total of 22 patients were included in the study. The cervical fracture was diagnosed after whole-body computed tomography scan on admission in all cases. Crutchfield traction was applied within 1-5 h from the diagnosis. Surgery consisting of anterior microdiscectomy and fusion with interbody cage and plating was performed 6-12 h after traction positioning. Most patients (19, 86%) had spinal cord injury: 7 were Frankel A (31%), 3 Frankel B (14%), 6 Frankel C (27%), 3 Frankel D (14%), and 3 Frankel E (14%). No neurologic deterioration was observed after the treatment. In 10 cases (45%), neurological symptoms improved 1 year after the trauma. Two patients (10%) died for complication related to spinal cord transition or other organ damage. Early reduction gives the best chance of recovery for patients affected by C-type subaxial cervical fracture. Rapid traction is more often successful and safer than manipulation under anesthesia. After close reduction achieving, anterior microdiscectomy, cage, and plating implant seem to be safe and effective with a low rate of complications.

  11. The Effect of the PEEK Cage on the Cervical Lordosis in Patients Undergoing Anterior Cervical Discectomy

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    Salih Gulsen

    2015-03-01

    CONCLUSION: We achieved better cervical lordotic angles at the postoperative period by implanting one-level, two-level, three-level or four-level PEEK cage filled with demineralized bone matrix. Also, the causes of cervical root and or medulla spinalis impingement were different in group1 and 2. While extruded cervical disc impingement was the first pathology in group 1, osteophyte formation was the first pathology in group 2.

  12. Economic burden of routine hematologic tests and intensive care unit observation for elective anterior cervical discectomy and fusion.

    Science.gov (United States)

    Lin, Ching-Kuo; Lin, Chih-Lung; Feng, Yu-Tung; Lau, Yu-Wa; Chian, Cheng-Ying; Wu, Yi-Tai; Hwang, Shiuh-Lin; Lee, King-Teh

    2014-01-01

    Anterior cervical discectomy and fusion is one of the most common surgical interventions performed by spine surgeons. As efforts are made to control healthcare spending because of the limited or capped resources offered by the National Health Insurance, surgeons are faced with the challenge of offering high-level patient care while minimizing associated healthcare expenditures. Routine ordering of postoperative hematologic tests and observational intensive care unit (ICU) stay might be areas of potential cost containment. This study was designed to determine the necessity of routine postoperative hematologic tests and ICU stay for patients undergoing elective anterior cervical discectomy and fusion and to investigate whether the elimination of unnecessary postoperative laboratory blood studies and ICU stay inhibits patient care. The necessity for postoperative blood tests was determined if there were needs for a postoperative blood transfusion and hospital readmission within 1 month after surgery. The necessity for postoperative ICU observation was decided if immediate surgical intervention was required when any kind of complications occurred during the ICU stay. There were 168 patients collected in the study. Among them, all had routine preoperative and postoperative blood tests and were transferred to ICU for observation. No need for blood transfusion was observed, and no patient required immediate surgical intervention when the complications occurred during the ICU stay. Cost savings per admission amounted to approximately 10% of the hospitalization cost by the elimination of unnecessary postoperative routine laboratory blood studies and observational ICU stay without waiving patient care in the current volatile, cost-conscious healthcare environment in Taiwan.

  13. Anterior cervical discectomy without fusion for a symptomatic cervical disk herniation

    NARCIS (Netherlands)

    de Rooij, Judith D.; Gadjradj, Pravesh S.; Soria van Hoeve, John S.; Harhangi, Biswadjiet S.

    2017-01-01

    Background: Cervical radiculopathy is characterized by dysfunction of the nerve root usually caused by a cervical disk herniation. The most important symptom is pain, radiating from the neck to the arm. When conservative treatment fails, surgical treatment is indicated to relieve symptoms. During

  14. Anterior cervical discectomy without fusion for a symptomatic cervical disk herniation

    NARCIS (Netherlands)

    de Rooij, J.D. (Judith D.); P.S. Gadjradj (Pravesh S.); J.S.S. van Hoeve (John); B.S. Harhangi (Biswadjiet)

    2017-01-01

    textabstractBackground: Cervical radiculopathy is characterized by dysfunction of the nerve root usually caused by a cervical disk herniation. The most important symptom is pain, radiating from the neck to the arm. When conservative treatment fails, surgical treatment is indicated to relieve

  15. Is Two-level Cervical Disc Replacement More Cost-effective Than Anterior Cervical Discectomy and Fusion at 7 Years?

    Science.gov (United States)

    Merrill, Robert K; McAnany, Steven J; Albert, Todd J; Qureshi, Sheeraz A

    2018-05-01

    Cost-effectiveness analysis. To investigate 7-years cost-effectiveness of two-level cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF). CDR and ACDF are both effective treatment strategies for managing degenerative conditions of the cervical spine. CDR has been shown to be a more-cost effective intervention in the short term, but the long-term cost-effectiveness has not been established. We analyzed 7-years follow-up data from the two-level Medtronic Prestige LP investigational device exemption study. Short-form 36 (SF-36) data were converted into health utility scores using the SF-6D algorithm. Costs were based on direct costs from the payer perspective, and effectiveness was measured as quality-adjusted life years (QALYs). The willingness-to-pay (WTP) threshold was set to $50,000/QALY. A probabilistic sensitivity analysis was conducted via Monte Carlo simulation. Two-level CDR had a 7-year cost of $176,654.19, generated 4.65 QALYs, and had a cost-effectiveness ratio of $37,993.53/QALY. Two-level ACDF had a 7-year cost of $158,373.48, generated 4.44 QALYs, and had a cost-effectiveness ratio of $35,635.72. CDR was associated with an incremental cost of $18,280.71 and an incremental effectiveness of 0.21 QALYs, resulting in an incremental cost-effectiveness ratio (ICER) of $89,021.04, above the WTP threshold. Our Monte Carlo simulation demonstrated CDR would be chosen 46% of the time based on 10,000 simulations. Two-level CDR and ACDF are both cost-effective procedures at 7-year follow up for treating degenerative conditions of the cervical spine. Based on an ICER of $89,021.04/QALY, we cannot conclude which treatment is the more cost-effective option at 7-years. CDR would be chosen 46% of the time based on 10,000 iterations of our Monte Carlo probabilistic sensitivity analysis. 3.

  16. Missing data treatments matter: an analysis of multiple imputation for anterior cervical discectomy and fusion procedures.

    Science.gov (United States)

    Ondeck, Nathaniel T; Fu, Michael C; Skrip, Laura A; McLynn, Ryan P; Cui, Jonathan J; Basques, Bryce A; Albert, Todd J; Grauer, Jonathan N

    2018-04-09

    The presence of missing data is a limitation of large datasets, including the National Surgical Quality Improvement Program (NSQIP). In addressing this issue, most studies utilize complete case analysis, which excludes cases with missing data, thus potentially introducing selection bias. Multiple imputation, a statistically rigorous approach that approximates missing data and preserves sample size, may be an improvement over complete case analysis. To evaluate the impact of using multiple imputation in comparison to complete case analysis for assessing the associations between preoperative laboratory values and adverse outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Retrospective review of prospectively collected data PATIENT SAMPLE: Patients undergoing one-level ACDF were identified in NSQIP 2012-2015. Perioperative adverse outcome variables assessed included the occurrence of any adverse event, severe adverse events, and hospital readmission. Missing preoperative albumin and hematocrit values were handled using complete case analysis and multiple imputation. These preoperative laboratory levels were then tested for associations with 30-day postoperative outcomes using logistic regression. A total of 11,999 patients were included. Of this cohort, 63.5% of patients were missing preoperative albumin and 9.9% were missing preoperative hematocrit. When utilizing complete case analysis, only 4,311 patients were studied. The removed patients were significantly younger, healthier, of a common BMI and male. Logistic regression analysis failed to identify either preoperative hypoalbuminemia or preoperative anemia as significantly associated with adverse outcomes. When employing multiple imputation, all 11,999 patients were included. Preoperative hypoalbuminemia was significantly associated with the occurrence of any adverse event and severe adverse events. Preoperative anemia was significantly associated with the occurrence of any adverse

  17. Anterior Cervical Discectomy with Instrumented Allograft Fusion: Lordosis Restoration and Comparison of Functional Outcomes among Patients of Different Age Groups.

    Science.gov (United States)

    Muzević, Dario; Splavski, Bruno; Boop, Frederick A; Arnautović, Kenan I

    2018-01-01

    To investigate clinical parameters of anterior cervical discectomy and fusion (ACDF) treatment and outcomes using osseous allografts in different age groups, study the postoperative results of restoration of lordosis, and evaluate the utility of bone allografts for ACDF, including graft subsidence. We reviewed data from 154 patients with clinical symptoms and radiologic signs of disc herniation and/or cervical spondylosis. Decompression was achieved through discectomy, osteophyte ablation, endplate drilling, and foraminotomy. Fusion was achieved with allografts, demineralized bone matrix, and cervical plates/screws. The relationships between preoperative and postoperative cervical spine configuration (ie, Benzel's criteria), pain intensity, and neurologic status were analyzed. The mean patient age was 51 years, and the median duration of symptoms was 6 months. The mean age differed significantly between the patients with diabetes and those without diabetes. The mean body mass index (BMI) was 30.36. Fifty-two patients had disc herniation, and 102 had spondylosis. Surgery was performed on a total of 313 levels. The median duration of follow-up was 24 months. Marked improvements in postoperative spine configuration or preservation of lordosis were recorded. Overall, 122 patients were neurologically intact, and 32 patients experienced residual postsurgery neurologic deficits (minor, n = 22; moderate, n = 9; severe, n = 1). Postoperative pain intensity and neurologic status were significantly improved. Outcomes were excellent in 66 patients, good in 61, fair in 24, and poor in 3 (no mortality). No significant differences in patient age, smoking habits, diabetes, or BMI were seen among outcomes, or between patients with soft disc herniation or spondylosis. Osseous allografting can excellently restore cervical lordosis regardless of age and is an excellent graft choice for ACDF. Patients of advanced age with comorbidities should not be denied surgery. Copyright © 2017

  18. Comparison of polyetheretherketone (PEEK cage and cervical disc prostheses used in anterior cervical microscopic discectomy operations

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    Bahadir Alkan

    2017-03-01

    Conclusion: It was shown that in the cervical disc prosthesis group (Group A in the early and later postoperative period, intervertebral disk heights were preserved by a statistically significant amount compared to the PEEK cage group (Group B. However, this scenario did not create any significant difference in the clinical evaluation results. [Arch Clin Exp Surg 2017; 6(1.000: 1-8

  19. Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference.

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    Brenda M Auffinger

    Full Text Available OBJECT: The concept of minimum clinically important difference (MCID has been used to measure the threshold by which the effect of a specific treatment can be considered clinically meaningful. MCID has previously been studied in surgical patients, however few studies have assessed its role in spinal surgery. The goal of this study was to assess the role of MCID in patients undergoing anterior cervical discectomy and fusion (ACDF for cervical spondylotic myelopathy (CSM. METHODS: Data was collected on 30 patients who underwent ACDF for CSM between 2007 and 2012. Preoperative and 1-year postoperative Neck Disability Index (NDI, Visual-Analog Scale (VAS, and Short Form-36 (SF-36 Physical (PCS and Mental (MCS Component Summary PRO scores were collected. Five distribution- and anchor-based approaches were used to calculate MCID threshold values average change, change difference, receiver operating characteristic curve (ROC, minimum detectable change (MDC and standard error of measurement (SEM. The Health Transition Item of the SF-36 (HTI was used as an external anchor. RESULTS: Patients had a significant improvement in all mean physical PRO scores postoperatively (p<0.01 NDI (29.24 to 14.82, VAS (5.06 to 1.72, and PCS (36.98 to 44.22. The five MCID approaches yielded a range of values for each PRO: 2.00-8.78 for PCS, 2.06-5.73 for MCS, 4.83-13.39 for NDI, and 0.36-3.11 for VAS. PCS was the most representative PRO measure, presenting the greatest area under the ROC curve (0.94. MDC values were not affected by the choice of anchor and their threshold of improvement was statistically greater than the chance of error from unimproved patients. CONCLUSION: SF-36 PCS was the most representative PRO measure. MDC appears to be the most appropriate MCID method. When MDC was applied together with HTI anchor, the MCID thresholds were: 13.39 for NDI, 3.11 for VAS, 5.56 for PCS and 5.73 for MCS.

  20. Adjacent segment disease after anterior cervical discectomy and fusion: Incidence and clinical outcomes of patients requiring anterior versus posterior repeat cervical fusion.

    Science.gov (United States)

    Bydon, Mohamad; Xu, Risheng; De la Garza-Ramos, Rafael; Macki, Mohamed; Sciubba, Daniel M; Wolinsky, Jean-Paul; Witham, Timothy F; Gokaslan, Ziya L; Bydon, Ali

    2014-01-01

    Adjacent segment disease (ASD) is a well-recognized long-term outcome in patients with degenerative disease of the spine. In this manuscript, we focus on the development in ASD in patients who have undergone a prior anterior cervical discectomy and fusion (ACDF). Patient data were collected via clinical notes and patient interviews. Patients were followed for an average of 92.4 ± 72.6 months after the index ACDF. Of the 108 patients who underwent revision surgery due to symptomatic ASD, 77 patients underwent re-do ACDF, while 31 patients had posterior fusion surgery. Patients were more likely to be operated on posteriorly if they were older (P = 0.0115), male (P = 0.006), or had a higher number of cervical vertebral segments fused during the index ACDF (P = 0.013). These patients were statistically also more likely to exhibit myelopathic symptoms (P = 0.0053), and usually had worse neurologic function as assessed on the Nurick (P = 0.0005) and ASIA scales (P = 0.0020). Postoperatively, patients receiving anterior revision surgeries had higher rates of recurrent radiculopathy (P = 0.0425) and higher recurrence of ASD compared with patients fused posteriorly (P < 0.0001). Patients undergoing an anterior revision surgery for ASD after ACDF have higher rates of postoperative radiculopathy and redevelopment of ASD when compared with posteriorly approached patients. Patients receiving posterior revision surgery had higher intraoperative blood loss, hospitalizations, and postoperative complications such as wound infections and discharge to rehabilitation, but had a statistically lower chance of redevelopment of ASD requiring secondary revision surgery. This may be due to the fact that posterior revision surgeries involved more levels fused. This study provides one of the longest and most comprehensive follow-ups of this challenging patient population. Prospective studies comparing surgical approaches and techniques are needed to corroborate our findings.

  1. Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis.

    Science.gov (United States)

    Mansfield, Haley E; Canar, W Jeffrey; Gerard, Carter S; O'Toole, John E

    2014-11-01

    Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs. After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery. The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status. In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF

  2. [Comparison of early clinical effects between Activ C cervical disc replacement and anterior cervical discectomy and fusion for single-level cervical spondylosis].

    Science.gov (United States)

    Li, Hong-ke; Zhang, Chang-jiang; Wang, Ming-jun; Yang, Xian-yu; Li, Lai-hao

    2015-11-01

    To compare the early clinical effects of Activ C cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) in treating single-level cervical spondylosis. The clinical data of 76 patients with single-level cervical spondylosis underwent surgery from July 2009 to September 2012 were retrospectively analyzed. Among them, 28 patients were treated with ACDR (ACDR group), including 18 males and 10 females, aged from 32 to 62 years old with an average of (45.2±6.2) years; and 48 patients were treated with ACDF (ACDF group), including 28 males and 20 females, aged from 33 to 60 years old with an average of (45.8±6.4) years. Visual analogue scale (VAS), Japanese Orthopedics Association (JOA) score, Short Form-36 (SF-36), imaging data were used to assess the clinical effects after operation. A total of 76 patients were followed up from 6 to 24 months with an average of 13.2 months. VAS of neck pain and brachialgia were improved in all patients after operation (P0.05). Somato-score and psycho-score of SF-36 of two groups were obviously increased (P0.05); heterotopic ossification around the edge of vertebral body occurred in 1 case on the 6th month after operation, no fusion was found on the 1st year after operation. In ACDF group, the adjacent vertebral disease occurred in 1 case and the patient underwent the reoperation. Activ C cervical disc replacement can reduce the degeneration of adjacent segments and its early outcomes for the treatment of single-level cervical spondylosis are satisfactory, but the long-term effects still need study.

  3. Comparison between anterior cervical discectomy with fusion by polyetheretherketone cages and tricortical iliac-crest graft for the treatment of cervical prolapsed intervertebral disc

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    Md. Anowarul Islam

    2016-10-01

    Full Text Available Anterior cervical discectomy and fusion is effective surgical modality in the treatment of cervical prolapsed intervertebral disc, radiculopathy and myelopathy. Aims of our study is to evaluate fusion of cervical spine  by ICG with plating and PEEK cage with bone graft, also assess the donor site morbidity. Thirty patients (male 16; female 14 with mean age 46 ± 9.2 years and were distributed  into two treatment groups (PEEK cage group and ICG group. We assess the patients clinically for myelopathy and functional outcome by Nurick scale and Odom's criteria respectively and  neck and arm pain by Visual Analogue Scale (VAS. Eighteen patients were operated for single level discectomy and fusion by either ICG or PEEK cages and twelve patients for two levels. After surgery follow up was 2 years and better  postoperative score which was assessed by Nurick scale, Odoms criteria and VAS score. Total patients 14(93%were graded excellent in the PEEK cage group compared to 13 patients (86% in the ICG group.  Statistically it was not significant between two groups and p value was <0.35. Difference was significant in VAS score  after 24 months with more reduction of pain in PEEK cage group. Fusion occurred in 13 patients (86% of the PEEK cage group and 14 patient (93% of the ICG group. Result showed more fusion rate in ICG group and less donor site morbidity in PEEK group.  

  4. PEEK Cages versus PMMA Spacers in Anterior Cervical Discectomy: Comparison of Fusion, Subsidence, Sagittal Alignment, and Clinical Outcome with a Minimum 1-Year Follow-Up

    Science.gov (United States)

    Krüger, Marie T.; Sircar, Ronen; Kogias, Evangelos; Scholz, Christoph; Volz, Florian; Scheiwe, Christian; Hubbe, Ulrich

    2014-01-01

    Purpose. To compare radiographic and clinical outcomes after anterior cervical discectomy in patients with cervical degenerative disc disease using PEEK cages or PMMA spacers with a minimum 1-year follow-up. Methods. Anterior cervical discectomy was performed in 107 patients in one or two levels using empty PEEK cages (51 levels), Sulcem PMMA spacers (49 levels) or Palacos PMMA spacers (41 levels) between January, 2005 and February, 2009. Bony fusion, subsidence, and sagittal alignment were retrospectively assessed in CT scans and radiographs at follow-up. Clinical outcome was measured using the VAS, NDI, and SF-36. Results. Bony fusion was assessed in 65% (PEEK cage), 57% (Sulcem), and 46% (Palacos) after a mean follow-up of 2.5 years. Mean subsidence was 2.3–2.6 mm without significant differences between the groups. The most pronounced loss of lordosis was found in PEEK cages (−4.1°). VAS was 3.1 (PEEK cage), 3.6 (Sulcem), and 2.7 (Palacos) without significant differences. Functional outcome in the PEEK cage and Palacos group was superior to the Sulcem group. Conclusions. The substitute groups showed differing fusion rates. Clinical outcome, however, appears to be generally not correlated with fusion status or subsidence. We could not specify a superior disc substitute for anterior cervical discectomy. This trial is registered with DRKS00003591. PMID:25110734

  5. Design of the PROCON trial: a prospective, randomized multi – center study comparing cervical anterior discectomy without fusion, with fusion or with arthroplasty

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    Grotenhuis J André

    2006-11-01

    Full Text Available Abstract Background PROCON was designed to assess the clinical outcome, development of adjacent disc disease and costs of cervical anterior discectomy without fusion, with fusion using a stand alone cage and implantation of a Bryan's disc prosthesis. Description of rationale and design of PROCON trial and discussion of its strengths and limitations. Methods/Design Since proof justifying the use of implants or arthroplasty after cervical anterior discectomy is lacking, PROCON was designed. PROCON is a multicenter, randomized controlled trial comparing cervical anterior discectomy without fusion, with fusion with a stand alone cage or with implantation of a disc. The study population will be enrolled from patients with a single level cervical disc disease without myelopathic signs. Each treatment arm will need 90 patients. The patients will be followed for a minimum of five years, with visits scheduled at 6 weeks, 3 months, 12 months, and then yearly. At one year postoperatively, clinical outcome and self reported outcomes will be evaluated. At five years, the development of adjacent disc disease will be investigated. Discussion The results of this study will contribute to the discussion whether additional fusion or arthroplasty is needed and cost effective. Trial registration Current Controlled Trials ISRCTN41681847

  6. Risk factors for postoperative subsidence of single-level anterior cervical discectomy and fusion: the significance of the preoperative cervical alignment.

    Science.gov (United States)

    Lee, Young-Seok; Kim, Young-Baeg; Park, Seung-Won

    2014-07-15

    Retrospective cohort study. To investigate and analyze the preoperative risk factors affecting subsidence after anterior cervical discectomy and fusion (ACDF) to reduce subsidence. Subsidence after ACDF may be caused by various risk factors, although the related information is scarce. Seventy-eight patients who underwent single-level ACDF between 2005 and 2011 were included. Patients were categorized into the subsidence (n = 26) and nonsubsidence groups (n = 52). Preoperative factors such as age, sex, operative level, bone mineral density, cervical alignment, segmental sagittal angle, and anterior/posterior disc height were assessed. The use of plates and the anterior/posterior disc height gap were examined as perioperative factors. The clinical outcome was assessed using a visual analogue scale for neck and arm pain. Subsidence occurred in 26 (33.3%) of 78 patients. A significant difference was found in clinical outcomes between the subsidence and nonsubsidence groups (P subsidence group. The mean time to subsidence was 4.8 months. Logistic regression analysis revealed that cervical alignment (P = 0.017), age (P = 0.022), and use of plates (P = 0.041) affected subsidence. In patients who received a stand-alone cage, the risk of subsidence was significantly greater in the kyphotic angle group than in the lordotic angle group (odds ratio = 13.56; P subsidence are cervical alignment, age, and use of plates. Our data suggest that surgeons should consider the kyphotic curvature and/or age when deciding on the use of plates.

  7. Can Multilevel Anterior Cervical Discectomy and Fusion Result in Decreased Lifting Capacity of the Shoulder?

    Science.gov (United States)

    Liu, Baoge; Zhu, Di; Yang, Jiang; Zhang, Yao; VanHoof, Tom; Okito, Jean-Pirre Kalala

    2015-12-01

    To investigate the upper-extremity abduction, and lifting limitations and associated factors after anterior cervical decompression and fusion. A total of 117 patients who underwent anterior cervical decompression and fusion for cervical spondylosis were assessed retrospectively. Their upper-extremity abduction and lifting capacity after operation and manual muscle test grade for deltoid muscle strength and its sensory status were recorded. In addition, spinal cord function (Japanese Orthopaedic Association and Neck Disability Index scores) and C4-5 intervertebral height (radiographs) were assessed. Finally, high signal and ossification of posterior longitudinal ligament were observed by T2 magnetic resonance imaging and computed tomography, respectively. Seven individuals had a decrease in muscle strength, with 2 patients also exhibiting sensory defect. Six individuals had bilateral weakness of deltoid and biceps brachii and 1 of unilateral. After 8-16 months of follow-up, the abduction function and lift capacity were restored. The manual muscle test grade recovered to 5 and 4 degrees, respectively, in 6 and 1 patients. Two patients remained with sensory defect. The mean recovery time 19.7 days on average, and Japanese Orthopaedic Association scores significantly improved. Among the 117 patients, less than 2-level decompression showed upper-extremity function limitations in 1 of 67 (1.5%), whereas more than a 3-level decompression resulted in greater rate in 6 of 50 (12%), a significant difference (P magnetic resonance imaging. The rate of upper-extremity abduction and lifting limitation after anterior cervical decompression and fusion is low, indicating a good prognosis after active treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Titanium cages versus autogenous iliac crest bone grafts in anterior cervical discectomy and fusion treatment of patients with cervical degenerative diseases: a systematic review and meta-analysis.

    Science.gov (United States)

    Shao, Ming-Hao; Zhang, Fan; Yin, Jun; Xu, Hao-Cheng; Lyu, Fei-Zhou

    2017-05-01

    A systematic review and partial meta-analysis is conducted to compare the efficacy and safety of anterior cervical decompression and fusion procedures employing either rectangular titanium cages or iliac crest autografts in patients suffering from cervical degenerative disc diseases. Medline, PubMed, CENTRAL, and Google Scholar databases were searched up to June 2015, using the key words cervical discectomy; bone transplantation; titanium cages; and iliac crest autografts. Outcomes of interbody fusion rates were compared using odds ratios (ORs) with 95% confidence intervals (CIs). Values of the Japanese Orthopaedic Association score, and visual analog scale before and after operation were also compared. The rate of interbody fusion was similar between patients in the iliac crest autograft and titanium cage groups (pooled OR = 0.33, 95% CI = 0.07 to 1.66, P = .178). The overall analysis showed that patients in the two groups did not have significantly different post-surgery Japanese Orthopaedic Association score (pooled difference in means = -0.05, 95% CI = 0.73 to 0.63, P = .876). Improvement in arm and neck pain scores were assessed with a visual analog scale and differed significantly between patients in the iliac crest autograft and titanium cage groups (pooled difference in means = 0.16, 95% CI = -0.44 to 0.76, P = .610; and pooled difference in means = -0.44, 95% CI = -2.23 to 1.36, P = .634, respectively). Our results suggest that the use of titanium cages constitutes a safe and efficient alternative to iliac crest bone autografts for anterior cervical discectomy with fusion.

  9. A Comparison of Anterior Cervical Discectomy and Fusion versus Fusion Combined with Artificial Disc Replacement for Treating 3-Level Cervical Spondylotic Disease.

    Science.gov (United States)

    Jang, Seo-Ryang; Lee, Sang-Bok; Cho, Kyoung-Suok

    2017-11-01

    The purpose of this study is to evaluate the efficacy and safety of 3-level hybrid surgery (HS), which combines fusion and cervical disc replacement (CDR), compared to 3-level fusionin patient with cervical spondylosis involving 3 levels. Patients in the anterior cervical discectomy and fusion (ACDF) group (n=30) underwent 3-level fusion and the HS group (n=19) underwent combined surgery with fusion and CDR. Clinical outcomes were evaluated using the visual analogue scale for the arm, the neck disability index (NDI), Odom criteria and postoperative complications. The cervical range of motion (ROM), fusion rate and adjacent segments degeneration were assessed with radiographs. Significant improvements in arm pain relief and functional outcome were observed in ACDF and HS group. The NDI in the HS group showed better improvement 6 months after surgery than that of the ACDF group. The ACDF group had a lower fusion rate, higher incidence of device related complications and radiological changes in adjacent segments compared with the HS group. The better recovery of cervical ROM was observed in HS group. However, that of the ACDF group was significantly decreased and did not recover. The HS group was better than the ACDF group in terms of NDI, cervical ROM, fusion rate, incidence of postoperative complications and adjacent segment degeneration.

  10. A Sternum-Disk Distance Method to Identify the Skin Level for Approaching a Surgical Segment without Fluoroscopy Guidance during Anterior Cervical Discectomy And Fusion

    OpenAIRE

    Lee, Gun Woo; Ahn, Myun-Whan; Shin, Ji-Hoon; Park, Jae Woo; Uh, Jae-Hyung; Park, Jong-Ho; Lee, Ji-Hoon; Kim, Dong-Wook; Yeom, Jin S.; Suh, Bo-Gun

    2017-01-01

    Study Design A retrospective review of prospectively collected data. Purpose To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability. Overview of Literature Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has ...

  11. Anterior cervical discectomy and fusion using a stand-alone polyetheretherketone cage packed with local autobone : assessment of bone fusion and subsidence.

    Science.gov (United States)

    Park, Jeong-Ill; Cho, Dae-Chul; Kim, Kyoung-Tae; Sung, Joo-Kyung

    2013-09-01

    It remains debatable whether cervical spine fusion cages should be filled with any kind of bone or bone substitute. Cortical and subcortical bone from the anterior and posterior osteophytes of the segment could be used to fill the cage. The purposes of the present study are to evaluate the clinical outcomes and radiological outcomes including bone fusion and subsidence that occurred after anterior cervical discectomy and fusion using a stand-alone cage packed with local autobone graft. Thirty-one patients who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage packed with local autobone graft from July 2009 to december 2011 were enrolled in this study. Bone fusion was assessed by cervical plain radiographs and computed tomographic scan. Nonunion was evaluated according to the absence of bony bridge on computed tomographic scan. Subsidence was defined as a ≥2 mm decrease of the interbody height at the final follow-up compared to that measured at the immediate postoperative period. Subsidence was observed in 7 patients (22.6%). Of 7 patients with subsidence greater 2 mm, nonunion was developed in 3. Three patients with subsidence greater 2 mm were related with endplate damage during intraoperative endplate preparation. Solid bone fusion was achieved in 28 out of 31 patients (90.3%). With proper patient selection and careful endplate preparation, anterior cervical discectomy and fusion (ACDF) using a stand-alone PEEK cage packed with local autobone graft could be a good alternative to the standard ACDF techniques with plating.

  12. Three-level anterior cervical discectomy and fusion in elderly patients with wedge shaped tricortical autologous graft: A consecutive prospective series

    Directory of Open Access Journals (Sweden)

    Lee Suk

    2008-01-01

    Full Text Available Background: Treatment of multilevel cervical spondylotic myelopathy/radiculopathy is a matter of debate, more so in elderly patients due to compromised physiology. We evaluated the clinical and radiological results of cervical fusion, using wedge-shaped tricortical autologous iliac graft and Orion plate for three-level anterior cervical discectomy in elderly patients. Materials and Methods: Twelve elderly patients with mean age of 69.7 years (65-76 years were treated between April 2000 and March 2005, for three-level anterior cervical discectomy and fusion, using wedge-shaped tricortical autologous iliac graft and Orion plate. Outcome was recorded clinically according to Odom′s criteria and radiologically in terms of correction of lordosis angle and intervertebral disc height span at the time of bony union. The mean follow-up was 29.8 months (12-58 months. Results: All the patients had a complete recovery of clinical symptoms after surgery. Postoperative score according to Odom′s criteria was excellent in six patients and good in remaining six. Bony union was achieved in all the patients with average union time of 12 weeks (8-20 weeks. The mean of sum of three segment graft height collapse was 2.50 mm (SD = 2.47. The average angle of lordosis was corrected from 18.2° (SD = 2.59° preoperatively to 24.9° (SD = 4.54° at the final follow-up. This improvement in the radiological findings is statistically significant (P < 0.05. Conclusion: Cervical fusion with wedge-shaped tricortical autologous iliac graft and Orion plate for three-level anterior cervical discectomy is an acceptable technique in elderly patients. It gives satisfactory results in terms of clinical outcome, predictable early solid bony union, and maintenance of disc space height along with restoration of cervical lordosis.

  13. Standalone Anterior Cervical Discectomy and Fusion Versus Combination with Foraminotomy for the Treatment of Cervical Spondylotic Radiculopathy Secondary to Bony Foraminal Stenosis.

    Science.gov (United States)

    Guo, Qunfeng; Wang, Liang; Zhang, Bangke; Jiang, Jiayao; Guo, Xiang; Lu, Xuhua; Ni, Bin

    2016-11-01

    To compare the results of anterior cervical discectomy and fusion (ACDF) combined with anterior cervical foraminotomy (ACF) and standalone ACDF for the treatment of cervical spondylotic radiculopathy (CSR). The data of 24 consecutive patients who underwent ACDF combined with ACF for significant bony foraminal stenosis were reviewed. The clinical outcomes, including visual analog scale (VAS) scores for neck pain and arm pain and Neck Disability Index, were evaluated by questionnaires. Radiologic outcomes as manifested by C2-7 angle and surgical segmental angle were recorded. The outcomes were compared with outcomes of standalone ACDF for CSR secondary to posterolateral spurs. At the final follow-up evaluation, all patients obtained bone fusion. No patient developed adjacent segment disease. Operative time was longer and blood loss was more in the ACDF combined with ACF group than in the ACDF group (all P 0.05). For CSR with foraminal stenosis secondary to significant bony pathology that cannot be managed with standalone ACDF, ACDF combined with ACF is an effective and safe treatment strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Clinical and radiological outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages.

    Science.gov (United States)

    Shiban, Ehab; Gapon, Karina; Wostrack, Maria; Meyer, Bernhard; Lehmberg, Jens

    2016-02-01

    To evaluate long-term results after one-, two-, and three-level anterior cervical discectomy and fusion (ACDF) with stand-alone empty polyetheretherketone (PEEK) cages. We performed a retrospective review of a consecutive patient cohort that underwent ACDF with stand-alone empty PEEK cages between 2007 and 2010 with a minimum follow-up of 12 months. Radiographic follow-up included static and flexion/extension radiographs. Changes in the operated segments were measured and compared to radiographs directly after surgery. Clinical outcome was evaluated by a physical examination, pain visual analog scale (VAS), and health-related quality of life (HRQL) using the EuroQOL questionnaire (EQ-5D). Analysis of associations between fusion, subsidence, cervical alignment, and clinical outcome parameters were performed. Of 407 consecutive cases, 318 met all inclusion criteria. Follow-up data were obtained from 265 (83 %) cases. The mean age at presentation was 55 years and 139 patients were male (52 %). In the sample, 127, 125, and 13 patients had one-, two-, and three-level surgeries, respectively; 132 (49 %) presented with spondylotic cervical myelopathy and 133 (50 %) with cervical radiculopathy. Fusion was achieved in 85, 95, and 94 % of segments in one-, two-, and three-level surgeries, respectively. Non-fusion was associated with higher VAS pain levels. Radiographic adjacent segment disease (ASD) was observed in 20, 29, and 15 % in one-, two-, and three-level surgeries, respectively. ASD was associated with lower HRQL. Subsidence was observed in 25, 27, and 15 % of segments in one-, two-, and three-level surgeries, respectively. However, this had no influence on clinical outcome. Follow-up operations for symptomatic adjacent disc disease and implant failure at index level were needed in 16 (6 %) and four (1.5 %) cases, respectively. Younger age was associated with better clinical outcome. Multilevel surgery favored better myelopathy outcomes and fusion reduced overall

  15. Comparing Health Related Quality of Life Outcomes in Patients Undergoing Either Primary or Revision Anterior Cervical Discectomy and Fusion.

    Science.gov (United States)

    Schroeder, Gregory D; Boody, Barrett S; Kepler, Christopher K; Kurd, Mark F; Silva, Stephen; Nicholson, Kristen; Wilson, Jefferson R; Woods, Barret I; Radcliff, Kris E; Anderson, D Greg; Hilibrand, Alan S; Vaccaro, Alexander R; Rihn, Jeffery A

    2017-12-05

    A retrospective review of prospectively collected data. Compare HRQOL outcome metrics in patients undergoing primary and revision ACDF. Anterior cervical discectomy and fusion (ACDF) is associated with significant improvements in health related quality of life (HRQOL) outcome metrics. However, 2.9% of patients per year will develop symptomatic adjacent segment disease and there is a paucity of literature on HRQOL outcomes following revision ACDF. Patients were identified who underwent either a primary or revision ACDF, and who had both preoperative and a minimum of one-year post-operative HRQOL outcome data. Pre- and postoperative Short Form 12 Physical Component Score (SF12 PCS), Short Form 12 Mental Component Score (SF12 MCS) VAS neck, VAS arm and Neck Disability Index (NDI) scores were compared. 360 patients (299 primary, 61 revision) were identified. Significant improvement in SF12 PCS, NDI, VAS neck and VAS arm was seen in both groups, however only a significant improvement in SF12 MCS was seen in the primary group. When comparing the results of a primary versus a revision surgery, the SF12 PCS score was the only outcome with a significantly different net improvement in the primary group (7.23 +/- 9.72) compared to the revision group (2.9 +/- 11.07; p = 0.006) despite similar baseline SF12 PCS scores. The improvement in each of the other reported HRQOL outcomes did not significantly vary between surgical groups. A revision ACDF for cervical radiculopathy or myelopathy leads to a significant improvement in the HRQOL outcome, and with the exception of the SF12 PCS, these results are similar to those of patients undergoing a primary ACDF. 2.

  16. Outcomes of contemporary use of rectangular titanium stand-alone cages in anterior cervical discectomy and fusion: cage subsidence and cervical alignment.

    Science.gov (United States)

    Yamagata, Toru; Takami, Toshihiro; Uda, Takehiro; Ikeda, Hidetoshi; Nagata, Takashi; Sakamoto, Shinichi; Tsuyuguchi, Naohiro; Ohata, Kenji

    2012-12-01

    Cervical intervertebral disc replacement using a rectangular titanium stand-alone cage has become a standard procedure for anterior cervical discectomy and fusion (ACDF). We examined outcomes resulting from the contemporary use of rectangular titanium stand-alone cages for ACDF, particularly focusing on cage subsidence and subsequent kyphotic malalignment. Patient data were collected prospectively, and a total of 47 consecutive patients who underwent periodic follow-up of at least 1 year's duration after ACDF were studied retrospectively. Sixty-three rectangular titanium cages were implanted during 31 1-level and 16 2-level procedures. None of the patients developed surgery-related complications (including cage displacement or extrusion). Mean Neurosurgical Cervical Spine Scale scores were significantly improved at 1 year after surgery. Twelve of the 63 inserted cages (19.0%) were found to have cage subsidence, occurring in 11 of 47 patients (23.4%). There was no significant difference in functional recovery between patients with and without cage subsidence. Logistic regression analysis indicated that fusion level, cage size and cage position were significantly related to cage subsidence. The distraction ratio among patients with cage subsidence was significantly higher than that among patients without cage subsidence. Cage subsidence resulted in early deterioration of local angle and total alignment of the cervical spine. Although a longer follow-up is warranted, a good surgical outcome with negligible complications appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF. Excessive distraction at the fusion level should be avoided, and cage position should be adjusted to the anterior vertical line. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. The change of adjacent segment after cervical disc arthroplasty compared with anterior cervical discectomy and fusion: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Dong, Liang; Xu, Zhengwei; Chen, Xiujin; Wang, Dongqi; Li, Dichen; Liu, Tuanjing; Hao, Dingjun

    2017-10-01

    Many meta-analyses have been performed to study the efficacy of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF); however, there are few data referring to adjacent segment within these meta-analyses, or investigators are unable to arrive at the same conclusion in the few meta-analyses about adjacent segment. With the increased concerns surrounding adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) after anterior cervical surgery, it is necessary to perform a comprehensive meta-analysis to analyze adjacent segment parameters. To perform a comprehensive meta-analysis to elaborate adjacent segment motion, degeneration, disease, and reoperation of CDA compared with ACDF. Meta-analysis of randomized controlled trials (RCTs). PubMed, Embase, and Cochrane Library were searched for RCTs comparing CDA and ACDF before May 2016. The analysis parameters included follow-up time, operative segments, adjacent segment motion, ASDeg, ASDis, and adjacent segment reoperation. The risk of bias scale was used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity. Twenty-nine RCTs fulfilled the inclusion criteria. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (padjacent segment reoperation increases with increasing follow-up time by subgroup analysis. There was no statistically significant difference in ASDeg between CDA and ACDF within the 24-month follow-up period; however, the rate of ASDeg in CDA was significantly lower than that of ACDF with the increase in follow-up time (p.05). Cervical disc arthroplasty provided a lower adjacent segment range of motion (ROM) than did ACDF, but the difference was not statistically significant. Compared with ACDF, the advantages of CDA were lower ASDeg and adjacent segment reoperation. However, there was no statistically significant difference in ASDis and

  18. Symptomatic adjacent segment disease after single-lever anterior cervical discectomy and fusion: Incidence and risk factors.

    Science.gov (United States)

    Wang, Feng; Hou, Hong-Tao; Wang, Peng; Zhang, Jing-Tao; Shen, Yong

    2017-11-01

    The purpose of this study was to determine the incidence and risk factors of symptomatic adjacent segment disease (ASD) following single-lever anterior cervical discectomy and fusion (ACDF) for cervical degenerative diseases.From January 2000 to December 2010, a total of 582 patients with cervical radiculopathy and myelopathy who had undergone single-lever ACDF surgery in the authors' institution were reviewed retrospectively. Patients who had a revision surgery for symptomatic ASD were selected for this study. The authors analyzed the incidence for ASD after single-lever ACDF. And univariate analysis and logistic regression analysis were performed to identify the risk factors of ASD.Among the 582 patients, 36 patients received subsequent surgical management for ASD after initial single-lever ACDF for an overall prevalence of 6.2%. The average onset time of ASD was 8.5 (2-15) years. The univariate analysis showed that there were no significant differences in sex, duration of disease, BMI, DM, smoking, operative levels, and follow-up period (P > .05) between the 2 groups with and without ASD. There were statistically significant differences in age at the time of operation (χ = 4.361, P = .037), and developmental canal stenosis (χ = 4.181, P = .041) between patients with and without ASD. The variables of age at the time of operation and developmental canal stenosis were included in a logistic regression model. The logistic regression analysis revealed that age at the time of operation ≤50 years (P = .045, OR = 3.015, 95% CI = 1.024-8.882) and developmental canal stenosis (P = .042, OR = 2.797, 95% CI = 1.039-7.527) were the risk factors for ASD after single-lever ACDF.In the present study, the incidence of symptomatic ASD after single-lever ACDF was 6.2%. And the age at the time of operation ≤50 years and developmental canal stenosis were the risk factors for ASD. The patients ≤50 years old at the time of operation

  19. Anterior Cervical Discectomy and Fusion for Adjacent Segment Disease: Clinical Outcomes and Cost Utility of Surgical Intervention.

    Science.gov (United States)

    O'Neill, Kevin R; Wilson, Robert J; Burns, Katharine M; Mioton, Lauren M; Wright, Brian T; Adogwa, Owoicho; McGirt, Matthew J; Devin, Clinton J

    2016-07-01

    Retrospective review. Determine clinical outcomes and cost utility of anterior cervical discectomy and fusion (ACDF) for the treatment of adjacent segment disease (ASD). The incidence of symptomatic ASD after ACDF has been estimated to occur in up to 26% of patients. Commonly, these patients will undergo an additional ACDF procedure. However, there are currently no studies available that adequately describe the clinical outcomes or cost utility of performing ACDF for ASD. A retrospective review of 40 patients undergoing ACDF for ASD was performed. Baseline and 2-year neck and arm pain (NRS-NP, NRS-AP), neck disability index (NDI), physical and mental quality of life (SF-12 PCS & MCS), and Zung depression score (ZDS) were assessed. Two-year total neck-related medical resource utilization, amount of missed work, and health-state values were determined. Quality-adjusted life years (QALYs) were calculated from EQ-5D assessments with US valuation. Comprehensive costs (indirect, direct, and total cost) and the value (cost-per-QALY gained) of performing ACDF for ASD were assessed. Performing ACDF to treat ASD resulted in significant improvements (P<0.05) in NRS-NP, NRS-AP, NDI, SF-12 PCS, and ZDS outcome measures. Patient-reported health states also significantly improved, with a mean cumulative 2-year gain of 0.54 QALYs. The mean 2-year cost of surgery was $32,616 (direct cost: $25,391; indirect cost: $7225). ACDF for the treatment of ASD was associated with a mean 2-year cost per QALY gained of $60,526. Performing ACDF for ASD resulted in significant improvements in patient pain, disability, and quality of life. Further, the mean 2-year cost-per-QALY was determined to be $60,526, which suggests surgical intervention to be cost effective. This study is the first to provide evidence that performing an ACDF for ASD is both clinically and cost effective.

  20. Impact of Age and Duration of Symptoms on Surgical Outcome of Single-Level Microscopic Anterior Cervical Discectomy and Fusion in the Patients with Cervical Spondylotic Radiculopathy

    Directory of Open Access Journals (Sweden)

    Farzad Omidi-Kashani

    2014-01-01

    Full Text Available We aim to evaluate the impact of age and duration of symptoms on surgical outcome of the patients with cervical spondylotic radiculopathy (CSR who had been treated by single-level microscopic anterior cervical discectomy and fusion (ACDF. We retrospectively evaluated 68 patients (48 female and 20 male with a mean age of 41.2±4.3 (ranged from 24 to 72 years old in our Orthopedic Department, Imam Reza Hospital. They were followed up for 31.25±4.1 months (ranged from 25 to 65 months. Pain and disability were assessed by Visual Analogue Scale (VAS and Neck Disability Index (NDI questionnaires in preoperative and last follow-up visits. Functional outcome was eventually evaluated by Odom’s criteria. Surgery could significantly improve pain and disability from preoperative 6.2±1.4 and 22.2±6.2 to 3.5±2.0 and 8.7±5.2 (1–21 at the last follow-up visit, respectively. Satisfactory outcomes were observed in 89.7%. Symptom duration of more and less than six months had no effect on surgical outcome, but the results showed a statistically significant difference in NDI improvement in favor of the patients aged more than 45 years (P=0.032, although pain improvement was similar in the two groups.

  1. Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.

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    Salvatori, Renata; Rowe, Robert H; Osborne, Raine; Beneciuk, Jason M

    2014-06-01

    Case report. Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.

  2. Adjacent segment motion after anterior cervical discectomy and fusion versus Prodisc-c cervical total disk arthroplasty: analysis from a randomized, controlled trial.

    Science.gov (United States)

    Kelly, Michael P; Mok, James M; Frisch, Richard F; Tay, Bobby K

    2011-07-01

    Post hoc analysis of data acquired in a prospective, randomized, controlled trial. To compare adjacent segment motion after anterior cervical discectomy and fusion (ACDF) versus cervical total disc arthroplasty (TDA). TDA has been designed to be a motion-preserving device, thus theoretically normalizing adjacent segment kinematics. Clinical studies with short-term follow-up have yet to demonstrate a consistent significant difference in the incidence of adjacent segment disease. Two hundred nine patients at 13 sites were treated in a prospective, randomized, controlled trial of ACDF versus TDA for single-level symptomatic cervical degenerative disc disease (SCDD). Flexion and extension radiographs were obtained at all follow-up visits. Changes in ROM were compared using the Wilcoxon signed-rank test and the Mann-Whitney U test. Predictors of postoperative ROM were determined by multivariate analysis using mixed effects linear regression. Data for 199 patients were available with 24-month follow-up. The groups were similar with respect to baseline demographics. A significant increase in motion at the cranial and caudal adjacent segments after surgery was observed in the ACDF group only (cranial: ACDF: +1.4° (0.4, 2.4), P = 0.01; TDA: +0.8°, (-0.1, +1.7), P = 0.166; caudal: ACDF: +2.6° (1.3, 3.9), P adjacent segment ROM was observed between ACDF and TDA. Only time was a significant predictor of postoperative ROM at both the cranial and caudal adjacent segments. Adjacent segment kinematics may be altered after ACDF and TDA. Multivariate analysis showed time to be a significant predictor of changes in adjacent segment ROM. No association between the treatment chosen (ACDF vs. TDA) and ROM was observed. Furthermore clinical follow-up is needed to determine whether possible differences in adjacent segment motion affect the prevalence of adjacent segment disease in the two groups.

  3. Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion for Incidence of Symptomatic Adjacent Segment Disease: A Meta-Analysis of Prospective Randomized Controlled Trials.

    Science.gov (United States)

    Zhu, Yuhang; Zhang, Boyin; Liu, Haochuan; Wu, Yuntao; Zhu, Qingsan

    2016-10-01

    Meta-analysis of randomized controlled trials. To evaluate the reported rate of adjacent segment disease (ASD) of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF). Motion-maintaining technologies such as CDA have developed rapidly because of the concern of ASD. Till date, however, it still has been under debate whether CDA is superior to ACDF regarding the incidence of ASD. We comprehensively searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trails for prospective randomized controlled trials (RCTs) that reported the incidence of ASD between CDA and ACDF. The retrieved results were last updated on November 20, 2015 without language restrictions. Two independent authors selected qualified studies, assessed methodological quality, and extracted requisite data. Fourteen relevant RCTs involving 3235 individuals with a follow-up period of 2 to 7 years were included in the meta-analysis (1696 in CDA group and 1539 in ACDF group). The outcomes indicated that CDA was superior to ACDF considering the lower rate of ASD (risk ratio, 0.57; 95% confidence interval, 0.37 to 0.87; P = 0.009). And compared with ACDF, there were significantly fewer adjacent segment reoperations in the CDA group (risk ratio, 0.47; confidence interval, 0.32 to 0.70; P = 0.0002). Subgroup analysis stratified by different types of disc prostheses was also performed. CDA was superior to ACDF regarding fewer ASDs and relative reoperations on the basis of available evidence from a meta-analysis of 14 RCTs. CDA may be a better surgical procedure to reduce the incidence of ASD for patients with cervical disc disease compared with ACDF. Further well-designed studies should continue to pay attention to excellent patients with longer-term follow-up to evaluate the incidence of ASD of these two procedures. 1.

  4. Comparison of allograft and polyetheretherketone (PEEK) cage subsidence rates in anterior cervical discectomy and fusion (ACDF).

    Science.gov (United States)

    Yson, Sharon C; Sembrano, Jonathan N; Santos, Edward Rainier G

    2017-04-01

    Structural allografts and PEEK cages are commonly used interbody fusion devices in ACDF. The subsidence rates of these two spacers have not yet been directly compared. The primary aim of this study was to compare the subsidence rate of allograft and PEEK cage in ACDF. The secondary aim was to determine if the presence of subsidence affects the clinical outcome. We reviewed 67 cases (117 levels) of ACDF with either structural allograft or PEEK cages. There were 85 levels (48 cases) with PEEK and 32 levels (19 cases) with allograft spacers. Anterior and posterior disc heights at each operative level were measured at immediate and 6months post-op. Subsidence was defined as a decrease in anterior or posterior disc heights >2mm. NDI of the subsidence (SG) and non-subsidence group (NSG) were recorded. Chi-square test was used to analyze subsidence rates. T-test was used to analyze clinical outcomes (α=0.05). There was no statistically significant difference between subsidence rates of the PEEK (29%; 25/85) and allograft group (28%; 9/32) (p=0.69). Overall mean subsidence was 2.3±1.7mm anteriorly and 2.6±1.2mm posteriorly. Mean NDI improvement was 11.7 (from 47.1 to 35.4; average follow-up: 12mos) for the SG and 14.0 (from 45.8 to 31.8; average follow-up: 13mos) for the NSG (p=0.74). Subsidence rate does not seem to be affected by the use of either PEEK or allograft as spacers in ACDF. Furthermore, subsidence alone does not seem to be predictive of clinical outcomes of ACDF. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. A prospective randomized trial comparing anterior cervical discectomy and fusion versus plate-only open-door laminoplasty for the treatment of spinal stenosis in degenerative diseases.

    Science.gov (United States)

    Jiang, Yun-Qi; Li, Xi-Lei; Zhou, Xiao-Gang; Bian, Chong; Wang, Han-Ming; Huang, Jian-Ming; Dong, Jian

    2017-04-01

    For three or more involved cervical levels, there is a debate over which approach yields the best outcomes for the treatment of multilevel cervical degenerative disease. Our objective is to compare the radiological and clinical outcomes of two treatments for multilevel cervical degenerative disease: anterior cervical discectomy and fusion (ACDF) versus plate-only open-door laminoplasty (laminoplasty). Patients were randomized on a 1:1 randomization schedule with 17 patients in the ACDF group and 17 patients in the laminoplasty group. Clinical outcomes were assessed by a visual analog scale (VAS), Japanese Orthopedic Association (JOA) scores, operative time, blood loss, rates of complications, drainage volume, discharge days after surgery, and complications. The cervical spine curvature index (CI) and range of motion (ROM) were assessed with radiographs. The mean VAS score, the mean JOA score, and the rate of complications did not differ significantly between groups. The laminoplasty group had greater blood loss, a longer operative time, more drainage volume, and a longer hospital stay than the ACDF group. There were no significant differences in the CI and ROM between the two groups at baseline and at each follow-up time point. ROM in both groups decreased significantly after surgery. Both ACDF and laminoplasty are effective and safe treatments for multilevel cervical degenerative disease. ACDF causes fewer traumas than laminoplasty.

  6. Zero-profile implant versus conventional cage-plate implant in anterior cervical discectomy and fusion for the treatment of degenerative cervical spondylosis: a meta-analysis.

    Science.gov (United States)

    Shao, Haiyu; Chen, Jinping; Ru, Bin; Yan, Feifei; Zhang, Jun; Xu, Shaonan; Huang, Yazeng

    2015-09-17

    Zero-profile implant has become more and more popular in anterior cervical discectomy and fusion (ACDF) for the treatment of degenerative cervical spondylosis. However, there was no enough evidence judging its efficiency and safety. The aim of this analysis was to evaluate the efficacy and safety of Zero-profile implant compared with conventional cage-plate (CCP) in ACDF. All studies directly comparing the outcomes between the Zero-profile implant and CCP implant in ACDF were included, and the search strategy followed the requirements of the Cochrane Library Handbook. Two of the authors extracted relevant data and checked the accuracy independently using standardized data collection form. Seven studies involving 560 patients were included, 262 in the Zero-profile group and 298 in the CCP group. Zero-profile implant had a lower rate of postoperative dysphagia at 2 weeks, 6 months, and 1 year (p = 0.0002, p = 0.008, and p = 0.001, respectively) than CCP implant. Zero-profile also reduced blood loss (p = 0.0001), while operation time and incidence of postoperative transient dysphagia had no statistical significance (p = 0.92, p = 0.42, respectively) between two groups. Based on the results of our analysis, the application of Zero-profile implant in ACDF had a lower rate of postoperative dysphagia at 2 weeks, 6 months, and 1 year than CCP implant. Zero-profile implant also had fewer blood loss during operation. More rigorous and adequately powered prospective randomized controlled trials with larger sample size are required to elucidate a more objective outcome.

  7. Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials

    Science.gov (United States)

    Hu, Yan; Lv, Guohua; Ren, Siying; Johansen, Daniel

    2016-01-01

    Purpose This study aimed to investigate the mid- to long-term outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of 1-level or 2-level symptomatic cervical disc disease. Methods Medline, Embase, and the Cochrane Central Register of Controlled Trials databases were searched to identify relevant randomized controlled trials that reported mid- to long-term outcomes (at least 48 months) of CDA versus ACDF. All data were analyzed by Review Manager 5.3 software. The relative risk (RR) and 95% confidence intervals (CIs) were calculated for dichotomous variables. The weighted mean difference (WMD) and 95%CIs were calculated for continuous variables. A random effect model was used for heterogeneous data; otherwise, a fixed effect model was used. Results Eight prospective randomized controlled trials (RCTs) were retrieved in this meta-analysis, including 1317 and 1051 patients in CDA and ACDF groups, respectively. Patients after an ACDF had a significantly lower rate of follow-up than that after CDA. Pooled analysis showed patients in CDA group achieved significantly higher rates of overall success, Neck Disability Index (NDI) success, neurological success and significantly lower rates of implant/surgery-related serious adverse events and secondary procedure compared with that in ACDF group. The long-term functional outcomes (NDI, Visual Analog Scale (VAS) neck and arm pain scores, the Short Form 36 Health Survey physical component score (SF-36 PCS)), patient satisfaction and recommendation, and the incidence of superior adjacent segment degeneration also favored patients in CDA group with statistical difference. Regarding inferior adjacent segment degeneration, patients in CDA group had a lower rate without statistical significance. Conclusions This meta-analysis showed that cervical disc arthroplasty was superior over anterior discectomy and fusion for the treatment of symptomatic cervical disc disease in

  8. Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages.

    Science.gov (United States)

    Niu, Chi-Chien; Liao, Jen-Chung; Chen, Wen-Jer; Chen, Lih-Huei

    2010-07-01

    A prospective study was performed in case with cervical spondylosis who underwent anterior cervical discectomy and fusion (ACDF) with titanium or polyetheretherketone (PEEK) cages. To find out which fusion cage yielded better clinical and radiographic results. Although use of autogenous iliac-bone grafts in ACDF for cervical disc diseases remain standard surgical procedure, donor site morbidity and graft collapse or breakage are concerns. Cage technology was developed to prevent these complications. However, there is no comparison regarding the efficacy between titanium and PEEK cage. January 2005 to January 2006, 53 patients who had 1 and 2-levels ACDF with titanium or PEEK cages were evaluated. We measured the rate and amount of interspace collapse, segmental sagittal angulations, and the radiographic fusion success rate. Odom criteria were used to assess the clinical results. The fusion rate was higher in the PEEK group (100% vs. 86.5%, P=0.0335). There was no significant difference between both groups in loss of cervical lordosis (3.2 + or - 2.4 vs. 2.8 + or - 3.4, P=0.166). The mean anterior interspace collapse (1.6 + or - 1.0 mm) in the titanium group was significantly higher than the collapse of the PEEK group (0.5 + or - 0.6 mm) (PPEEK group (PPEEK group achieved an 80% rate of successful clinical outcomes, compared with 75% in the titanium group (P=0.6642). The PEEK cage is superior to the titanium cage in maintaining cervical interspace height and radiographic fusion after 1 and 2-levels anterior cervical decompression procedures.

  9. Significant relationship between local angle at fused segments and C2-7 angle: Average duration of longer than 20 years after anterior cervical discectomy and fusion

    Directory of Open Access Journals (Sweden)

    T Nagata

    2011-01-01

    Full Text Available Background : The authors have focused their attention to the radiological durability of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF using autologous bone grafting. Materials and Methods : Among the patients who underwent ACDF with trans-unco-discal (TUD approach between 1976 and 1997, 22 patients (16 males and 6 females made return visits for a clinical evaluation. Patients with trauma or previously treated by anterior cervical fusion or by posterior decompression were excluded from the present study. Clinical evaluation included adjacent segment degeneration (ASD, osseous fusion, local angle at the fused segments and C2-7 angle of cervical spine. Results : The duration after ACDF ranged from 13 to 34 years with an average of 21.3 ± 7.0 years. A single level fusion was done on 8 patients, 2 levels on 11 patients, 3 levels on 2 patients, and 4 levels on 1 patient. Imaging studies indicated that 12 of the 22 patients (54.5% were graded as having symptomatic ASD. Osseous bony fusion at ACDF was recognized in all cases. None of the patients demonstrated kyphotic malalignment of the cervical spine. Average degrees of local angle at the fused segments and the C2-7 angle were 7.06 and 17.6, respectively. Statistical analysis indicated a significant relationship between the local at the fused segments and C2-7 angles. Conclusions : Sagittal alignment of the cervical spine was durable long after ACDF when the local angle at the fused segments was well stabilized.

  10. Comparison of a zero-profile anchored spacer (ROI-C) and the polyetheretherketone (PEEK) cages with an anterior plate in anterior cervical discectomy and fusion for multilevel cervical spondylotic myelopathy.

    Science.gov (United States)

    Liu, Yijie; Wang, Heng; Li, Xuefeng; Chen, Jie; Sun, Han; Wang, Genlin; Yang, Huilin; Jiang, Weimin

    2016-06-01

    We aimed to analyze the clinical and radiographic efficacy of a new zero-profile anchored spacer called the ROI-C in anterior discectomy and fusion (ACDF) for multilevel cervical spondylotic myelopathy (MCSM). We retrospectively reviewed the clinical, radiological outcomes and complications of multilevel ACDF with the ROI-C or with the polyetheretherketone (PEEK) cages with an anterior plate. From April 2011 to April 2014, 60 patients with MCSM were operated on using ACDF, with the ROI-C in 28 patients and PEEK cages with an anterior plate in 32 patients. The operative time, intraoperative blood loss, and clinical and radiological results were compared between the ROI-C group and the cage-plate group. The mean follow-up time was 23.8 ± 6.6 months, ranging from 12 to 36 months. At the first month and the last follow-up, the neck disability index (NDI) scores were decreased, and the Japanese Orthopedic Association (JOA) scores were significantly increased, compared with the presurgical measurements in both groups. There were no significant differences in NDI scores or JOA scores between the two groups (P > 0.05), but there were significant differences in the operation time, blood loss and the presence of dysphagia (P PEEK cage with an anterior plate.

  11. Anterior cervical discectomy and fusion with "mini-invasive" harvesting of iliac crest graft versus polyetheretherketone (PEEK) cages: a retrospective outcome analysis.

    Science.gov (United States)

    Spallone, A; Marchione, P; Li Voti, P; Ferrante, L; Visocchi, M

    2014-12-01

    Limited outcome data suggested a minimal evidence for better clinical and radiographic outcome of polyetheretherketone cages compared with bone grafts in the anterior cervical discectomy and fusion. We proposed a "mini-invasive" surgical technique for harvesting iliac crest grafts that provides bicortical autografts of sufficient size to be used in multilevel cervical procedures and is not associated with long-term significant donor site pain. All patients undergoing discectomy and fusion during a three years period were consecutively extracted from computer database and retrospectively evaluated by means of telephonic interview, independently from surgical procedure (iliac crest autograph or prosthesis). Two procedure-blinded neurologists retrieved baseline clinical-demographic data and pre-surgical scores of routinely performed scales for pain and functional abilities. Afterwards, a third blinded neurologist performed clinical follow up by a semi-structured interview including Verbal Analog Scale for pain and Neck Disability Scale for discomfort. 80 patients out of 115 selected cases completed the follow up. 40 patients had been treated by mini-invasive bone graft harvesting and 40 with PEEK cages for cervical fusion. VAS for both neck and arm pain were significantly reduced within groups. Patients did not complaint any significant pain and/or paraesthesias at donor site from the first week after intervention. Neck Disability Scale was significantly lower at the end of follow up in both groups. "Miniinvasive" bicortical autografts is a less invasive, inexpensive technique to harvest iliac graft that may produce a reduced amount of general and local donor-site complications without outcome differences with prosthetic cages. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  12. Efficacy and safety of Mobi-C cervical artificial disc versus anterior discectomy and fusion in patients with symptomatic degenerative disc disease: A meta-analysis.

    Science.gov (United States)

    Lu, Hui; Peng, Lihua

    2017-12-01

    Total disc replacement (TDR) using Mobi-C cervical artificial disc might be promising to treat symptomatic degenerative disc disease. However, the results remained controversial. We conducted a systematic review and meta-analysis to compare the efficacy and safety of Mobi-C cervical artificial disc and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic degenerative disc disease. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of Mobi-C versus ACDF on the treatment of symptomatic degenerative disc disease were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were neck disability index (NDI) score, patient satisfaction, and subsequent surgical intervention. Meta-analysis was performed using the random-effect model. Four RCTs were included in the meta-analysis. Overall, compared with ACDF surgery for symptomatic degenerative disc disease, TDR using Mobi-C was associated with a significantly increased NDI score (Std. mean difference = 0.32; 95% CI = 0.10-0.53; P = .004), patient satisfaction (odds risk [OR] = 2.75; 95% confidence interval [CI] = 1.43-5.27; P = .002), and reduced subsequent surgical intervention (OR = 0.20; 95% CI = 0.11-0.37; P degenerative disc disease, TDR using Mobi-C cervical artificial disc resulted in a significantly improved NDI score, patient satisfaction, and reduced subsequent surgical intervention. There was no significant difference of neurological deterioration, radiographic success, and overall success between TDR using Mobi-C cervical artificial disc versus ACDF surgery. TDR using Mobi-C cervical artificial disc should be recommended for the treatment of symptomatic degenerative disc disease.

  13. Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life.

    Science.gov (United States)

    Kapetanakis, Stylianos; Thomaidis, Tryfon; Charitoudis, George; Pavlidis, Pavlos; Theodosiadis, Panagiotis; Gkasdaris, Grigorios

    2017-09-01

    Anterior cervical discectomy and fusion (ACDF) constitutes the conventional treatment of cervical disc herniation due to degenerative disc disease (DDD). ACDF with plating presents a variety of complications postoperatively and stand-alone cages are thought to be a promising alternative. The aim of this study was firstly, to analyze prospectively collected data from a sample of patients treated with single ACDF using C-Plus self-locking stand-alone PEEK cage system, without the use of plates or screws, in order to evaluate pain levels of patients, utilizing Neck and Arm Pain scale as an expression of visual analogue scale (VAS). Secondly, we aimed to evaluate health-related quality of life, via the short-form 36 (SF-36) and Neck Disability Index (NDI). Thirty-six patients (19 male and 17 female) with mean age 49.6±7 years old who underwent successful single ACDF using self-locking stand-alone PEEK cage for symptomatic cervical DDD were selected for the study. Neck and Arm pain, as well as SF-36 and NDI were estimated preoperatively and 1, 3, 6, and 12 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological and radiological evaluation. The clinical and radiological outcomes were satisfactory after a minimum 1-year follow-up. All results were statistically important (P<0.05), excluding improvement in NDI measured between 6 and 12 months. SF-36, Neck Pain, as well as Arm Pain featured gradual and constant improvement during follow-up, with best scores presenting at 12 months after surgery, while NDI reached its best at 6 months postoperatively. Generally, all scores showed improvement postoperatively during the different phases of the follow-up. Subsequently, ACDF using C-Plus cervical cage constitutes an effective method for cervical disc herniation treatment, in terms of postoperative improvement on pain levels and health-related quality of life and a safe alternative to the conventional method of treatment for cervical DDD.

  14. Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the C4-C5 levels: a technical note.

    Science.gov (United States)

    Deng, Zhong-Liang; Chu, Lei; Chen, Liang; Yang, Jun-Song

    2016-05-01

    With the continuous development of the spinal endoscopic technique in recent years, percutaneous endoscopic cervical discectomy (PECD) has emerged, which bridges the gap between conservative therapy and traditional surgery and has been mainly divided into the anterior transdiscal approach and the posterior interlaminar access. Because of the relatively greater violation to the anterior nucleus pulposus, there is a higher potential of postoperative intervertebral space decrease in the anterior transdiscal approach than in the posterior interlaminar access. In addition, when the herniated lesion is migrated upward or downward behind the vertebral body, both approaches, and even anterior cervical discectomy and fusion, are impractical, and corpectomy is commonly considered as the only efficacious treatment. Anterior transcorporeal approach under endoscopy could enable an individual and adjustable trajectory within the vertebral body under different conditions of disc herniation preserving the motion of adjacent segment, especially in a migrated or sequestered lesion. This report aimed to first describe a novel anterior transcorporeal approach under endoscopy in which we addressed a migrated disc herniation at the C4-C5 levels. A technical report was carried out. A 37-year-old woman presented with posterior neck pain and weakness of extremities for 9 months. On neurologic examination, tingling sensation and numbness were not obvious. However, the power of extremities was dramatically decreased at a level of 3. Hoffmann sign was positive in the bilateral hand. Magnetic resonance imaging (MRI) showed a huge herniation of the C4-C5 disc compressing the median area of the spinal cord. Besides the C4-C5 disc herniation, preoperative computer tomography (CT) also detected that the herniated disc had partial calcification. A novel anterior transcorporeal approach of PECD, through the vertebral body of C5, was performed to address a migrated disc herniation at the C4-C5 levels

  15. Safety and Efficiency of Biomimetic Nanohydroxyapatite/Polyamide 66 Composite in Rabbits and Primary Use in Anterior Cervical Discectomy and Fusion

    Directory of Open Access Journals (Sweden)

    Hui Xu

    2014-01-01

    Full Text Available This study was conducted to validate the safety and efficiency of biomimetic nanohydroxyapatite/polyamide 66 (n-HA/PA66 composite in animal model (rabbit and report its application in anterior cervical discectomy and fusion (ACDF for 4, 12, and 24 weeks. N-HA/PA66 composite was implanted into one-side hind femur defects and the control defects were kept empty as blank controls. A combination of macroscopic and histomorphometric studies was performed up to 24 weeks postoperatively and compared with normal healing. 60 cervical spondylosis myelopathy and radiculopathy patients who were subjected to ACDF using n-HA/PA66 and PEEK cage were involved in this study with six-month minimum follow-up. Their radiographic (cage subsidence, fusion status, and segmental sagittal alignment (SSA and clinical (VAS and JOA scales data before surgery and at each follow-up were recorded and compared. Nanohydroxyapatite/polyamide 66 composite is safe and effective in animal experiment and ACDF.

  16. Anterior cervical discectomy and fusion surgery versus total disc replacement: A comparative study with minimum of 10-year follow-up.

    Science.gov (United States)

    Yang, Si-Dong; Zhu, Yan-Bo; Yan, Suo-Zhou; Di, Jun; Yang, Da-Long; Ding, Wen-Yuan

    2017-11-27

    Based on long-term follow-ups, this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) in treating cervical degenerative diseases. Between January 2000 and December 2005, 108 cases undergoing ACDF and 78 undergoing TDR, were enrolled into this study. All medical records were retrospectively collected. Every patient was followed up at least 10 years. Outcome assessment included visual analogue scale (VAS) score, Neck Disability Index (NDI) score, Japanese Orthopaedic Association (JOA) score, and radiographic parameters. Consequently, thirty-eight (35.2%) of 108 cases suffered from ASD in ACDF group, and 26 (33.3%) of 78 cases in TDR group. There was no statistical difference between the two groups regarding ASD incidence, VAS/NDI/JOA score, recovery rate. Logistic regression analysis showed that age (OR = 2.86, 95% CI, 1.58-4.14) and preoperative segmental lordosis (OR = 1.90, 95% CI, 1.05-3.20) were risk factors associated with increased odds of ASD regardless of surgical procedures. On the other hand, preoperative overall lordosis (OR = 0.54, 95% CI, 0.26-0.82) was most likely protective. In conclusion, advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD, while preoperative overall lordosis proves to be a protective factor.

  17. Adjacent segment degeneration following ProDisc-C total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF): does surgeon bias effect radiographic interpretation?

    Science.gov (United States)

    Laxer, Eric B; Brigham, Craig D; Darden, Bruce V; Bradley Segebarth, P; Alden Milam, R; Rhyne, Alfred L; Odum, Susan M; Spector, Leo R

    2017-04-01

    Many investigators have reported the financial conflicts of interest (COI), which could result in potential bias in the reporting of outcomes for patients undergoing total disc replacement (TDR) rather than anterior cervical discectomy and fusion (ACDF). This bias may be subconsciously introduced by the investigator in a non-blinded radiographic review. The purpose of this study was to determine if bias was present when a group of spine specialists rated adjacent segment degeneration (ASD) following cervical TDR or ACDF. Potential bias in the assessment of ASD was evaluated through the reviews of cervical radiographs (pre- and 6 years post-operative) from patients participating in the ProDisc-C FDA trial (ProDisc-C IDE #G030059). The index level was blinded on all radiographs during the first review, but unblinded in the second. Five reviewers (a radiologist, two non-TDR surgeons, and two TDR surgeons), two of whom had a COI with the ProDisc-C trial sponsor, assessed ASD on a three point scale: yes, no, or unable to assess. Intra- and inter-rater reliabilities between all raters were assessed by the Kappa statistic. The intra-rater reliability between reviews was substantial, indicating little to no bias in assessing ASD development/progression. The Kappa statistics were 0.580 and 0.644 for the TDR surgeons (p < 0.0001), 0.718 and 0.572 for the non-TDR surgeons (p < 0.0001), and 0.642 for the radiologist (p < 0.0001). Inter-rater reliability for the blinded review ranged from 0.316 to 0.607 (p < 0.0001) and from 0.221 to 0.644 (p < 0.0001) for the unblinded review. The knowledge of the surgical procedure performed did not bias the assessment of ASD.

  18. Prevalence of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion based on pre-operative MRI findings.

    Science.gov (United States)

    Lundine, Kristopher M; Davis, Gavin; Rogers, Myron; Staples, Margaret; Quan, Gerald

    2014-01-01

    Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the "strain" on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons' practice was carried out to identify patients who had undergone a one- or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion: a study of 672 consecutive patients.

    Science.gov (United States)

    van Eck, Carola F; Regan, Conor; Donaldson, William F; Kang, James D; Lee, Joon Y

    2014-12-15

    retrospective cohort study. The aim of this study was to determine the rate of revision surgery and the occurrence of adjacent segment disease of patients undergoing ACDF for cervical radiculopathy and myelopathy using more modern-day instrumentation techniques. Anterior cervical discectomy and fusion (ACDF) has long been the preferred treatment for cervical radiculopathy and myelopathy. All patients undergoing ACDF between January of 2000 and December of 2010 were included. Age, sex, height, weight, body mass index, symptoms at presentation, number of levels fused, graft type, and smoking status were recorded. Outcomes included revision rate, reason for revision surgery, time to revision surgery, presence and grade of adjacent segment disease, distance from the instrumentation to the cranial and caudal endplate (plate-to-disc distance), and reporting of symptoms of adjacent segment disease at the final follow-up. A total of 672 patients were included in this study. The average duration of follow-up was 31 months. One hundred one (15%) patients underwent revision surgery. The reason for revision surgery was adjacent segment disease in 47 (47.5%), pseudarthrosis in 45 (45.5%) and a new problem at a nonadjacent level in 7 (7.1%) of those patients. The need for revision surgery was not affected by patient age, sex, body mass index, smoking status, symptoms at presentation, number of levels fused, plate-to-disc distance or graft type. The revision rate after ACDF is 15%. Most revisions were done for either adjacent segment disease or pseudarthrosis. No specific risk factors for revision surgery were identified in this study. 3.

  20. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Directory of Open Access Journals (Sweden)

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.

  1. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Directory of Open Access Journals (Sweden)

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.    

  2. Cost-Utility Analysis of Anterior Cervical Discectomy and Fusion With Plating (ACDFP) Versus Posterior Cervical Foraminotomy (PCF) for Patients With Single-level Cervical Radiculopathy at 1-Year Follow-up.

    Science.gov (United States)

    Alvin, Matthew D; Lubelski, Daniel; Abdullah, Kalil G; Whitmore, Robert G; Benzel, Edward C; Mroz, Thomas E

    2016-03-01

    A retrospective 1-year cost-utility analysis. To determine the cost-effectiveness of anterior cervical discectomy and fusion with plating (ACDFP) in comparison with posterior cervical foraminotomy (PCF) for patients with single-level cervical radiculopathy. Cervical radiculopathy due to cervical spondylosis is commonly treated by either PCF or ACDFP for patients who are refractory to nonsurgical treatment. Although some have suggested superior outcomes with ACDFP as compared with PCF, the former is also associated with greater costs. The present study analyzes the cost-effectiveness of ACDFP versus PCF for patients with single-level cervical radiculopathy. Forty-five patients who underwent ACDFP and 25 patients who underwent PCF for single-level cervical radiculopathy were analyzed. One-year postoperative health outcomes were assessed based on Visual Analogue Scale, Pain Disability Questionnaire, Patient Health Questionnaire, and EuroQOL-5 Dimensions questionnaires to analyze the comparative effectiveness of each procedure. Direct medical costs were estimated using Medicare national payment amounts and indirect costs were based on patient missed work days and patient income. Postoperative 1-year cost/utility ratios and the incremental cost-effectiveness ratio (ICER) were calculated to assess for cost-effectiveness using a threshold of $100,000/QALY gained. The 1-year cost-utility ratio for the PCF cohort was significantly lower ($79,856/QALY gained) than that for the ACDFP cohort ($131,951/QALY gained) (P<0.01). In calculating the 1-year ICER, as the ACDFP cohort showed lower QALY gained than the PCF cohort, the ICER was negative and is not reported, meaning that ACDFP was dominated by PCF. Statistically significant and clinically relevant improvements (through minimum clinically important differences) were seen in both cohorts. Although both cohorts showed improved health outcomes, ACDFP was not cost-effective relative to the threshold of $100,000/QALY gained at 1

  3. A Lower T1 Slope as a Predictor of Subsidence in Anterior Cervical Discectomy and Fusion with Stand-Alone Cages.

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    Lee, Su Hun; Lee, Jun Seok; Sung, Soon Ki; Son, Dong Wuk; Lee, Sang Weon; Song, Geun Sung

    2017-09-01

    Preoperative parameters including the T1 slope (T1S) and C2-C7 sagittal vertical axis (SVA) have been recognized as predictors of kyphosis after laminoplasty, which is accompanied by posterior neck muscle damage. The importance of preoperative parameters has been under-estimated in anterior cervical discectomy and fusion (ACDF) because there is no posterior neck muscle damage. We aimed to determine whether postoperative subsidence and pseudarthrosis could be predicted according to specific parameters on preoperative plain radiographs. We retrospectively analyzed 41 consecutive patients (male: female, 22: 19; mean age, 51.15±9.25 years) who underwent ACDF with a stand-alone polyether-ether-ketone (PEEK) cage (>1 year follow-up). Parameters including SVA, T1S, segmental angle and range of motion (ROM), C2-C7 cervical angle and ROM, and segmental inter-spinous distance were measured on preoperative plain radiographs. Risk factors of subsidence and pseudarthrosis were determined using multivariate logistic regression. Fifty-five segments (27 single-segment and 14 two-segment fusions) were included. The subsidence and pseudarthrosis rates based on the number of segments were 36.4% and 29.1%, respectively. Demographic data and fusion level were unrelated to subsidence. A greater T1S was associated with a lower risk of subsidence (p=0.017, odds ratio=0.206). A cutoff value of T1Ssubsidence (sensitivity: 70%, specificity: 68.6%). There were no preoperative predictors of pseudarthrosis except old age. A lower T1S (T1Ssubsidence following ACDF. Surgeons need to be aware of this risk factor and should consider various supportive procedures to reduce the subsidence rates for such cases.

  4. Comparison Between Acrylic Cage and Polyetheretherketone (PEEK) Cage in Single-level Anterior Cervical Discectomy and Fusion: A Randomized Clinical Trial.

    Science.gov (United States)

    Farrokhi, Majid R; Nikoo, Zahra; Gholami, Mehrnaz; Hosseini, Khadijeh

    2017-02-01

    Prospective, single-blind randomized-controlled clinical study. To compare polyetheretherketone (PEEK) cage with a novel Acrylic cage to find out which fusion cage yielded better clinical outcomes following single-level anterior cervical discectomy and fusion (ACDF). ACDF is considered a standard neurosurgical treatment for degenerative diseases of cervical intervertebral disks. There are many options, including bone grafts, bone cement, and spacers made of titanium, carbon fiber, and synthetic materials, used to restore physiological disk height and enhance spinal fusion, but the ideal device, which would provide immediate structural support and subsequent osteointegration and stability, has not been identified yet. To overcome this, we designed a new, inexpensive Acrylic cage. A total of 64 patients were eligible to participate and were randomly allocated to undergo ACDF either with Acrylic interbody fusion cage filled with bone substitute (n=32) or PEEK cage (n=32). Nurick's grading was used for quantifying the neurological deficit. Clinical and radiologic outcome was assessed preoperatively, immediately after surgery, and subsequently at 2, 6, and 12 months of follow-up using Odom's criteria and dynamic radiographs (flexion-extension) and computed tomography scans, respectively. There was a statistically significant improvement in the clinical outcomes of the Acrylic cage group compared with the PEEK cage group (mean difference: -0.438; 95% confidence interval, -0.807 to -0.068; P=0.016). There was a statistically significant difference in disk space height increase between the 2 groups at the 6- and 12-month follow-up. The Acrylic cage achieved higher fusion rate (good fusion) than the PEEK cage (96.9% vs. 93.8%). Intervertebral angle demonstrated a significant difference among the 2 treated groups throughout the follow-up period. This study suggests that the use of Acrylic cage is associated with good clinical and radiologic outcomes and it can be therefore a

  5. Comparing Short-term Complications of Inpatient Versus Outpatient Single-level Anterior Cervical Discectomy and Fusion: An Analysis of 6940 Patients Using the ACS-NSQIP Database.

    Science.gov (United States)

    Khanna, Ryan; Kim, Robert B; Lam, Sandi K; Cybulski, George R; Smith, Zachary A; Dahdaleh, Nader S

    2018-02-01

    Multicenter propensity score-adjusted retrospective cohort study. To determine baseline 30-day complication rates for anterior cervical discectomy and fusion (ACDF) and compare clinical complications for patients undergoing single-level ACDFs between inpatient and outpatient settings. ACDF remains the most common procedure in the treatment of a variety of cervical disc pathologies, making it a focus of quality improvement initiatives. Outpatient single-level ACDFs are becoming more common and offer advantages including reducing nosocomial infections and costs, as well as improved patient satisfaction. The 2011-2013 NSQIP datasets were queried to identify all patients who underwent single-level ACDF procedures using current procedural terminology codes. Outpatient and inpatient cohorts were matched 1:1 using propensity score analysis to assess short-term outcomes. The outcomes assessed included 30-day medical and surgical complications, reoperation, readmission, and mortality. In total, 6940 patients underwent a single-level ACDF with an overall complication rate of 4.2%. A total of 5162 patients (74.4%) had an inpatient hospital stay after surgery, whereas 1778 patients (25.6%) had outpatient surgery. After matching based on preoperative and operative characteristics to account for potential confounders, the overall complication rate was higher in the inpatient arm compared with the outpatient arm (2.5% vs. 1.2%; P=0.003). The 30-day readmission rate was also higher but not significant in the inpatient group than the outpatient group (2.2% vs. 1.8%; P=0.355). Mortality was the same with 0.1% in both groups (P=0.564). Patients undergoing outpatient single-level ACDF had a lower 30-day complication rates than those undergoing it in the inpatient setting. Outpatient surgery for single-level ACDF is safe and a favorable option for suitable patients. Level 3.

  6. A Sternum-Disk Distance Method to Identify the Skin Level for Approaching a Surgical Segment without Fluoroscopy Guidance during Anterior Cervical Discectomy And Fusion.

    Science.gov (United States)

    Lee, Gun Woo; Ahn, Myun-Whan; Shin, Ji-Hoon; Park, Jae Woo; Uh, Jae-Hyung; Park, Jong-Ho; Lee, Ji-Hoon; Kim, Dong-Wook; Yeom, Jin S; Suh, Bo-Gun

    2017-02-01

    A retrospective review of prospectively collected data. To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability. Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported. In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons. The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3-C4, 85.3 mm at C4-C5, 64.4 mm at C5-C6, 44.3 mm at C6-C7, and 24.1 mm at C7-T1; and those in the extension-position MRI were 112.9 mm at C3-C4, 88.7 mm at C4-C5, 67.3 mm at C5-C6, 46.5 mm at C6-C7, and 24.3 mm at C7-T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability). Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.

  7. Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology.

    Science.gov (United States)

    Chotai, Silky; Sielatycki, J Alex; Parker, Scott L; Sivaganesan, Ahilan; Kay, Harrison L; Stonko, David P; Wick, Joseph B; McGirt, Matthew J; Devin, Clinton J

    2016-11-01

    Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared with their non-obese counterparts. The aim of the present study was to determine cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients. This study analyzed prospectively collected data. Patients undergoing elective ACDF for degenerative cervical pathology at a single academic institution were included in the study. Cost and quality-adjusted life years (QALYs) were the outcome measures. One- and two-year medical resource utilization, missed work, and health state values (QALYs) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost (direct+indirect) was used to compute cost per QALY gained. Patients were defined as obese for body mass index (BMI) ≥35 based on the WHO definition of class II obesity. A subgroup analysis was conducted in morbidly obese patients (BMI≥40). There were significant improvements in pain (neck pain or arm pain), disability (Neck Disability Index), and quality of life (EuroQol-5D and Short Form-12) at 2 years after surgery (pdirect cost, indirect cost, and total cost between obese and non-obese patients at postoperative 1-year and 2-year follow-up. Mean 2-year direct cost for obese patients was $19,225±$8,065 and $17,635±$6,413 for non-obese patients (p=.14). There was no significant difference in the mean total 2-year cost between obese ($23,144±$9,216) and non-obese ($22,183±$10,564) patients (p=.48). Obese patients had a lower mean cumulative gain in QALYs versus non-obese patients at 2-years (0.34 vs. 0.42, p=.32). Two-year cost-utility in obese ($68,070/QALY) versus non-obese patients ($52,816/QALY) was not

  8. The duration of symptoms and clinical outcomes in patients undergoing anterior cervical discectomy and fusion for degenerative disc disease and radiculopathy.

    Science.gov (United States)

    Burneikiene, Sigita; Nelson, E Lee; Mason, Alexander; Rajpal, Sharad; Villavicencio, Alan T

    2015-03-01

    There have been controversial reports published in the literature on the duration of symptoms (DOS) and clinical outcome correlation in patients undergoing anterior cervical discectomy and fusion (ACDF) for painful degenerative disc disease and radiculopathy. The primary purpose of this study was to analyze if the DOS has any effect on clinical outcomes. A post hoc analysis was performed on an original prospective clinical study analyzing clinical outcomes and cervical sagittal alignment correlations. Fifty-eight patients undergoing one- or two-level ACDF surgeries for cervical degenerative radiculopathy were analyzed. Standardized questionnaires were used to evaluate clinical outcomes. Neck and arm pain was evaluated using (Visual Analog Scale [VAS]). Two scales of Health-Related Quality-of-Life Questionnaire (Short-Form 36 Health Survey [SF-36]) were used for this study: the physical component summary (PCS) and mental component summary (MCS). Neck disability index (NDI) was used to evaluate chronic disability in activities of daily living. The patients completed a self-reported Patient Satisfaction with Results Survey. Patients who had previous or redo surgeries, were diagnosed with myelopathy or had more than two-level ACDF surgeries were excluded, leaving a total of 58 patients. The mean follow-up was 37.2 months (range 12-54). Patients were divided into two groups for clinical outcome analyses according to the DOS: patients who had surgery within 6 months (n=29) or more than 6 months (n=29) after becoming symptomatic. There were no statistically significant differences in any demographic or clinical parameters among the patient groups. Controlling for preoperative scores, the patients who had surgery within 6 months reported significantly higher reduction (p=.04) in arm pain scores compared with the patients who waited more than 6 months. No significant differences were detected in postoperative neck pain VAS (p=.3), NDI (p=.06), SF-36 PCS (p=.08), and MCS (p

  9. Porous silicon nitride spacers versus PEEK cages for anterior cervical discectomy and fusion: clinical and radiological results of a single-blinded randomized controlled trial.

    Science.gov (United States)

    Arts, Mark P; Wolfs, Jasper F C; Corbin, Terry P

    2017-04-05

    Anterior cervical discectomy with fusion is a common procedure for treating radicular arm pain. Polyetheretherketone (PEEK) plastic is a frequently used material in cages for interbody fusion. Silicon nitride is a new alternative with desirable bone compatibility and imaging characteristics. The aim of the present study is to compare silicon nitride implants with PEEK cages filled with autograft harvested from osteophytes. The study is a prospective, randomized, blinded study of 100 patients with 2 years follow-up. The primary outcome measure was improvement in the Neck Disability Index. Other outcome measures included SF-36, VAS arm pain, VAS neck pain, assessment of recovery, operative characteristics, complications, fusion and subsidence based on dynamic X-ray and CT scan. There was no significant difference in NDI scores between the groups at 24 months follow-up. At 3 and 12 months the NDI scores were in favor of PEEK although the differences were not clinically relevant. On most follow-up moments there was no difference in VAS neck and VAS arm between both groups, and there was no statistically significant difference in patients' perceived recovery during follow-up. Fusion rate and subsidence were similar for the two study arms and about 90% of the implants were fused at 24 months. Patients treated with silicon nitride and PEEK reported similar recovery rates during follow-up. There was no significant difference in clinical outcome at 24 months. Fusion rates improved over time and are comparable between both groups.

  10. Comparison of surgical outcomes after anterior cervical discectomy and fusion: does the intra-operative use of a microscope improve surgical outcomes.

    Science.gov (United States)

    Adogwa, Owoicho; Elsamadicy, Aladine; Reiser, Elizabeth; Ziegler, Cole; Freischlag, Kyle; Cheng, Joseph; Bagley, Carlos A

    2016-03-01

    The primary aim of this study was to assess and compare the complications profile as well as long-term clinical outcomes between patients undergoing an Anterior Cervical Discectomy and Fusion (ACDF) procedure with and without the use of an intra-operative microscope. One hundred and forty adult patients (non-microscope cohort: 81; microscope cohort: 59) undergoing ACDF at a major academic medical center were included in this study. Enrollment criteria included available demographic, surgical and clinical outcome data. All patients had prospectively collected patient-reported outcomes measures and a minimum 2-year follow-up. Patients completed the neck disability index (NDI), short-form 12 (SF-12) and visual analog pain scale (VAS) before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts. Baseline characteristics were similar between both cohorts. The mean ± standard deviation duration of surgery was longer in the microscope cohort (microscope: 169±34 minutes vs. non-microscope: 98±42 minutes, Pmicroscope and non-microscope cohorts demonstrated similar improvement from base line in NDI (microscope: 13.52±25.77 vs. non-microscope: 19.51±27.47, Pmicroscope: 4.15±26.39 vs. non-microscope: 11.98±22.96, Pmicroscope: 9.47±32.38 vs. non-microscope: 16.19±30.44, Pmicroscope: 2.22±4.00 vs. non-microscope: 3.69±3.61, Pmicroscope does not improve overall surgery-related outcomes, nor does it lead to superior long-term outcomes in pain and functional disability, 2 years after index surgery.

  11. There is no increased risk of adjacent segment disease at the cervicothoracic junction following an anterior cervical discectomy and fusion to C7.

    Science.gov (United States)

    Louie, Philip K; Presciutti, Steven M; Iantorno, Stephanie E; Bohl, Daniel D; Shah, Kevin; Shifflett, Grant D; An, Howard S

    2017-09-01

    Anterior cervical discectomy and fusion (ACDF) is a very common operative intervention for the treatment of cervical spine degenerative disease in those who have failed non-operative measures. However, studies examining long-term follow-up on patients who underwent ACDF reveal evidence of radiographic and clinical degenerative disc disease at the levels adjacent to the fusion construct. Consistent with other junctional regions of the spine, the cervicothoracic junction (CTJ) has significant morphologic variations. As a result, the CTJ undergoes significant static and dynamic stress. Given these findings, there has been some thought that ACDF down to C7 may experience additional risks for adjacent segment degeneration/disease (ASD) when compared with ASDFs that are cephalad to C7. The goal of this study is to evaluate the rate of radiographic and clinical ASD in patients who have undergone single- or multilevel ACDF, down to C7. This is a retrospective cohort study. The sample included consecutive patients from a single orthopedic surgeon at one quaternary referral medical center who underwent an ACDF between January 2008 and November 2014. Indications for surgery included radiculopathy, myelopathy, or myeloradiculopathy in the setting of failed conservative treatments. Patients were excluded if they had an ACDF of which the caudal level was cephalad to C7 or if they had undergone a previous cervical fusion. Radiographic diagnosis of ASD was determined by the presence of disc space narrowing >50%, new or enlarged osteophytes, end plate sclerosis, or increased calcification of the anterior longitudinal ligament (ALL). Postoperatively, data were collected on the presence of new radicular or myelopathic symptoms indicative of pathology at C7-T1, indicating a diagnosis of clinical ASD. Demographic information was collected for all patients, which included age, sex, body mass index, smoking status, and Charleston Comorbidity Index (CCI). Several radiographic parameters

  12. Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage

    Directory of Open Access Journals (Sweden)

    Roenning Paal

    2010-03-01

    Full Text Available Abstract Background Anterior cervical discectomy with fusion (ACDF is challenging with respect to both patient selection and choice of surgical procedure. The aim of this study was to evaluate the clinical outcome of ACDF, with respect to both patient selection and choice of surgical procedure: fusion with an autologous iliac crest graft (AICG versus fusion with an artificial cage made of polyetheretherketone (PEEK. Methods This was a non-randomized prospective single-center outcome study of 258 patients who underwent ACDF for cervical disc degeneration (CDD. Fusion was attained with either tricortical AICG or PEEK cages without additional anterior plating, with treatment selected at surgeon's discretion. Radicular pain, neck-pain, headache and patient satisfaction with the treatment were scored using the visual analogue scale (VAS. Results The median age was 47.5 (28.3-82.8 years, and 44% of patients were female. 59% had single-level ACDF, 40% had two level ACDF and 1% had three-level ACDF. Of the patients, 181 were fused with AICG and 77 with a PEEK-cage. After surgery, the patients showed a significant reduction in radicular pain (ΔVAS = 3.05, neck pain (ΔVAS = 2.30 and headache (ΔVAS = 0.55. Six months after surgery, 48% of patients had returned to work: however 24% were still receiving workers' compensation. Using univariate and multivariate analyses we found that high preoperative pain intensity was significantly associated with a decrease in pain intensity after surgery, for all three pain categories. There were no significant correlations between pain relief and the following patient characteristics: fusion method (AICG or PEEK-cage, sex, age, number of levels fused, disc level fused, previous neck surgery (except for neck pain, previous neck trauma, or preoperative symptom duration. Two hundred out of the 256 (78% patients evaluated the surgical result as successful. Only 27/256 (11% classified the surgical result as a failure

  13. Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage)

    Science.gov (United States)

    2010-01-01

    Background Anterior cervical discectomy with fusion (ACDF) is challenging with respect to both patient selection and choice of surgical procedure. The aim of this study was to evaluate the clinical outcome of ACDF, with respect to both patient selection and choice of surgical procedure: fusion with an autologous iliac crest graft (AICG) versus fusion with an artificial cage made of polyetheretherketone (PEEK). Methods This was a non-randomized prospective single-center outcome study of 258 patients who underwent ACDF for cervical disc degeneration (CDD). Fusion was attained with either tricortical AICG or PEEK cages without additional anterior plating, with treatment selected at surgeon's discretion. Radicular pain, neck-pain, headache and patient satisfaction with the treatment were scored using the visual analogue scale (VAS). Results The median age was 47.5 (28.3-82.8) years, and 44% of patients were female. 59% had single-level ACDF, 40% had two level ACDF and 1% had three-level ACDF. Of the patients, 181 were fused with AICG and 77 with a PEEK-cage. After surgery, the patients showed a significant reduction in radicular pain (ΔVAS = 3.05), neck pain (ΔVAS = 2.30) and headache (ΔVAS = 0.55). Six months after surgery, 48% of patients had returned to work: however 24% were still receiving workers' compensation. Using univariate and multivariate analyses we found that high preoperative pain intensity was significantly associated with a decrease in pain intensity after surgery, for all three pain categories. There were no significant correlations between pain relief and the following patient characteristics: fusion method (AICG or PEEK-cage), sex, age, number of levels fused, disc level fused, previous neck surgery (except for neck pain), previous neck trauma, or preoperative symptom duration. Two hundred out of the 256 (78%) patients evaluated the surgical result as successful. Only 27/256 (11%) classified the surgical result as a failure. Patient satisfaction

  14. Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial.

    Science.gov (United States)

    Radcliff, Kris; Coric, Domagoj; Albert, Todd

    2016-08-01

    OBJECTIVE The purpose of this study was to report the outcome of a study of 2-level cervical total disc replacement (Mobi-C) versus anterior cervical discectomy and fusion (ACDF). Although the long-term outcome of single-level disc replacement has been extensively described, there have not been previous reports of the 5-year outcome of 2-level cervical disc replacement. METHODS This study reports the 5-year results of a prospective, randomized US FDA investigational device exemption (IDE) study conducted at 24 centers in patients with 2-level, contiguous, cervical spondylosis. Clinical outcomes at up to 60 months were evaluated, including validated outcome measures, incidence of reoperation, and adverse events. The complete study data and methodology were critically reviewed by 3 independent surgeon authors without affiliation with the IDE study or financial or institutional bias toward the study sponsor. RESULTS A total of 225 patients received the Mobi-C cervical total disc replacement device and 105 patients received ACDF. The Mobi-C and ACDF follow-up rates were 90.7% and 86.7%, respectively (p = 0.39), at 60 months. There was significant improvement in all outcome scores relative to baseline at all time points. The Mobi-C patients had significantly more improvement than ACDF patients in terms of Neck Disability Index score, SF-12 Physical Component Summary, and overall satisfaction with treatment at 60 months. The reoperation rate was significantly lower with Mobi-C (4%) versus ACDF (16%). There were no significant differences in the adverse event rate between groups. CONCLUSIONS Both cervical total disc replacement and ACDF significantly improved general and disease-specific measures compared with baseline. However, there was significantly greater improvement in general and disease-specific outcome measures and a lower rate of reoperation in the 2-level disc replacement patients versus ACDF control patients. Clinical trial registration no. NCT00389597

  15. Comparison of Hybrid Surgery Incorporating Anterior Cervical Discectomy and Fusion and Artificial Arthroplasty Versus Multilevel Fusion for Multilevel Cervical Spondylosis: A Meta-Analysis

    Science.gov (United States)

    Zang, Leyuan; Ma, Min; Hu, Jianxin; Qiu, Hao; Huang, Bo; Chu, Tongwei

    2015-01-01

    Background Few studies have reported the safety and efficacy of hybrid surgery (HS), and some of the studies comparing HS with ACDF have reported conflicting results. We conducted this meta-analysis to clarify the advantages of HS in the treatment of multilevel cervical spondylosis. Material/Methods We performed a systematic literature search in PubMed, Medline, and CNKI to identify relevant controlled trials published up to October 2015. The standardized mean difference (SMD) and 95% confidence interval (95% CI) of the perioperative parameters, visual analogue scale pain score (VAS), neck disability index (NDI), and range of motion (ROM) of C2–C7 and adjacent segments were calculated. We also analyzed complications and Odom scale scores using risk difference (RD) and 95% CI. Results In total, 7 studies were included. The pooled data exhibited significant differences in blood loss between the 2 groups. However, there was no evidence indicating significant differences in operation time, complications, VAS, NDI, or Odom scale scores. Compared with the ACDF group, the HS group exhibited significantly protected C2-C7 ROM and reduced adjacent-segment ROM. Conclusions The safety of HS may be as good as that of ACDF. Furthermore, HS is superior to ACDF in conserving cervical spine ROM and decreasing adjacent-segment ROM. However, the results should be accepted cautiously due to the limitations of the study. Studies with larger sample sizes and longer follow-up periods are required to confirm and update the results of the present study. PMID:26709008

  16. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease.

    Science.gov (United States)

    Murrey, Daniel; Janssen, Michael; Delamarter, Rick; Goldstein, Jeffrey; Zigler, Jack; Tay, Bobby; Darden, Bruce

    2009-04-01

    Cervical total disc replacement (TDR) is intended to address radicular pain and preserve functional motion between two vertebral bodies in patients with symptomatic cervical disc disease (SCDD). The purpose of this trial is to compare the safety and efficacy of cervical TDR, ProDisc-C (Synthes Spine Company, L.P., West Chester, PA), to anterior cervical discectomy and fusion (ACDF) surgery for the treatment of one-level SCDD between C3 and C7. The study was conducted at 13 sites. A noninferiority design with a 1:1 randomization was used. Two hundred nine patients were randomized and treated (106 ACDF; 103 ProDisc-C). Visual analog scale (VAS) pain and intensity (neck and arm), VAS satisfaction, neck disability index (NDI), neurological exam, device success, adverse event occurrence, and short form-36 (SF-36) standardized questionnaires. A prospective, randomized, controlled clinical trial was performed. Patients were enrolled and treated in accordance with the US Food and Drug Administration (FDA)-approved protocol. Patients were assessed pre- and postoperatively at six weeks, 3, 6, 12, 18, and 24 months. Demographics were similar between the two patient groups (ProDisc-C: 42.1+/-8.4 years, 44.7% males; Fusion: 43.5 +/- 7.1 years, 46.2% males). The most commonly treated level was C5-C6 (ProDisc-C: 56.3%; Fusion=57.5%). NDI and SF-36 scores were significantly less compared with presurgery scores at all follow-up visits for both the treatment groups (pFusion patients (p=.638). Results show that at 24 months postoperatively, 84.4% of ProDisc-C patients achieved a more than or equal to 4 degrees of motion or maintained motion relative to preoperative baseline at the operated level. There was a statistically significant difference in the number of secondary surgeries with 8.5% of Fusion patients needing a re-operation, revision, or supplemental fixation within the 24 month postoperative period compared with 1.8% of ProDisc-C patients (p=.033). At 24 months, there was a

  17. A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up.

    Science.gov (United States)

    Chen, Yuqiao; Lü, Guohua; Wang, Bing; Li, Lei; Kuang, Lei

    2016-07-01

    To evaluate the clinical efficacy and radiological outcomes of anterior cervical discectomy and fusion (ACDF) using self-locking polyetheretherketone (PEEK) cages for treatment of three-level cervical degenerative spondylopathy. Twenty-eight patients underwent three-level ACDF using self-locking stand-alone PEEK cages (group A), and 26 patients underwent three-level ACDF using cages and plate fixation (group B) were reviewed retrospectively. Clinical efficacy was evaluated by pre- and post-operative Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI). The operation time, blood loss, surgical results according to Odom's criteria and post-operative dysphagia status were also recorded. Radiological outcomes including fusion, cervical Cobb's lordosis, fused segment angle, disc height, and cage subsidence were assessed. Clinical outcome measures such as dysphagia and fusion rate and the results of surgery evaluated according to Odom's criteria were not statistically significant (P > 0.05) between groups. The operation time was shorter and blood loss was less in group A (P  0.05). Post-operative cage subsidence, the loss of disc height, cervical lordosis and the fused segment angle were relatively higher in group A than group B (P < 0.05). ACDF using self-locking stand-alone cages showed similar clinical results as compared to ACDF using cages and plate fixation for the treatment of three-level cervical degenerative spondylopathy. However, potential long-term problems such as cage subsidence, loss of cervical lordosis and fused segment angle post-operatively were shown to be associated with patients who underwent ACDF using self-locking stand-alone cages.

  18. Minimally invasive posterior cervical discectomy for cervical radiculopathy: technique and clinical results.

    Science.gov (United States)

    Lidar, Zvi; Salame, Khalil

    2011-12-01

    Retrospective analysis of data of all patients treated by minimally invasive posterior discectomy for cervical radiculopathy between January 2004 and February 2008. To describe our technique and report the outcome of minimally invasive posterior cervical discectomy using the MetRx tubular retractor system and surgical microscope. Although several studies have been published on posterior minimally invasive approaches to cervical radiculopathy, most have focused on decompression of the nerve root by laminoforaminotomy only without the removal of the offending disc. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status, visual analog scale (VAS) for neck and arm pain, and by the short form-36 health survey questionnaire. Thirty-two patients were included in this study. The follow-up time was 20 to 67 months (mean, 39 mo). Muscle weakness improved in all patients; sensory deficits resolved in 21 patients and improved in 7 patients. Analysis of the mean VAS for radicular pain, VAS for neck pain, and all 8 domains of the short form-36 health survey questionnaire showed significant improvement. Complications included 1 case of incidental dural tear without postoperative cerebrospinal fluid leakage and 1 case of longstanding neck pain. Minimally invasive posterior cervical discectomy is safe and effective in the management of lateral cervical disc herniation manifested by radiculopathy. In addition to eliminating some of the disadvantages of open surgical approaches, it may also have swifter symptoms resolution compared with laminoforaminotomy without discectomy.

  19. Compression of the Seventh Cervical Vertebra Following C6-7 and C7-T1 Discectomy, PEEK Cage Implantation in these Intervertebral Spaces, and Management of this Complication in a Patient with Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Salih Gulsen

    2014-09-01

    Herein we present a case that we think exemplifies the management of cervical disc herniation and its complications. Consecutive multilevel cervical discectomy and placement of PEEK cages between the intervertebral cervical disc spaces may cause compression fracture of the vertebrae located between the PEEK cages in osteoporotic patients under continuous corticosteroid treatment¾whether or not they  have MM; therefore, we recommend use of an anterior plate to prevent this complication.

  20. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Y.; Lee, S.H.; Shin, S.W. [Wooridul Spine Hospital, Department of Neurosurgery, Kangnam-gu (Korea); Chung, S.E.; Park, H.S. [Wooridul Spine Hospital, Department of Radiology, Kangnam-gu (Korea)

    2005-12-01

    A discogenic cervical headache is a subtype of cervicogenic headache (CEH) that arises from a degenerative cervical disc abnormality. The purpose of this study was to evaluate the clinical outcome of percutaneous endoscopic cervical discectomy (PECD) for patients with chronic cervical headache due to soft cervical disc herniation. Seventeen patients underwent PECD for intractable headache. The inclusion criteria were soft disc herniation without segmental instability, proven by both local anesthesia and provocative discography for headache unresponsive to conservative treatment. The mean follow-up period was 37.6 months. Fifteen of the 17 patients (88.2%) showed successful outcomes based on the Macnab criteria. Pain scores on a visual analog scale (VAS) improved from a preoperative mean of 8.35{+-}0.79 to 2.12{+-}1.17, postoperatively (P<0.01). The mean disc height decreased from 6.81{+-}1.08 to 5.98{+-}1.07 mm (P<0.01). There was no newly developed segmental instability or spontaneous fusion on follow-up radiography. In conclusion, PECD appears to be effective for chronic severe discogenic cervical headache under strict inclusion criteria. (orig.)

  1. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation

    International Nuclear Information System (INIS)

    Ahn, Y.; Lee, S.H.; Shin, S.W.; Chung, S.E.; Park, H.S.

    2005-01-01

    A discogenic cervical headache is a subtype of cervicogenic headache (CEH) that arises from a degenerative cervical disc abnormality. The purpose of this study was to evaluate the clinical outcome of percutaneous endoscopic cervical discectomy (PECD) for patients with chronic cervical headache due to soft cervical disc herniation. Seventeen patients underwent PECD for intractable headache. The inclusion criteria were soft disc herniation without segmental instability, proven by both local anesthesia and provocative discography for headache unresponsive to conservative treatment. The mean follow-up period was 37.6 months. Fifteen of the 17 patients (88.2%) showed successful outcomes based on the Macnab criteria. Pain scores on a visual analog scale (VAS) improved from a preoperative mean of 8.35±0.79 to 2.12±1.17, postoperatively (P<0.01). The mean disc height decreased from 6.81±1.08 to 5.98±1.07 mm (P<0.01). There was no newly developed segmental instability or spontaneous fusion on follow-up radiography. In conclusion, PECD appears to be effective for chronic severe discogenic cervical headache under strict inclusion criteria. (orig.)

  2. Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion With an Autologous Iliac Crest Graft: A Magnetic Resonance Imaging Study of 59 Patients With a Mean Follow-up of 27 yr.

    Science.gov (United States)

    Burkhardt, Benedikt W; Simgen, Andreas; Wagenpfeil, Gudrun; Reith, Wolfgang; Oertel, Joachim M

    2017-05-30

    Anterior cervical decompression and fusion (ACDF) is a widely accepted surgical technique for the treatment of degenerative disc disease. ACDF is associated with adjacent segment degeneration (ASD). To assess whether physiological aging of the spine would overcome ASD by comparing adjacent to adjoining segments more than 18 yr after ACDF. Magnetic resonance imaging of 59 (36 male, 23 female) patients who underwent ACDF was performed to assess degeneration. The mean follow-up was 27 yr (18-45 yr). Besides measuring the disc height, a 5-step grading system (segmental degeneration index [SDI]) including disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis was used to assess the grade of adjacent and adjoining segments. The SDI of cranial and caudal adjacent segments was significantly higher compared to adjoining segments ( P spine does not overcome ASD. The disc height and the SDI in adjacent segment are significantly worse compared to adjoining segments. Patients who underwent repeat procedure had even worse findings of disc height and SDI. Copyright © 2017 by the Congress of Neurological Surgeons

  3. [Anterior interbody fusion of cervical spine with case-plate PCB].

    Science.gov (United States)

    Radek, M; Radek, A; Zapałowicz, K; Maciejczak, A

    2001-01-01

    Two cases with cervical discopathy and radiculopathy are presented. Discectomy and anterior interbody fusion with cage-plate PCB manufactured by French company Scient'x was performed. Authors present the shape of the implant and technical details of implantation. The paper discusses the advantages of the PCB which simplifies and shortens the operation procedure, minimizes the risk of traditional bone graft harvesting and provides immediate stabilization of the operated segment.

  4. Evaluation of arthrodesis and cervical alignment in the surgical results of cervical discectomy using polymethylmetacrylate Avaliação da artrodese e do alinhamento cervical após discectomia cervical com interposição de polimetilmetacrilato

    Directory of Open Access Journals (Sweden)

    Marcelo Luis Mudo

    2009-09-01

    Full Text Available BACKGROUND AND OBJECTIVES: Surgical treatment of cervical radiculopathy with or without myelopathy is a controversy issue, although anterior discectomy is the most common form of treatment. METHOD: We present the evaluation of the arthrodesis' rate and cervical alignment in 48 patients with cervical degenerative disease (CDD submitted to anterior cervical discectomy with interposition of polymethylmetacrylate (PMMA. Odom and Nürick scales were used to evaluation of functional status before and after surgery. Cervical spine X-rays were used to access arthrodesis and alignment, at least 2 years after the procedure. RESULTS: Excellent and good results (Odom I and II were obtained in 91% of the patients with radiculopathy and in 69% of those with myelopathy. Using the chi square test of independence (1% of significance, there was no association between excellent and good clinical results with the presence of arthrodesis verified in cervical X-rays. The presence of cervical alignment had association with good results, whereas the misalignment was associated with unfavorable outcomes. Two patients died: one cervical hematoma and other from graft migration with cord compression. CONCLUSIONS: Cervical alignment was more important than fusion to achieve good surgical results in CDD.TEMA E OBJETIVO: O tratamento cirúrgico da radiculopatia cervical com ou sem mielopatia é um tema controverso, embora a discectomia por via anterior seja uma das formas mais comuns de tratamento. MÉTODO: Apresentamos a avaliação da artrodese cervical e do alinhamento pós operatório em 48 pacientes com doença degenerativa cervical (DDC submetidos a discectomia por via anterior seguida da interposição de polimetilmetacrilato (PMMA. As escalas de Odom e de Nurick foram utilizadas para avaliar o status funcional dos pacientes antes e após a cirurgia. Radiografias da coluna cervical foram utilizadas para avaliar a artrodese e o alinhamento cervical, pelo menos 2 anos ap

  5. Adjacent segment pathology: natural history or effect of anterior cervical discectomy and fusion? A 10-year follow-up radiological multicenter study using an evaluation scale of the ageing spine.

    Science.gov (United States)

    Pesce, Alessandro; Wierzbicki, Venceslao; Piccione, Emanuele; Frati, Alessandro; Raco, Antonino; Caruso, Riccardo

    2017-05-01

    Aim of this study is to compare late degenerative MRI changes in a subset of patients operated on with ACDF to a second subset of patients presenting indication to ACDF but never operated on. Patients from both subgroups received surgical indication according to the same criteria. Both subgroups underwent a cervical spine MRI in 2004-2005 and 10 years later in 2015. These MRI scans were retrospectively evaluated with a cervical spine ageing scale. Comparing the two subset of patients both suffering from clinically relevant single-level disease returns no statistically significant difference in the degenerative condition of posterior ligaments, presence of degenerative spondylolisthesis, foraminal stenosis, diameter of the spinal canal, Modic alteration, and intervertebral discs degeneration at 10-year follow-up. The adjacent segment degeneration represents, in the present cohort, a result of the natural history of cervical spondylosis rather than a consequence of fusion.

  6. Anterior cervical spine surgery-associated complications in a retrospective case-control study.

    Science.gov (United States)

    Tasiou, Anastasia; Giannis, Theofanis; Brotis, Alexandros G; Siasios, Ioannis; Georgiadis, Iordanis; Gatos, Haralampos; Tsianaka, Eleni; Vagkopoulos, Konstantinos; Paterakis, Konstantinos; Fountas, Kostas N

    2017-09-01

    Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

  7. Risk Factors for the Development of Adjacent Segment Disease Following Anterior Cervical Arthrodesis

    Directory of Open Access Journals (Sweden)

    Ezgi Akar

    2015-06-01

    Full Text Available Aim: The aim of this study was to clinically and radiologically evaluate the efficacy of anterior cervical discectomy and fusion (ACDF in the treatment of adjacent level degeneration. Methods: We retrospectively evaluated 89 patients (55 females, 34 males who underwent ACDF. Adjacent segment degeneration findings were evaluated by investigating new osteophyte formation, growth of existing osteophytes, ossification of the anterior longitudinal ligament, presence of intervertebral disc space narrowing, sagittal alignment and range of motion (ROM using serial radiographs and magnetic resonance imaging. Results: The mean age of the 89 patients was 41.3 (24-76 years. The mean follow-up duration was 34.3 (12-64 months. Radiographic evidence of adjacent segment degeneration was observed in 12 patients (13.4%. Nine (75% patients had new complaints. Of the patients who had degenerative changes, 7 were (58% were male, 5 (42% were female; the mean age was 46 (30- 62 years. It was observed that the level of fusion and the number of fusion did not increase the adjacent segment degeneration. All of 12 patients were observed to have a non lordotic cervical spine and increased ROM. Conclusion: Development of degeneration at the level adjacent to region anterior cervical discectomy and fusion performed is higher compared to non-adjacent levels. The level of fusion and the number of fusion levels have no effect on the development of degeneration. (The Medical Bulletin of Haseki 2015; 53:120-3

  8. Cervical arthroplasty versus anterior cervical fusion for symptomatic adjacent segment disease after anterior cervical fusion surgery: Review of treatment in 41 patients.

    Science.gov (United States)

    Lee, Sang-Bok; Cho, Kyoung-Suok

    2017-11-01

    The purpose of this study is to compare the efficacy and safety of anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (CTDR) as revision surgeries for symptomatic adjacent segment degeneration (ASD) in cases with previous ACDF. Between 2010 and 2014, 41 patients with previous cervical fusion surgery underwent ACDF or CTDR for symptomatic ASD. Twenty-two patients in the ACDF group underwent 26 ACDFs, and 19 patients in the CTDR group underwent 25 arthroplasties for symptomatic ASD. Clinical outcomes were assessed by a visual analogue scale (VAS) for arm pain, the neck disability index (NDI) and Odom's criteria. Radiological evaluations were performed preoperatively and postoperatively to measure changes in the range of motion (ROM) of the cervical spine and adjacent segments and arthroplasty level. The radiological change of ASD was assessed in radiographs. Clinical outcomes as assessed with VAS for arm pain and Odom's criteria were significantly improved in both groups. The CTDR group showed better NDI improvement after surgery (Padjacent segment between the ACDF and CTDR groups (Padjacent segment compared with the CTDR group (Padjacent segment, and a lower incidence of adjacent segment degeneration than did the ACDF group. Copyright © 2017. Published by Elsevier B.V.

  9. Cervical Spondylosis and Hypertension

    OpenAIRE

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-01-01

    Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully w...

  10. Adjacent Segment Pathology after Anterior Cervical Fusion

    OpenAIRE

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon; Kim, Sung Kyu

    2016-01-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of mo...

  11. [Computer-aided discectomy and corpectomy in anterior reconstruction of the injured thoracolumbar spine. A prospective, controlled clinical trial].

    Science.gov (United States)

    Blattert, T R; Springwald, J; Glasmacher, S; Siekmann, H; Josten, C

    2008-11-01

    In anterior reconstruction of the unstable thoracolumbar spine, discectomy and corpectomy are technically demanding steps requiring maximal surgical precision. This study investigated the feasibility of computer-aided guidance for discectomy and corpectomy. It also analysed the precision, advantages, and disadvantages of the procedure. Vertebral body fractures of the non-osteoporotic thoracolumbar spine addressed by discectomy/corpectomy and subsequent implant interposition (cage, tricortical strut graft) for anterior reconstruction were included. All surgical steps were done under endoscopic assistance. In the trial group, discectomy and corpectomy were performed with computer-aided guidance; in the control group, no computer navigation was used. The time required for surgery was noted. To assess surgical precision, decentralization of the implant in the frontal plane was measured in postoperative x-rays and computed tomography. Additionally, parallel alignment of vertebral body end plates with the implant was evaluated. The trial group (TG) consisted of 16 patients, and the control group (CG) of 10 patients. Fractures were localized between T10 and L1 in TG, and between T9 and L1 in CG. Operating time was significantly shorter in CG: 104+/-28 min compared with 229+/-64 min in TG (pComputer-aided guidance for anterior reconstruction of the thoracolumbar spine is a technically feasible option that may help in performing discectomy and corpectomy. However, this technique significantly prolongs the operating time. There were no differences in the precision of implant positioning between the groups. However, during discectomy the use of computer navigation may possibly add to the protection of adjacent end plates.

  12. Cervical Spondylosis and Hypertension

    Science.gov (United States)

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-01-01

    Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. PMID:25761188

  13. The effectiveness of anterior cervical decompression and fusion for the relief of dizziness in patients with cervical spondylosis: a multicentre prospective cohort study.

    Science.gov (United States)

    Peng, B; Yang, L; Yang, C; Pang, X; Chen, X; Wu, Y

    2018-01-01

    Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Ruffini corpuscles into diseased cervical discs may be related to cervicogenic dizziness. In order to evaluate whether cervicogenic dizziness stems from the diseased cervical disc, we performed a prospective cohort study to assess the effectiveness of anterior cervical discectomy and fusion on the relief of dizziness. Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain. There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group. This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis. Cite this article: Bone Joint J 2018;100-B:81-7. ©2018 The British Editorial Society of Bone & Joint Surgery.

  14. Anterior approach to the cervical spine for treatment of spondylosis or disc herniation: Long-term results. Comparison between ACD, ACDF, TDR.

    Science.gov (United States)

    Caruso, R; Pesce, A; Marrocco, L; Wierzbicki, V

    2014-01-01

    Many surgical techniques are used for the treatment of cervical myelopathy and radiculopathy due to spondylosis or disc herniation. The aim of this article is to evaluate and to compare the long term outcomes of 1. anterior cervical discectomy (ACD), 2. anterior cervical discectomy with fusion (ACDF) and 3. anterior cervical discectomy with total disc replacement (TDR) in order to find the most appropriate surgical option according to the medical condition of the patient. Three retrospective cohort studies were performed to assess the long-term results of ACD, ACDF and TDR procedures. Data from the three studies were compared by statistical methods to highlight the differences in results. All patients presented a neurological improvement that endures. The results of three surgical techniques were different as regards the alignment of the cervical spine, the preservation of mobility and the pathology of adjacent space. TDR is the most appropriate technique in young patients, below the age of 55 years and whose pathology is prevalently a hernia. The best surgical choice is ACDF in patients above the age of 55 years and in all those cases in which there is a prevalence of spondyloarthrotic alterations. In highly selected cases, in which the cervical spine is in a flattened condition and the intervertebral space is very restricted ACD, according to Hirsh, is a surgical method which ensures a very high degree of spinal motility preservation.

  15. A technical case report on use of tubular retractors for anterior cervical spine surgery.

    Science.gov (United States)

    Kulkarni, Arvind G; Patel, Ankit; Ankith, N V

    2017-12-19

    The authors put-forth this technical report to establish the feasibility of performing an anterior cervical corpectomy and fusion (ACCF) and a two-level anterior cervical discectomy and fusion (ACDF) using a minimally invasive approach with tubular retractors. First case: cervical spondylotic myelopathy secondary to a large postero-inferiorly migrated disc treated with corpectomy and reconstruction with a mesh cage and locking plate. Second case: cervical disc herniation with radiculopathy treated with a two-level ACDF. Both cases were operated with minimally invasive approach with tubular retractor using a single incision. Technical aspects and clinical outcomes have been reported. No intra or post-operative complications were encountered. Intra-operative blood loss was negligible. The patients had a cosmetic scar on healing. Standard procedure of placement of tubular retractors is sufficient for adequate surgical exposure with minimal invasiveness. Minimally invasive approach to anterior cervical spine with tubular retractors is feasible. This is the first report on use of minimally invasive approach for ACCF and two-level ACDF.

  16. Roentgenographic findings following anterior cervical fusion

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    Gore, D.R.; Gardner, G.M.; Sepic, S.B.; Murray, M.P.

    1986-10-01

    We reviewed the pre- and postoperative lateral cervical roentgenograms in 90 patients who had anterior fusions and compared their findings with age and sex-matched people without neck problems. The average interval from surgery to review was 5 years. Preoperatively, all patients had a higher incidence of degenerative spondylosis at the levels to be fused than their asymptomatic counterparts. Postoperatively, there was no difference in the incidence of degenerative change between the operated and the control group at the levels above and below the fusion with the exception of anterior osteophyte formation which was more frequent in those with fusions.

  17. Adjacent Segment Pathology after Anterior Cervical Fusion.

    Science.gov (United States)

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon; Kim, Sung Kyu

    2016-06-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion.

  18. Adjacent Segment Pathology after Anterior Cervical Fusion

    Science.gov (United States)

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon

    2016-01-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion. PMID:27340541

  19. Are patient-reported outcomes predictive of patient satisfaction 5 years after anterior cervical spine surgery?

    Science.gov (United States)

    Schroeder, Gregory D; Coric, Dom; Kim, Han Jo; Albert, Todd J; Radcliff, Kris E

    2017-07-01

    Patient satisfaction is becoming an increasing common proxy for surgical quality; however, the correlation between patient satisfaction and surgical outcomes 2 and 5 years after anterior cervical surgery has not been evaluated. The study aimed to determine if patient satisfaction is predicted by improvement in patient-reported outcomes (PRO) 2 and 5 years after anterior cervical spine surgery. This is a retrospective analysis of prospectively collected data. The sample included patients enrolled in the Food and Drug Administration investigational device exemption clinical trial comparing total disc replacement with Mobi-C cervical artificial disc and anterior cervical discectomy and fusion. The outcome measures were visual analog scale (VAS) neck pain score, Neck Disability Index (NDI), and Short-Form 12-Item scores, as well as patient satisfaction. Receiver operating characteristic curves were used to determine if improvement in different PRO metrics can accurately identify patient satisfaction. Additionally, a logistic regression analysis was performed on the results at 24 months and 60 months to identify independent predictors of patient satisfaction. This research was supported by LDR (Zimmer Biomet) 13785 Research Boulevard - Suite 200 Austin, TX 78750. Data were available for 512 patients at 60 months. At 24 months postoperatively, NDI score improvement (area under the curve [AUC]=0.806), absolute NDI score (AUC=0.823), and absolute VAS neck pain score (AUC=0.808) were all excellent predictors of patient satisfaction. At 60 months postoperatively, NDI score improvement (AUC=0.815), absolute NDI score (AUC=0.839), VAS neck pain score improvement (AUC=0.803), and absolute VAS neck pain score (AUC=0.861) were all excellent predictors of patient satisfaction. In patients undergoing one- and two-level anterior cervical spine surgery, between 2 and 5 years postoperatively, patient satisfaction is significantly predicted by PROs, including the VAS neck score and the

  20. Clinical experience using polyetheretherketone (PEEK) intervertebral structural cage for anterior cervical corpectomy and fusion.

    Science.gov (United States)

    Kasliwal, Manish K; O'Toole, John E

    2014-02-01

    Anterior cervical corpectomy and fusion (ACCF) is commonly performed for various pathologies involving the cervical spine. Although polyetheretherketone (PEEK) cages have been widely used following anterior cervical discectomy and fusion (ACDF), clinical literature demonstrating its efficacy following ACCF is sparse. A retrospective review of patients enrolled in a prospective database who underwent single/multi-level ACCF was performed. Fifty-nine patients were identified who underwent corpectomy reconstruction with PEEK cages for symptomatic degenerative, neoplastic, infectious, or traumatic pathologies of the cervical spine. Thirty-five patients having at least 6 months follow-up (FU) were included in the final analysis. The mean age of patients was 51 years (range, 18-81 years) with FU ranging from 6 to 33 months (mean, 6.6 months). None of the patients had dysphagia at last FU. There was no implant failure with fusion occurring in all patients. While 57% of patients (20/35) remained stable with no progression of myelopathy, 43% (15/35) improved one (11 patients) or two (four patients) Nurick grades after surgery. The use of PEEK cages packed with autograft or allograft is safe and effective following anterior cervical corpectomy, demonstrating high fusion rates and good clinical results. This synthetic material obviates the morbidity associated with autograft harvest and possible infectious risks of allograft. The wide array of cage dimensions facilitates ease of use in patients of all sizes and appears safe for use in the typical pathologic conditions encountered in the cervical spine. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. What's the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial

    NARCIS (Netherlands)

    Donk, R.D.; Verbeek, A.L.M.; Verhagen, W.I.; Groenewoud, H.; Hosman, A.J.F.; Bartels, R.H.M.A.

    2017-01-01

    BACKGROUND: To investigate the efficacy of adding supplemental fusion or arthroplasty after cervical anterior discectomy for symptomatic mono-level cervical degenerative disease (radiculopathy), which has not been substantiated in controlled trials until now. METHODS: A randomized controlled trial

  2. Loading effects of anterior cervical spine fusion on adjacent segments

    OpenAIRE

    Chien-Shiung Wang; Jia-Hao Chang; Ti-Sheng Chang; Hung-Yi Chen; Ching-Wei Cheng

    2012-01-01

    Adjacent segment degeneration typically follows anterior cervical spine fusion. However, the primary cause of adjacent segment degeneration remains unknown. Therefore, in order to identify the loading effects that cause adjacent segment degeneration, this study examined the loading effects to superior segments adjacent to fused bone following anterior cervical spine fusion. The C3–C6 cervical spine segments of 12 sheep were examined. Specimens were divided into the following groups: intact sp...

  3. Modified anterior-only reduction and fixation for traumatic cervical facet dislocation (AO type C injuries).

    Science.gov (United States)

    Kanna, Rishi M; Shetty, Ajoy P; Rajasekaran, S

    2017-12-26

    Surgical reduction of uni and bi-facetal dislocations of the cervical spine (AO type C injuries) can be performed by posterior, anterior or combined approaches. Ease of access, low infection rates and less risks of neurological worsening has popularized anterior approach. However, the reduction of locked cervical facets can be intricate through anterior approach. We analyzed the safety, efficacy and outcomes at a minimum 1 year, of a novel anterior reduction technique for consecutively treated cervical facet dislocations. Patients with single level traumatic sub-axial cervical dislocation (n = 39) treated by this modified anterior technique were studied. The technique involved standard Smith-Robinson approach, discectomy beyond PLL, use of inter-laminar distracter to distract while Caspar pins were used as "joysticks" (either flexion-extension or lateral rotation moments are provided), to reduce the sub-luxed facets. Among 51 patients with cervical type C injury treated during the study period, 4 patients who had spontaneous reduction and 8 treated by planned global fusion were excluded. 39 patients of mean age 49.9 years were studied. The levels of injury included (C3-4 = 2, C4-5 = 5, C5-6 = 20, C6-7 = 12). 18 were bi-facetal and 21 were uni-facetal dislocation. One facet was fractured in 17 and both in 5 patients. 30% (n = 13) had a concomitant disc prolapse. The neurological status was as follows: 9 ASIA A, 9 ASIA C, 13 ASIA D and 8 ASIA E. All the patients were successfully reduced by this technique and fixed with anterior locking cervical locking plates. No supplemental posterior surgery was performed. 22 patients with incomplete deficit showed recovery. The mean follow-up was 14.3 months and there was no implant failure except one patient who had partial loss of the reduction. Patients with traumatic sub-axial cervical dislocation (AO type C injuries) can be safely and effectively reduced by this technique. Other advantages include minimal

  4. Thyroid storm following anterior cervical spine surgery for tuberculosis of cervical spine

    Directory of Open Access Journals (Sweden)

    Sanjiv Huzurbazar

    2014-01-01

    Full Text Available Objective: The primary objective was to report this rare case and discuss the probable mechanism of thyroid storm following anterior cervical spine surgery for Kochs cervical spine.

  5. Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication.

    Science.gov (United States)

    Ghobrial, George M; Harrop, James S; Sasso, Rick C; Tannoury, Chadi A; Tannoury, Tony; Smith, Zachary A; Hsu, Wellington K; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; De Giacomo, Anthony F; Jobse, Bruce C; Rahman, Ra'Kerry K; Thompson, Sara E; Riew, K Daniel

    2017-04-01

    Retrospective multi-institutional case series. The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections. A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections. A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities. The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to

  6. Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial.

    Science.gov (United States)

    Kast, Erich; Derakhshani, Sharam; Bothmann, Matthias; Oberle, Joachim

    2009-04-01

    In ventral fusion after anterior cervical discectomy there is still a remarkable number of cage subsidence and segmental kyphosis seen. The aim of the present study is to assess whether the cage design influences the extent of correction loss during follow-up. Sixty patients with single-level cervical disc herniation were randomly treated with two different cervical inter-body cages (group 1: Solis cage, Stryker Company and group 2: Shell cage, AMT Company). Clinical and radiological follow-up was done before and after surgery, 3 and 6 months post-surgery. Clinical follow-up was done with the help of Odom's criteria. Both groups were similar in the baseline parameters (age, sex, treated level). Statistically, the subsidence was significantly higher at 3 and 6-month follow-ups in group 1 than in group 2, however, clinical results showed no significant differences. In 67%, subsidence was seen in the anterior lower aspect of the treated segment. Segmental kyphosis was seen in seven patients of group 1 and two patients of group 2. A significant correlation is found between Odom's criteria and subsidence. Although there was no significant difference in a short-term clinical result between the two treatment groups, we recommend the use of cages which preserve the determined segmental height and lordosis.

  7. Dysphagia due to anterior cervical osteophytosis: case report

    Directory of Open Access Journals (Sweden)

    Frederico Miguel Santos Silva Marquez Correia

    2014-12-01

    Full Text Available The objective of this study is to highlight the possibility of dysphagia induced by anterior cervical osteophytes. When not diagnosed early this condition may be responsible for complications such as severe dysphagia and potential lung aspiration, especially in elderly patients. Analysis of a case report of a 72-year old woman who presented cervical pain and progressive dysphagia. Imaging studies have shown anterior cervical osteophytosis and multilevel degenerative changes in the cervical spine. The patient underwent surgical excision of the cervical anterior osteophytes (C4, C5 and C6 and C5/C6 arthrodesis through anterior approach. The postoperative period was uneventful and symptoms resolved within 2 weeks. Early diagnosis and treatment led to complete resolution, avoiding late and serious complications associated with this pathology in the geriatric population, especially severe and progressive dysphagia and risk of pulmonary aspiration, and the consequent morbidity and mortality associated. A multidisciplinary approach is essential for the correct assessment of this condition

  8. Utilization trends of cervical artificial disc replacement after FDA approval compared with anterior cervical fusion: adoption of new technology.

    Science.gov (United States)

    Lu, Young; McAnany, Steven J; Hecht, Andrew C; Cho, Samuel K; Qureshi, Sheeraz A

    2014-02-01

    Epidemiologic study. To compare the utilization of anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) in terms of patient and hospital characteristics during the 3 years after Food and Drug Administration (FDA) approval of CDA devices in 2007. There was a surge in CDA adoption in the 3 years prior to FDA approval of CDA devices in 2007. However, utilization trends of CDA versus ACDF since the FDA approval are unknown. The Nationwide Inpatient Sample database was used to identify CDA and ACDF procedures performed in the United States in the 3 years after FDA approval of CDA devices (2008-2010). The frequencies of CDA and ACDF were estimated, stratified by patient and hospital characteristics. Average length of hospital stay and total charges and costs were estimated. Multivariable analysis was performed to identify patient and hospital characteristics associated with CDA utilization. In the 3 years after FDA approval of cervical disc devices, population-adjusted growth rates for CDA and ACDF were 4.9% and 11.8%, respectively (P = 0.6977). Female, African American and Medicaid patients were less likely to receive CDA. CDA was less likely to be performed in patients with cervical spondylotic changes and more likely to be performed in younger and healthier patients. CDA was less likely to be performed in the Midwestern United States or in public hospitals. The prevalence of CDA increased in the 3 years after FDA approval with a growth rate that is approximately twice than that for ACDF. Although there seems to be CDA adoption, CDA growth seemed to have reached a plateau and ACDF still remained the dominant surgical strategy for cervical disc disease. Possible regional, racial, and sex disparities in CDA utilization and a more strict approach in the selection of CDA over traditional ACDF may have impeded rapid adoption of CDA. 3.

  9. Fusion around cervical disc prosthesis: case report.

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Donk, R.

    2005-01-01

    OBJECTIVE AND IMPORTANCE: Cervical arthroplasty is a relatively new method to maintain motion after cervical anterior discectomy. Two cases are presented in which bony fusion occurred around a cervical disc prosthesis. CLINICAL PRESENTATION: A 30-year-old man and a 49-year-old woman underwent a

  10. Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage.

    Science.gov (United States)

    Yang, Jae Jun; Yu, Chang Hun; Chang, Bong-Soon; Yeom, Jin Sup; Lee, Jae Hyup; Lee, Choon-Ki

    2011-03-01

    The purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications. Thirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as ≥ a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being ≥ 2 mm in the interspinous distance on the flexion-extension lateral radiographs. The anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 ± 1.46 mm and 0.81 ± 1.27 mm, respectively. Subsidence ≥ 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001). Anterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention for avoiding nonunion.

  11. Results of the biocompatible osteoconductive polymer (BOP) as an intersomatic graft in anterior cervical surgery.

    Science.gov (United States)

    Ibáñez, J; Carreño, A; García-Amorena, C; Caral, J; Gastón, F; Ferrer, E

    1998-01-01

    Eighty-two patients operated on in our Department between 1989 and 1995 with an anterior cervical approach for soft and hard cervical disc herniations and cervical stenosis were included in this study. In 41 cases a heterologous intersomatic bovine graft (Surgibone) was used. Another 41 patients underwent surgery with a biocompatible osteoconductive polymer (BOP) as intervertebral graft. Both groups were retrospectively reviewed and compared with the objectives of evaluating the biodynamic behaviour of the grafts in the intersomatic space, the complications which appeared (specially those related to the grafts), the bone fusion rate achieved and the clinical outcome of the patients. The results of our study show that the BOP group presented a higher tendency to intersomatic space collapse 6 months after discectomy. There were no differences in the general surgical complications between both groups, but those related directly to the graft were significantly higher in the BOP group. The vast majority of the graft complications recorded had no clinical correlation. Without a strict radiological follow-up such complications would never have been discovered. Bone fusion in the BOP group was significantly slower and worse. Finally, the clinical outcome in both groups did not show any significant difference.

  12. Posterior or Single-stage Combined Anterior and Posterior Approach Decompression for Treating Complex Cervical Spondylotic Myelopathy Coincident Multilevel Anterior and Posterior Compression.

    Science.gov (United States)

    Zhou, Xiaoxiao; Cai, Pan; Li, Yuwei; Wang, Haijiao; Xia, Shengli; Wang, Xiuhui

    2017-12-01

    A single-center, retrospective, longitudinal matched cohort clinical study of prospectively collected outcomes. To compare retrospectively the clinical outcomes and complications of the posterior approach laminoplasty and single-stage anterior approach laminoplasty combined with anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion for treating patients with cervical spondylotic myelopathy coincident multilevel anterior and posterior compression, known as complex cervical spondylotic myelopathy (cCSM) here. The optimal surgical management of this type of cCSM remains controversial. Sixty-seven patients with multilevel cCSM underwent decompression surgery from 1996 to 2007. Among these patients, 31 underwent a single-stage combined approach with decompression (combined approach group) and 36 underwent laminoplasty for posterior approach (posterior approach group). Average operative duration, operative estimated blood loss, surgical costs, and cervical alignment were measured. Average operative duration, operative estimated blood loss, and surgical costs were significantly lower in the posterior approach group than those in the combined approach group (P0.05). No statistical difference was observed in the preoperative Cobb angle (P>0.05), whereas a significant statistical difference was observed for the postoperative Cobb angle (Pgroups. The surgical incidences of complications were 22.2% and 48.4% in the posterior and combined approach groups (Papproach laminoplasty and single-stage combined approach led to significant neurological improvement and pain reduction in the majority of patients. Both approaches showed similar results in terms of decompression and neurological improvement. The posterior approach was superior to the combined approach in terms of surgical costs, surgical time, blood loss, and complication rate.

  13. Subsidence after single-level anterior cervical fusion with a stand-alone cage.

    Science.gov (United States)

    Park, Jae-Young; Choi, Ki-Young; Moon, Bong Ju; Hur, Hyuk; Jang, Jae-Won; Lee, Jung-Kil

    2016-11-01

    To investigate the risk factors for subsidence in patients treated with stand-alone anterior cervical discectomy and fusion (ACDF) using polyetheretherketone (PEEK) cages for single-level degenerative cervical disease. Seventy-seven consecutive patients who underwent single-level stand-alone ACDF with a PEEK cage between 2005 and 2012 were included. Subsidence was defined as a decrease in the interbody height of more than 3mm on radiographs at the 1-year follow-up compared with that in the immediate post-operative image. Patients were divided into the subsidence and non-subsidence groups. The following factors were investigated in relation to the occurrence of subsidence: age, pre-operative overall cervical sagittal angle, segmental angle of the operated level, interbody height, cage height, cage devices and cage location (distance between anterior margin of the body endplate and that of the cage). The clinical outcomes were assessed with visual analog scale, modified Japanese Orthopedic Association score and neck disability index. Twenty-six out of the 77 (33.8%) patients had radiological signs of cage subsidence. Solid fusion was achieved in 25 out of the 26 patients (96.2%) in the subsidence group and in 47 out of the 51 patients (92.2%) in the non-subsidence group. More than 3mm distance between anterior margin of the vertebral body and that of the cage was significantly associated with subsidence (psubsidence did not correlate with fusion rate or clinical outcomes. Cage location was the only significant risk factor. Therefore, cage location should be taken into consideration during stand-alone ACDF using PEEK cages. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Cervical spondylosis and hypertension: a clinical study of 2 cases.

    Science.gov (United States)

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-03-01

    Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis.

  15. Fibular allograft and anterior plating for dislocations/fractures of the cervical spine

    Directory of Open Access Journals (Sweden)

    Ramnarain A

    2008-01-01

    Full Text Available Background: Subaxial cervical spine dislocations are common and often present with neurological deficit. Posterior spinal fusion has been the gold standard in the past. Pain and neck stiffness are often the presenting features and may be due to failure of fixation and extension of fusion mass. Anterior spinal fusion which is relatively atraumatic is thus favored using autogenous grafts and cages with anterior plate fixation. We evaluated fresh frozen fibular allografts and anterior plate fixation for anterior fusion in cervical trauma. Materials and Methods: Sixty consecutive patients with single-level dislocations or fracture dislocations of the subaxial cervical spine were recruited in this prospective study following a motor vehicle accident. There were 38 males and 22 females. The mean age at presentation was 34 years (range 19-67 years. The levels involved were C5/6 ( n = 36, C4/5 ( n = 15, C6/7 ( n = 7 and C3/4 ( n = 2. There were 38 unifacet dislocations with nine posterior element fractures and 22 were bifacet dislocations. Twenty-two patients had neurological deficit. Co-morbidities included hypertension ( n = 6, non-insulin-dependent diabetes mellitus ( n = 2 and asthma ( n = 1. All patients were initially managed on skull traction. Following reduction further imaging included Computerized Tomography and Magnetic Resonance Imaging. Patients underwent anterior surgery (discectomy, fibular allograft and plating. All patients were immobilized in a Philadelphia collar for eight weeks (range 7-12 weeks. Eight patients were lost to follow-up within a year. Follow-up clinical and radiological examinations were performed six-weekly for three months and subsequently at three-monthly intervals for 12 months. Pain was analyzed using the visual analogue scale (VAS. The mean follow-up was 19 months (range 14-39 months. Results: Eight lost to followup, hence 52 patients were considered for final evaluation. The neurological recovery was 1.1 Frankel

  16. [Treatment of multi-segmental cervical spondylosis by long or segmented anterior cervical decompression and fixation surgery].

    Science.gov (United States)

    Duan, Chunyue; Wu, Jianhuang; Hu, Jianzhong; Zhang, Hongqi; Wang, Xiyang

    2014-12-01

    To investigate the clinical efficacy of two different anterior cervical surgeries in treatment of multi-segmental cervical spondylosis. A total of 86 patients with multi-segmental cervical spondylosis were treated by anterior cervical surgery procedure. Among them, 62 and 24 cases were involved in three and four gap, respectively. Each patient underwent the surgery of long or segmented anterior cervical decompression and fixation. Preoperative and postoperative cervical curvature change, internal fixation stability, fusion rate and nerve function were evaluated. All patients were successfully completed the operation, segmented surgery showed better cervical lordosis recovery, but there were no significant difference between long and segmented anterior cervical surgery in blood loss and recovery of neurological function (P> 0.05). The segmented anterior cervical surgery has advantages in the treatment of multisegmental cervical spondylosis.

  17. Adjacent segment pathology following anterior decompression and fusion using cage and plate for the treatment of degenerative cervical spinal diseases.

    Science.gov (United States)

    Song, Kyung-Jin; Choi, Byung-Wan; Kim, Jong-Kil

    2014-12-01

    Retrospective study. To analyze the incidence and prevalence of clinical adjacent segment pathology (CASP) following anterior decompression and fusion with cage and plate augmentation for degenerative cervical diseases. No long-term data on the use of cage and plate augmentation have been reported. The study population consisted of 231 patients who underwent anterior cervical discectomy and fusion (ACDF) with cage and plate for degenerative cervical spinal disease. The incidence and prevalence of CASP was determined by using the Kaplan-Meier survival analysis. To analyze the factors that influence CASP, data on preoperative and postoperative sagittal alignment, spinal canal diameter, the distance between the plate and adjacent disc, extent of fusion level, and the presence or absence of adjacent segment degenerative changes by imaging studies were evaluated. CASP occurred in 15 of the cases, of which 9 required additional surgery. At 8-year follow-up, the average yearly incidence was 1.1%. The rate of disease-free survival based on Kaplan-Meier survival analysis was 93.6% at 5 years and 90.2% at 8 years. No statistically significant differences in CASP incidence based on radiological analysis were observed. Significantly high incidence of CASP was observed in the presence of increased adjacent segment degenerative changes (pdegenerative cervical disease is associated with a lower incidence in CSAP by 1.1% per year, and the extent of preoperative adjacent segment degenerative changes has been shown as a risk factor for CASP.

  18. Cervical anterior hybrid technique with bi-level Bryan artificial disc replacement and adjacent segment fusion for cervical myelopathy over three consecutive segments.

    Science.gov (United States)

    Chen, Jiang; Xu, Lin; Jia, Yu-Song; Sun, Qi; Li, Jin-Yu; Zheng, Chen-Ying; Bai, Chun-Xiao; Yu, Qin-Sheng

    2016-05-01

    This study aimed to assess the preliminary clinical efficacy and feasibility of the hybrid technique for multilevel cervical myelopathy. Considering the many shortcomings of traditional treatment methods for multilevel cervical degenerative myelopathy, hybrid surgery (bi-level Bryan artificial disc [Medtronic Sofamor Danek, Memphis, TN, USA] replacement and anterior cervical discectomy and fusion) should be considered. Between March 2006 and November 2012, 108 patients (68 men and 40 women, average age 45years) underwent hybrid surgery. Based on the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom's criteria, the clinical symptoms and neurological function before and after surgery were evaluated. Mean surgery duration was 90minutes, with average blood loss of 30mL. Mean follow-up duration was 36months. At the final follow-up, the mean JOA (± standard deviation) scores were significantly higher compared with preoperative values (15.08±1.47 versus 9.18±1.22; P<0.01); meanwhile, NDI values were markedly decreased (12.32±1.03 versus 42.68±1.83; P<0.01). Using Odom's criteria, the clinical outcomes were rated as excellent (76 patients), good (22 patients), fair (six patients), and poor (four patients). These findings indicate that the hybrid method provides an effective treatment for cervical myelopathy over three consecutive segments, ensuring a good clinical outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Clinically relevant anatomy of high anterior cervical approach.

    Science.gov (United States)

    Haller, Justin M; Iwanik, Michael; Shen, Francis H

    2011-12-01

    An anatomic study of anterior cervical dissection of 11 embalmed cadavers and measurement of structures relative to cervical spine. To determine the anatomic relationship of the hypoglossal nerve (HN), internal and external superior laryngeal nerves (ESLNs), superior thyroid artery (STA), and superior laryngeal artery (SLA) to cervical spine and demonstrate any vulnerability. The anterior approach is a common approach to the cervical spine. Much of the operative morbidity in high cervical region is related to neurovascular injury leading to dysphagia, dysphonia, impaired high-pitch phonation, and impaired cough reflex. Eleven adult cadavers (5 male/6 female) were dissected bilaterally to expose structures of the high anterior cervical region. The HN consistently traveled toward the midline at C2-3 and was safe caudal to C3-4. In 95% of dissections, the internal superior laryngeal nerve (ISLN) was exposed within 1 cm of C3-4. The path of the ESLN was variable, but it was safe above C3-4 and below C6-7. The ESLN was deep to the STA, and it was less bulky and tauter than the ISLN in all dissections. The origin of the STA was quite variable along the carotid artery, but it was most commonly located at C4. Two anatomic variants of the SLA were observed. In 15 dissections, the SLA branched off the superior thyroid. In six dissections, the SLA branched directly from external carotid artery. There was no appreciable side-to-side variation in the neurovascular structures studied. On the basis this study, spine surgeons can have enhanced knowledge of high anterior cervical anatomy. The neurovascular structures in this study did not demonstrate side-to-side anatomic variation; therefore, patient pathology and surgeon preference should dictate the operative side.

  20. Anterior cervical decompression and fusion with caspar plate fixation

    International Nuclear Information System (INIS)

    Rehman, L.; Akbar, H.; Das, G.; Hashim, A.S.M.

    2013-01-01

    Objective: To evaluate the role of anterior cervical decompression and fixation with Caspar plating in cervical spine injury on neurological outcome. Study Design: A case series. Place and Duration of Study: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, from July 2008 to March 2011. Methodology: Thirty patients admitted with cervical spine injuries were inducted in the study. All cases were evaluated for their clinical features, level of injury and degree of neurological injury was assessed using Frankel grading. Pre and postoperative record with X-rays and MRI were maintained. Cervical traction was applied to patients with sub-luxation. All patients underwent anterior cervical decompression, fusion and Caspar plate fixation. The follow-up period was 6 months with clinical and radiological assessment. Results: Among 30 patients, 24 (80%) were males and 6 (20%) were females. Age ranged from 15 to 55 years. Causes of injury were road traffic accident (n = 20), fall (n = 8) and assault (n = 2). Commonest mode of injury was road traffic accident (66.6%). Postoperative follow-up showed that pain and neurological deficit were improved in 21 patients. There was no improvement in 7 patients, one patient deteriorated and one expired. All patients developed pain at donor site. Conclusion: Anterior decompression, fusion and fixation with Caspar plate is an effective method with good neurological and radiological outcome. However, it is associated with pain at donor site. (author)

  1. Elective non-instrumented anterior cervical diskectomy and fusion in ...

    African Journals Online (AJOL)

    Background: This study is a retrospective analysis of forty-one consecutive patients who underwent elective single or multilevel anterior cervical diskectomy and fusion (ACDF) in Ghana. All the patients had been followed up for at least six months. Methods: The medical records of forty-one consecutive cases were analysed ...

  2. Genetic studies in congenital anterior midline cervical cleft

    DEFF Research Database (Denmark)

    Jakobsen, L P; Pfeiffer, P; Andersen, M

    2012-01-01

    Congenital anterior midline cervical cleft (CAMCC) is a rare anomaly, with less than 100 cases reported. The cause of CAMCC is unknown, but genetic factors must be considered as part of the etiology. Three cases of CAMCC are presented. This is the first genetic study of isolated CAMCC. Conventional...

  3. Oesophageal perforation in anterior cervical spine plating: A Case ...

    African Journals Online (AJOL)

    A case report of a 48-year-old man who had a pharyngo-esophageal perforation with instrumentation failure 10 weeks after anterior cervical spine plating is presented and the literature on this issue is reviewed. Diagnosis of the perforation was made late as he had been lost to follow up and he eventually died of severe ...

  4. Transient paralysis shortly after anterior cervical corpectomy and fusion.

    Science.gov (United States)

    Zhang, Ji-dong; Xia, Qun; Ji, Ning; Liu, Yan-cheng; Han, Yue; Ning, Shang-long

    2013-02-01

    To report three cases of transient paralysis shortly after (within 4 hours) anterior cervical corpectomy and fusion (ACCF), and investigate the possible causes. Clinical and radiological data of three cases (two men and one woman, aged 41-61 years) were analyzed retrospectively. All three patients underwent ACCF for cervical spondylotic myelopathy. The decompressed segments were located in C(5) , C(6) and C(5) + C(6-7) discs, respectively. Paralysis occurred from 30 minutes to 4 hours after surgery. In two cases the paralysis was complete; it was incomplete in the third. All patients received immediate dehydration, neurotrophic drugs and high-dose methylprednisolone therapy upon recognition of their paralysis. Meanwhile, cervical MRIs were performed and showed no significant hematomas compressing the cervical spinal cord; spinal cord edema was clearly evident in all cases. In two cases the paralysis resolved within 2 hours of diagnosis and immediate medication. In the third case, because the neurological symptoms were incompletely resolved 24 hours after beginning medication, a second laminoplasty was performed. During decompression, tremendous pressure was released from the cervical spinal cord. The neurological symptoms had resolved completely by 1 week after decompression. The precise cause for transient paralysis after these anterior cervical surgeries is not yet clear. Spinal cord ischemia-reperfusion injury is generally regarded as the most likely cause. Therefore, a combination of cervical spinal cord edema and limited anterior decompression space may have been the main contributing factors to the paralysis reported here. Early diagnosis and early intervention to relieve the paralysis can restore spinal cord function and result in a satisfactory prognosis. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  5. The treatment of pharyngoesophageal perforation following anterior cervical spine intervention.

    Science.gov (United States)

    Aslıer, Mustafa; Doğan, Ersoy; Ecevit, Mustafa Cenk; Erdağ, Taner Kemal; Ikiz, Ahmet Omer

    2016-06-01

    We aimed to investigate the diagnostic and therapeutic approaches in pharyngoesophageal perforation (PEP) following anterior cervical spine intervention (ACSI). We reviewed the records of four patients with PEP after ACSI. Symptoms, physical examination findings, imaging results, treatment, and follow-up characteristics were evaluated. All four patients had undergone ACSI for either cervical trauma or cervical disc herniation with cervical cage reconstruction. Symptoms developed within the first 10 days of the postoperative period in three patients, and in the eighth month in one patient. Mucosal defects were detected during neck exploration in three patients. Reconstruction with primary suture and a local muscle flap was utilized in two patients. Three patients were discharged 3-8 weeks after surgical treatment. In cases of PEP after ACSI, a good prognosis can be achieved when symptoms are detected in the early period and reconstruction with local muscle flap is applied. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Recurrent Aspiration Pneumonia due to Anterior Cervical Osteophyte

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    Jae Jun Lee

    2017-02-01

    Full Text Available A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.

  7. Cervical adjacent segment pathology following fusion: Is it due to fusion?

    OpenAIRE

    Rosenthal, Philip; Kim, Kee D

    2013-01-01

    Adjacent segment pathology affects 25% of patients within ten years of anterior cervical diskectomy and fusion (ACDF). Laboratory studies demonstrate fused segments increase adjacent level stress including elevated intradiscal pressure and increased range of motion. Radiographic adjacent segment pathology (RASP) has been associated to ACDF in multiple statistically significant studies. Randomized controlled trials (RCTs) comparing anterior cervical discectomy and arthroplasty (ACDA) and ACDF ...

  8. Adjacent segment disease after anterior cervical interbody fusion: a multicenter retrospective study of 288 patients with long-term follow-up.

    Science.gov (United States)

    Litrico, S; Lonjon, N; Riouallon, G; Cogniet, A; Launay, O; Beaurain, J; Blamoutier, A; Pascal-Mousselard, H

    2014-10-01

    Cervical discectomy with interbody fusion is a common procedure in spinal surgery. The resultant biomechanical alterations accelerate degeneration of the adjacent segment, but the contribution of natural degeneration to adjacent segment disease is unclear. To assess the long-term rate of surgery to discs adjacent to cervical interbody fusion; and to assess the associated incidence of cervico-brachial neuralgia and radiological degeneration of adjacent discs. A multicenter retrospective study included anterior cervical discectomy patients at a minimum of 10 years' follow-up. Clinical variables comprised pain, use of analgesics and surgical revision. Functional assessment was performed on the Neck Disability Index (NDI). Radiologic degeneration was assessed on the Goffin score based on cervical spine X-ray. Two hundred and eighty-eight patients were contacted and filled out the clinical questionnaire. Among the patients, 153 underwent radiological reassessment. Mean age was 46 years (range, 16-73 years). Mean follow-up was 14.5 years (12-18 years). The rate of surgical revision on a disc adjacent to the primary level was 5.9%. Frequent attacks of cervico-brachial neuralgia were reported in 20.5% of cases. Radiologic adjacent segment degeneration was found in 81.3% of cases over follow-up. There was a significant correlation between degree of radiologic adjacent segment degeneration and NDI (P=0.02). Degeneration adjacent to discectomy/fusion is partly due to aging. The present findings, however, agree with the literature and indicate accelerated degeneration in adjacent segments. These findings should be taken into account in treatment decision-making and suggest a possible interest of more physiological surgery such as arthroplasty. IV - Multicenter retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. In vitro comparison of bioresorbable and titanium anterior cervical plates in the immediate postoperative condition.

    Science.gov (United States)

    Freeman, Andrew L; Derincek, Alihan; Beaubien, Brian P; Buttermann, Glenn R; Lew, William D; Wood, Kirkham B

    2006-12-01

    Bioresorbable plates have recently been used with anterior cervical discectomy and fusion (ACDF). Compared with metallic plates, bioresorbable plates provide segmental stabilization with minimal imaging artifact, eventual resorption, and increased load sharing. The objectives of the present study were to determine whether a bioresorbable plate can withstand simulated physiologic static and cyclic loading, to compare the reduction in flexibility provided by bioresorbable and titanium plates, and to quantify load sharing between the plate and spine with graft. Sixteen human cervical motion segments were tested to +/-2.5 Nm in flexion-extension, lateral bending, and axial rotation. Range of motion (ROM) was measured (1) in the intact state, (2) with ACDF without plating, (3) after addition of either a bioresorbable or titanium plate, and (4) after 500 cycles of combined flexion-extension and axial torsion. Load sharing was evaluated by applying the same fixed rotation both without and with the plate, and was calculated as the moment resisted by the uninstrumented ACDF expressed as a percentage of the plated ACDF state. No plate failures or graft migration occurred during testing. Compared with the uninstrumented ACDF, bioresorbable plates reduced mean ROM by 49% in flexion-extension and 25% in lateral bending, with very little change in torsion. Titanium plates reduced uninstrumented ACDF ROM by 69% in flexion-extension, 45% in lateral bending, and 27% in torsion. Differences between bioresorbable and titanium plates were significant in flexion-extension and lateral bending. Cyclic loading did not significantly change ROM for either plate. More moment was shared in lateral bending by the spine/graft with bioresorbable plates (78%) compared with titanium plating (63%). Bioresorbable plates contained an intervertebral graft, provided some stabilization, remained intact throughout the simulated immediate postoperative loading, and shared more load with the graft and

  10. Anterior cervical fusion versus minimally invasive posterior keyhole decompression for cervical radiculopathy

    Directory of Open Access Journals (Sweden)

    Richard M. Young

    2015-12-01

    Conclusion: ACDF has been demonstrated to be an effective surgical procedure in treating degenerative spine disease in patients with radiculopathy and/or myelopathy. However, in a population with isolated radiculopathy and radiological imaging confirming an anterolateral disc or osteophyte complex, the MIPKF can provide similar results without the associated risks that accompany an anterior cervical spine fusion.

  11. [Clinical study of a cervical anterior Hybrid technique with posterior longitudinal ligament retained for cervical spondylosis].

    Science.gov (United States)

    Jia, Yu-song; Chen, Jiang; Sun, Qi; Li, Jin-yu; Zheng, Chen-ying; Bai, Chun-xiao; Xu, Lin

    2015-01-01

    To explore the clinical effects and significances of a cervical anterior Hybrid technique with posterior longitudinal ligament retained in treating cervical spondylosis. The clinical data of 138 patients with cervical spondylosis underwent cervical anterior Hybrid surgery were retrospectively analyzed from March 2009 to March 2013. There were 52 males and 86 females,the age ranged from 36 to 58 years old with an average of 45.3 years. Course of disease was from 3 to 16 months. Cervical spondylosis classification included 22 cases with nerve root type, 68 cases with myelopathic type, 48 cases with mixed type. All patients were treated with the primary Hybrid surgery and their cervical posterior longitudinal ligaments were retained in anterior decompression. JOA score and image examination were used to evaluate clinical effect, and image examination included range of motion of the replacement segment, range of motion of the whole cervical spine, the sagittal diameter of the spinal cord before and after operation. All operations were successful and operation time was 60 to 125 min (averaged 90.6 min), perioperative bleeding was 10 to 60 ml (averaged 30.1 ml). All patients were followed up from 12 to 48 months with an average of 22.2 months. All pathological segments obtained fully decompression, reserved posterior longitudinal ligament had no obvious hypertrophy, proliferation and calcification. The prosthesis had good location and the incision healed well without complications. Upper limbs root symptoms were completely relieved in the patients with cervical spondylotic radiculopathy, muscle strengths and sensations got different recovery in the patients with cervical spondylotic myelopathy. JOA score was increased from preoperative 8.62±1.22 to final follow-up 14.26±1.47 (P0.05). Spinal cord sagittal diameter was increased from preoperative (5.2±1.3) mm to postoperative (8.8±0.5) mm (P<0.05). Anterior cervical Hybrid surgery with posterior longitudinal ligament

  12. Artrodese cervical anterior em três e quatro níveis com dispositivo intersomático não associado à placa cervical Artrodesis cervical anterior en tres y cuatro niveles con dispositivo intersomático no asociado a placa cervical Anterior cervical arthrodesis for three and four levels using stand-alone interbody cages without cervical plates

    Directory of Open Access Journals (Sweden)

    Marcel Luiz Benato

    2009-06-01

    en tercer y cuarto niveles; dolor axial y/o irradiada; con mínimo seis meses de postoperatorio. El criterio de exclusión fue la presencia de inestabilidad cervical traumática. Fueron evaluadas las tasas de consolidación, la presencia de síntomas, la tasa de complicaciones y la posición de los dispositivos intersomáticos (subsidente después de seis meses. RESULTADOS: todos los pacientes obtuvieron consolidación en tres meses, sin embargo, dos pacientes presentaron el fenómeno de subsidente, o sea, migración con consolidación en cifosis, sin alterar los resultados clínicos y la consolidación de la artrodesis a los seis meses de postoperatorio. Los pacientes presentaron mejoría del dolor preoperatorio y solo tres (15% presentaron dolor residual. No hubo complicaciones mayores. El tiempo de hospitalización fue de dos días. No fue utilizada inmovilización rígida en el postoperatorio. CONCLUSIÓN: fue obtenida consolidación con esta técnica en todos los casos. La técnica se mostró segura y promovió buenos resultados radiológicos y clínicos.evaluate the rates of fusion of the anterior cervical discectomy and arthrodesis for three and four levels using interbody cages (stand-alone without cervical plates six months after post-operative. METHODS: from November 2005 to July 2008, 20 patients were treated as proposed. The inclusion criteria were: cervical degenerative disease of three and four levels; axial and/or irradiated pain at least six months of follow-up. The exclusion criteria were: cervical traumatic instability. The fusion rate, clinical symptoms, rate of complications and the implant position were evaluated six months after post-operative. RESULTS: results were favorable in 100% of the patients, with residual pain in two cases. Fusion was found in 100% of the patients, except for two cases with minimum subsidence and fusion in a slight kyphotic position. There were not significant complications. The discharge of the hospital was performed

  13. Comparison of two anterior fusion methods in two-level cervical spondylosis myelopathy: a meta-analysis

    Science.gov (United States)

    Huang, Zhe-Yu; Wu, Ai-Min; Li, Qing-Long; Lei, Tao; Wang, Kang-Yi; Xu, Hua-Zi; Ni, Wen-Fei

    2014-01-01

    Objective The aim of this study was to evaluate the efficacy and safety of anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) for treating two-adjacent-level cervical spondylosis myelopathy (CSM). Design A meta-analysis of the two anterior fusion methods was conducted. The electronic databases of PubMed, the Cochrane Central Register of Controlled Trials, ScienceDirect, CNKI, WANFANG DATA and CQVIP were searched. Quality assessment of the included studies was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomised Studies criteria. Pooled risk ratios of dichotomous outcomes and standardised mean differences (SMDs) of continuous outcomes were generated. Using the χ2 and I2 tests, the statistical heterogeneity was assessed. Subgroup and sensitivity analyses were also performed. Participants Nine eligible trials with a total of 631 patients and a male-to-female ratio of 1.38:1 were included in this meta-analysis. Inclusion criteria Randomised controlled trials (RCTs) and non-randomised controlled trials that adopted ACCF and ACDF to treat two-adjacent-level CSM were included. Results No significant differences were identified between the two groups regarding hospital stay, the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) scores for neck and arm pain, total cervical range of motion (ROM), fusion ROM, fusion rate, adjacent-level ossification and complications, while ACDF had significantly less bleeding (SMD=1.14, 95% CI (0.74 to 1.53)); a shorter operation time (SMD=1.13, 95% CI (0.82 to 1.45)); greater cervical lordosis, total cervical (SMD=−2.95, 95% CI (−4.79 to −1.12)) and fused segment (SMD=−2.24, 95% CI (−3.31 to −1.17)); higher segmental height (SMD=−0.68, 95% CI (−1.03 to −0.34)) and less graft subsidence (SMD=0.40, 95% CI (0.06 to 0.75)) compared to ACCF. Conclusions The results suggested that ACDF has more advantages compared to

  14. Loading effects of anterior cervical spine fusion on adjacent segments

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    Chien-Shiung Wang

    2012-11-01

    Full Text Available Adjacent segment degeneration typically follows anterior cervical spine fusion. However, the primary cause of adjacent segment degeneration remains unknown. Therefore, in order to identify the loading effects that cause adjacent segment degeneration, this study examined the loading effects to superior segments adjacent to fused bone following anterior cervical spine fusion. The C3–C6 cervical spine segments of 12 sheep were examined. Specimens were divided into the following groups: intact spine (group 1; and C5–C6 segments that were fused via cage-instrumented plate fixation (group 2. Specimens were cycled between 20° flexion and 15° extension with a displacement control of 1°/second. The tested parameters included the range of motion (ROM of each segment, torque and strain on both the body and inferior articular process at the superior segments (C3–C4 adjacent to the fused bone, and the position of the neutral axis of stress at under 20° flexion and 15° extension. Under flexion and Group 2, torque, ROM, and strain on both the bodies and facets of superior segments adjacent to the fused bone were higher than those of Group 1. Under extension and Group 2, ROM for the fused segment was less than that of Group 1; torque, ROM, and stress on both the bodies and facets of superior segments adjacent to the fused bone were higher than those of Group 1. These analytical results indicate that the muscles and ligaments require greater force to achieve cervical motion than the intact spine following anterior cervical spine fusion. In addition, ROM and stress on the bodies and facets of the joint segments adjacent to the fused bone were significantly increased. Under flexion, the neutral axis of the stress on the adjacent segment moved backward, and the stress on the bodies of the segments adjacent to the fused bone increased. These comparative results indicate that increased stress on the adjacent segments is caused by stress-shielding effects

  15. Tracheostomy following anterior cervical spine fusion in trauma patients.

    Science.gov (United States)

    Binder, Harald; Lang, Nikolaus; Tiefenboeck, Thomas M; Bukaty, Adam; Hajdu, Stefan; Sarahrudi, Kambiz

    2016-06-01

    Traumatic injuries to the cervical spine are frequently accompanied by cervical spinal cord injuries-often necessitating tracheostomy. The purpose of this study was to evaluate patient characteristics and outcomes after undergoing anterior cervical spine fusion (ACSF) with tracheostomy. All patients with cervical spine injury (CSI) who underwent ACSF and tracheostomy between December 1992 and June 2014 were included in this retrospective data analysis. The study group consisted of 32 men (84 %) and six women (16 %), with an average age of 47 ± 20 years. Blunt trauma to the cervical spine was the cause of CSI in all 38 patients. The mean Injury Severity Score (ISS) was 30.50 ± 6.25. Eighteen patients sustained severe concomitant injuries related to the spinal injury. In 15 patients (39.5 %), traumatic brain injury (TBI) with fractures of the cranium and/or intracranial lesions were observed. The mean Glasgow Coma Scale (GCS) score was 11 ± 4.5 (range 3-15). Two tracheostomies (5.3 %) were performed simultaneously with ACSF. The remaining 36 were performed with an average "delay" of 15 ± ten days. We observed no difference in time to tracheostomy among patients initially presenting with an American Spinal Injury Association (ASIA) score of either A, B, C or D. Only two patients (5.3 %) were identified as having an infection at the site of ACSF after placement of a tracheostomy. There were no deaths directly related to airway difficulties in our cohort. Our data show that tracheostomy is safely performed after an average of 15 days post-ACSF, thereby being associated with a very low rate of complications. However, future prospective randomised studies are needed to identify the optimal timing of tracheostomy placement after ACSF. IV; retrospective case series.

  16. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery.

    Science.gov (United States)

    Starmer, Heather M; Riley, Lee H; Hillel, Alexander T; Akst, Lee M; Best, Simon R A; Gourin, Christine G

    2014-02-01

    Dysphonia and dysphagia are common complications of anterior cervical discectomy (ACD). We sought to determine the relationship between dysphagia and in-hospital mortality, complications, speech therapy/dysphagia training, length of hospitalization, and costs associated with ACD. Discharge data from the Nationwide Inpatient Sample for 1,649,871 patients who underwent ACD of fewer than four vertebrae for benign acquired disease between 2001 and 2010 were analyzed using cross-tabulations and multivariate regression modeling. Dysphagia was reported in 32,922 cases (2.0 %). Speech therapy/dysphagia training was reported in less than 0.1 % of all cases and in only 0.2 % of patients with dysphagia. Dysphagia was significantly associated with age ≥65 years (OR = 1.5 [95 % CI 1.4-1.7], P Dysphagia was a significant predictor of aspiration pneumonia (OR = 8.6 [6.7-10.9], P dysphagia training (OR = 32.0 [15.4-66.4], P Dysphagia, vocal cord paralysis, and aspiration pneumonia were significant predictors of increased length of hospitalization and hospital-related costs, with aspiration pneumonia having the single largest impact on length of hospitalization and costs. Dysphagia is significantly associated with increased morbidity, length of hospitalization, and hospital-related costs in ACD patients. Despite the known risk of dysphagia in ACD patients and an established role for the speech-language pathologist in dysphagia management, speech-language pathology intervention appears underutilized in this population.

  17. A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study

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    Rodrigo Ramos-Zúñiga

    2015-01-01

    Full Text Available Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma; and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.

  18. Three-level cervical disc herniation

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    St. Iencean Andrei

    2015-09-01

    Full Text Available Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6 treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

  19. Management of cervical polyradiculopathy through multisegmental ...

    African Journals Online (AJOL)

    Introduction: Posterior cervical laminoforaminotomy and discectomy remain as viable options for the treatment of foraminal stenosis or lateral herniated discs with radiculopathy. In contrast to the anterior approach, it does not entail fusion. Objective: Is to assess the clinical outcome of multisegmental laminoforaminotomies in ...

  20. Anterior cervical debridement and strut-grafting for osteomyelitis of the cervical spine.

    Science.gov (United States)

    Stone, J L; Cybulski, G R; Rodriguez, J; Gryfinski, M E; Kant, R

    1989-06-01

    A retrospective review of the surgical experience in treating 18 patients with osteomyelitis of the cervical spine is reported. The patients ranged in age from 20 to 60 years and all complained of neck pain upon admission. Ten patients had a prior history of intravenous drug abuse, three had previously suffered penetrating injuries of the neck, and one had an extraspinal site of osteomyelitis. Bacteria were isolated in 13 cases and tuberculosis in three. Neurological abnormalities were present in over one-half of the patients, consisting of myelopathy (nine cases) or radiculopathy (four cases). Plain cervical spine films and polytomography demonstrated vertebral and end-plate destruction, spinal instability, and increased paravertebral soft-tissue shadow in all cases. Computerized tomography and, more recently, magnetic resonance imaging have proven helpful in detecting bone involvement and the presence of epidural extension associated with cervical osteomyelitis. The risk of vertebral body collapse, kyphosis, and myelopathy in the osteomyelitic cervical spine has standardized the management of this problem in this institution to consist of skeletal traction, needle aspiration or blood culture for organism identification, anterior cervical debridement, autogenous iliac graft fusion, and intravenous administration of antibiotics. Spinal stability and neurological improvement were achieved in all 18 patients.

  1. Anatomic Relationship Between Right Recurrent Laryngeal Nerve and Cervical Fascia and Its Application Significance in Anterior Cervical Spine Surgical Approach.

    Science.gov (United States)

    Shan, Jianlin; Jiang, Heng; Ren, Dajiang; Wang, Chongwei

    2017-04-15

    An anatomic study of anterior cervical dissection of 42 embalmed cadavers. The aim was to study the anatomic relationship between recurrent laryngeal nerve (RLN) and cervical fascia combined with the requirements in anterior cervical spine surgery (ACSS). There has been no systematic research about how to avoid RLN injury in anterior cervical spine surgical approach from the aspect of the anatomic relationship between RLN and cervical fascia. Forty-two adult cadavers were dissected to observe the relationships between RLN and different cervical fascia layers. RLN pierced out the alar fascia from the inner edge of the carotid sheath in all cases, and the piercing position in 22 cases (52.4%) was located at the lower segment of T1. The enter point into visceral fascia of RLN was located at C7-T1 in 25 cases (59.5%). The middle layer of deep cervical fascia exhibited the most stable anatomic relationship with RLN at the carotid sheath confluence site. Pulling visceral sheath leftwards would significantly increase the RLN tension. Using the close and stable relationship between RLN and cervical fascia could help to avoid RLN injury in anterior cervical spine surgical approach. 4.

  2. Reliability and validity of CODA motion analysis system for measuring cervical range of motion in patients with cervical spondylosis and anterior cervical fusion

    Science.gov (United States)

    Gao, Zhongyang; Song, Hui; Ren, Fenggang; Li, Yuhuan; Wang, Dong; He, Xijing

    2017-01-01

    The aim of the present study was to evaluate the reliability of the Cartesian Optoelectronic Dynamic Anthropometer (CODA) motion system in measuring the cervical range of motion (ROM) and verify the construct validity of the CODA motion system. A total of 26 patients with cervical spondylosis and 22 patients with anterior cervical fusion were enrolled and the CODA motion analysis system was used to measure the three-dimensional cervical ROM. Intra- and inter-rater reliability was assessed by interclass correlation coefficients (ICCs), standard error of measurement (SEm), Limits of Agreements (LOA) and minimal detectable change (MDC). Independent samples t-tests were performed to examine the differences of cervical ROM between cervical spondylosis and anterior cervical fusion patients. The results revealed that in the cervical spondylosis group, the reliability was almost perfect (intra-rater reliability: ICC, 0.87–0.95; LOA, −12.86–13.70; SEm, 2.97–4.58; inter-rater reliability: ICC, 0.84–0.95; LOA, −13.09–13.48; SEm, 3.13–4.32). In the anterior cervical fusion group, the reliability was high (intra-rater reliability: ICC, 0.88–0.97; LOA, −10.65–11.08; SEm, 2.10–3.77; inter-rater reliability: ICC, 0.86–0.96; LOA, −10.91–13.66; SEm, 2.20–4.45). The cervical ROM in the cervical spondylosis group was significantly higher than that in the anterior cervical fusion group in all directions except for left rotation. In conclusion, the CODA motion analysis system is highly reliable in measuring cervical ROM and the construct validity was verified, as the system was sufficiently sensitive to distinguish between the cervical spondylosis and anterior cervical fusion groups based on their ROM. PMID:29285065

  3. Reliability and validity of CODA motion analysis system for measuring cervical range of motion in patients with cervical spondylosis and anterior cervical fusion.

    Science.gov (United States)

    Gao, Zhongyang; Song, Hui; Ren, Fenggang; Li, Yuhuan; Wang, Dong; He, Xijing

    2017-12-01

    The aim of the present study was to evaluate the reliability of the Cartesian Optoelectronic Dynamic Anthropometer (CODA) motion system in measuring the cervical range of motion (ROM) and verify the construct validity of the CODA motion system. A total of 26 patients with cervical spondylosis and 22 patients with anterior cervical fusion were enrolled and the CODA motion analysis system was used to measure the three-dimensional cervical ROM. Intra- and inter-rater reliability was assessed by interclass correlation coefficients (ICCs), standard error of measurement (SEm), Limits of Agreements (LOA) and minimal detectable change (MDC). Independent samples t-tests were performed to examine the differences of cervical ROM between cervical spondylosis and anterior cervical fusion patients. The results revealed that in the cervical spondylosis group, the reliability was almost perfect (intra-rater reliability: ICC, 0.87-0.95; LOA, -12.86-13.70; SEm, 2.97-4.58; inter-rater reliability: ICC, 0.84-0.95; LOA, -13.09-13.48; SEm, 3.13-4.32). In the anterior cervical fusion group, the reliability was high (intra-rater reliability: ICC, 0.88-0.97; LOA, -10.65-11.08; SEm, 2.10-3.77; inter-rater reliability: ICC, 0.86-0.96; LOA, -10.91-13.66; SEm, 2.20-4.45). The cervical ROM in the cervical spondylosis group was significantly higher than that in the anterior cervical fusion group in all directions except for left rotation. In conclusion, the CODA motion analysis system is highly reliable in measuring cervical ROM and the construct validity was verified, as the system was sufficiently sensitive to distinguish between the cervical spondylosis and anterior cervical fusion groups based on their ROM.

  4. Cervical intervertebral disc replacement.

    Science.gov (United States)

    Cason, Garrick W; Herkowitz, Harry N

    2013-02-06

    Symptomatic adjacent-level disease after cervical fusion has led to the development and testing of several disc-replacement prostheses. Randomized controlled trials of cervical disc replacement (CDR) compared with anterior cervical discectomy and fusion (ACDF) have demonstrated at least equivalent clinical results for CDR with similar or lower complication rates. Biomechanical, kinematic, and radiographic studies of CDR reveal that the surgical level and adjacent vertebral level motion and center of rotation more closely mimic the native state. Lower intradiscal pressures adjacent to CDR may help decrease the incidence of adjacent spinal-level disease, but long-term follow-up is necessary to evaluate this theory.

  5. The Outcomes of Anterior Spinal Fusion for Cervical Compressive Myelopathy—A Retrospective Review

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    Tsz-King Suen

    2011-12-01

    Conclusion: Anterior cervical decompression with bone fusion is a viable surgical option for patients with one level of anterior cervical cord compression, especially for patients with kyphosis or straight canal spine. For patients with two- to three-level involvement, anterior cervical decompression with bone fusion provides good functional result in proper selection of cases. We also identified some prognostic factors (male sex, symptoms less than 1 year, and age less than 70 years in predicting a favourable outcome of anterior spinal fusion for CCM.

  6. Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion: A retrospective study of 49 patients.

    Science.gov (United States)

    Wang, Feng; Wang, Peng; Miao, De-Chao; Du, Wei; Shen, Yong

    2017-06-01

    Studies in the literature have not delineated the surgical approaches of symptomatic adjacent segment diseases (ASDs) in patients undergoing reoperation after an initial anterior cervical fusion (ACF). The purpose of this study was to determine the optimal surgical approaches of ASD and the incidence of the dysphagia after reoperation.This was a retrospective study of 49 patients with ASD after an initial ACF surgery, which had undergone a reoperation at our medical center between January 2010 and December 2014. The surgical approaches were used by anterior cervical discectomy and fusion (ACDF), ACDF with the Zero-profile device, laminoplasty, and laminectomy with internal fixation. Patients were classified according to the different surgical approaches of anterior (n = 38) versus posterior (n = 11) groups and ACDF (n = 25) versus Zero-P (n = 13) groups. Clinical evaluations were performed preoperatively and repeated in 24 months after operation.This retrospective study included 26 men and 23 women with a mean age at revision surgery of 54.3 years and ASD onset time of 7.3 years. The patients were followed up with an average of 4.1 years. The reoperation rate was 5.4% in this study. The Japanese Orthopaedic Association (JOA), Neck Disability Index (NDI), and visual analogue scale (VAS) scores demonstrated significant improvements compared with preoperative in both anterior and posterior groups (P  .05). The operation time of ACDF group was more than Zero-P group, with significant differences (P  .05). A total of 12 (24.5%) patients had dysphagia after reoperation. The incidence of dysphagia in Zero-P group (1/13) was less than ACDF group (11/25), with significant differences (P < .05). There were no cases of major neurological or vascular complications, and wound complications.The clinical situation, initial operation, and secondary preoperative imaging findings were analyzed comprehensively, anterior or posterior approach were chosen, which

  7. Follow-up radiographs of the cervical spine after anterior fusion with titanium intervertebral disc; Roentgen-Verlaufsuntersuchung der Halswirbelsaeule nach anteriorer Fusion mit Titaninterponaten

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    Biederer, J.; Hutzelmann, A.; Heller, M. [Kiel Univ. (Germany). Klinik fuer Diagnostische Radiologie; Rama, B. [Paracelsus Klinik, Osnabrueck (Germany). Klinik fuer Neurochirurgie

    1999-08-01

    Purpose: We examined the postoperative changes of the cervical spine after treatment of cervical nerve root compression with anterior cervical discectomy and fusion with a new titanium intervertebral disc. Patients and Methods: 37 patients were examined prior to, as well as 4 days, 6 weeks, and 7 months after surgery. Lateral view X-rays and functional imaging were used to evaluate posture and mobility of the cervical spine, the position of the implants, and the reactions of adjacent bone structures. Results: Implantation of the titanium disc led to post-operative distraction of the intervertebral space and slight lordosis. Within the first 6 months a slight loss of distraction and re-kyphosis due to impression of the implants into the vertebral end-plates were found in all patients. We noted partial infractions into the vertebral end-plates in 10/42 segments and slight mobility of the implants in 14/42 segments. Both groups of patients showed reactive spondylosis and local symptoms due to loosening of the implants. The pain subsided after onset of bone bridging and stable fixation of the loosened discs. Conclusions: The titanium intervertebral disc provides initial distraction of the fusioned segments with partial recurrence of kyphosis during the subsequent course. Loosening of the implants with local symptoms can be evaluated with follow-up X-rays and functional imaging. (orig.) [German] Ziel: An Patienten mit zervikalen Kompressionssyndromen wurden Stellung und Funktion der Halswirbelsaeule nach Diskektomie und Fusion mit einem neuartigen Titaninterponat untersucht. Patienten und Methoden: Bei 37 Patienten (42 Segmente) wurden praeoperativ sowie 4 Tage, 6 Wochen und 7 Monate postoperativ mit seitlichen Uebersichts- und Funktionsaufnahmen Stellung und Mobilitaet der HWS beurteilt. Erfasst wurden Lageveraenderungen des Titaninterponates und die Reaktion der angrenzenden Wirbelkoerperabschlussplatten. Ergebnisse: Das Titaninterponat bewirkte postoperativ eine

  8. Mid-term Outcomes of Anterior Cervical Fusion for Cervical Spondylosis With Sympathetic Symptoms.

    Science.gov (United States)

    Li, Jun; Jiang, Dong-Jie; Wang, Xin-Wei; Yuan, Wen; Liang, Lei; Wang, Zhan-Chao

    2016-07-01

    Prospective study. The purpose of this study is to elucidate mid-term outcomes of anterior cervical fusion for cervical spondylosis with sympathetic symptoms (CSSS). The terminology, pathogenesis, diagnosis, and treatment of CSSS remain controversial. Surgical treatment of CSSS has been rarely reported. This is the first prospective study to evaluate the mid-term outcome of surgical treatment of CSSS. Thirty-one patients who were diagnosed with CSSS in 2006 were evaluated prospectively. All patients were assigned to undergo anterior cervical fusion with posterior longitudinal ligament (PLL) resection and followed up for ≥5 years. Sympathetic symptoms such as vertigo, headache, and tinnitus, etc. were evaluated using the sympathetic symptom 20-point score. Neurological status was assessed using the Japanese Orthopedic Association (JOA) score. Clinical and radiologic data were prospectively collected before surgery, and at 1 week, 2 months, 6 months, 2 years, and 5 years after surgery. Surgical complications and morbidities of other diseases during the follow-up were also recorded. The mean 20-point score decreased significantly from 7.3±3.5 before surgery to 2.2±2.7 at the final follow-up (P<0.001), giving a mean recovery rate of 66.1%±50.3%. Good to excellent results were attained in 80.6% of these patients. The sympathetic symptoms were relieved in 23 of the 31 patients in the early postoperative period, and 5 patients in 2 months. No relief of sympathetic symptoms was found in 3 patients. The mean JOA score improved significantly from 12.0±1.9 before surgery to 14.8±1.5 by the end of the follow-up (P<0.001). No late neurological deterioration was found in this group. The mid-term outcomes of anterior cervical fusion with PLL resection for CSSS have been satisfactory. Differential diagnosis before surgery is of great importance. PLL may play a role in presenting sympathetic symptoms.

  9. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease

    NARCIS (Netherlands)

    Jacobs, Wilco; Willems, Paul C.; van Limbeek, Jacques; Bartels, Ronald; Pavlov, Paul; Anderson, Patricia G.; Oner, Cumhur

    2011-01-01

    Background The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear. Objectives To determine which technique of anterior interbody fusion

  10. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease

    NARCIS (Netherlands)

    Jacobs, W.; Willems, P.C.P.H.; Limbeek, J. van; Bartels, R.H.M.A.; Pavlov, P.; Anderson, P.G.; Oner, C.

    2011-01-01

    BACKGROUND: The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear. OBJECTIVES: To determine which technique of anterior interbody fusion

  11. ANTERIOR CERVICAL INTRADURAL ARACHNOID CYST - A RARE CAUSE OF SPINAL CORD COMPRESSION

    Directory of Open Access Journals (Sweden)

    Kollam Chandra Sekhar

    2016-07-01

    Full Text Available BACKGROUND Arachnoid cysts of spinal cord are relatively uncommon lesions. Most of them arise dorsal to the cord, and anteriorly placed intradural arachnoid cyst is a rare cause of cervical cord compression. To the best of our knowledge, only 30 cases were reported in the literature. We present a case of anterior cervical intradural arachnoid cyst with review of literature. METHODS We performed a literature search for anteriorly placed intradural arachnoid cysts in the cervical spinal cord through http://pubmed.com, a well-known worldwide internet medical address. To the best of our knowledge, only 30 cases were reported in the literature. We reviewed the literature with illustration of our case. We present a case of a 40-year-old male patient who presented with insidious onset of radicular pain. MRI cervical spine demonstrated cervical intradural cystic lesion extending from C2 to upper border of C4, lying anteriorly with compression over the cord. Cervical laminectomy followed by wide cyst fenestration and subtotal excision of cyst was done. Histopathological diagnosis was arachnoid cyst. RESULTS Patient totally recovered from his pain and sensory symptoms within a week and motor symptoms improved gradually over a period of six to eight weeks. With two years followup, patient had no further complaints. CONCLUSION Anterior cervical intradural arachnoid cysts are rare. These are amenable to resection through posterior approach safely with good postoperative recovery.

  12. Hidden Blood Loss in Anterior Cervical Fusion Surgery: An Analysis of Risk Factors.

    Science.gov (United States)

    Wen, Longfei; Jin, Daxiang; Xie, Weixing; Li, Yue; Chen, Weijian; Zhang, Shuncong; Jiang, Xiaobing

    2018-01-01

    A retrospective study. Anterior cervical fusion surgery is widely used procedure in cervical spondylosis. When considering the blood reinfusion strategies of cervical fusion surgery, the amount of blood loss is one of the key elements. We usually calculate the blood loss according to the surgical bleeding plus the postoperative drainage; however, this method ignores the possibility that there may be hidden blood loss (HBL). We performed a retrospective study to determine the risk factors for HBL in patients who underwent anterior cervical fusion surgery for degenerative spine from 2013 to 2016. The Pearson correlation, Spearman correlation, and multivariate liner analysis were used to find association between patient characteristics and HBL. A total of 107 consecutive patients who underwent anterior cervical fusion surgery for degenerative spine in our hospital were reviewed. The amount of HBL was 261 mL, or 50% of the total blood loss. According to the model of multiple linear regression analysis, patient sex (P = 0.028) and American Society of Anesthesiologists physical status classification (P = 0.029) were independent risk factors contributing to HBL, but preoperative hematocrit was not (P = 0.741). We concluded that sex and American Society of Anesthesiologists physical status classification were independent risk factors of HBL in anterior cervical fusion surgery. In addition, there was a high proportion of HBL in anterior cervical fusion. When considering the strategies of transfusion, we should pay attention to the risk factors for HBL. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Effect of posterior subsidence on cervical alignment after anterior cervical corpectomy and reconstruction using titanium mesh cages in degenerative cervical disease.

    Science.gov (United States)

    Jang, Jae-Won; Lee, Jung-Kil; Lee, Jung-Heon; Hur, Hyuk; Kim, Tae-Wan; Kim, Soo-Han

    2014-10-01

    Subsidence after anterior cervical reconstruction using a titanium mesh cage (TMC) has been a matter of debate. The authors investigated and analyzed subsidence and its effect on clinical and radiologic parameters after cervical reconstruction using a TMC for degenerative cervical disease. Thirty consecutive patients with degenerative cervical spine disorders underwent anterior cervical corpectomy followed by reconstruction with TMC. Twenty-four patients underwent a single-level corpectomy, and six patients underwent a two-level corpectomy. Clinical outcomes were assessed using a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). Fusion status, anterior and posterior subsidence of the TMC, segmental angle (SA) and cervical sagittal angle (CSA) were assessed by lateral and flexion-extension radiographs of the neck. The mean follow-up period was 27.6 months (range, 24 to 49 months). The VAS, NDI and JOA scores were all significantly improved at the last follow-up. No instances of radiolucency or motion-related pseudoarthrosis were detected on radiographic analysis, yielding a fusion rate of 100%. Subsidence occurred in 28 of 30 patients (93.3%). The average anterior subsidence of the cage was 1.4 ± 0.9 mm, and the average posterior subsidence was 2.9 ± 1.2 mm. The SA and CSA at the final follow-up were significantly increased toward a lordotic angle. Anterior cervical reconstruction using TMC and plating in patients with cervical degenerative disease provides good clinical and radiologic outcomes. Cage subsidence occurred frequently, especially at the posterior part of the cage. Despite the prominent posterior subsidence of the TMC, SA and CSA were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Lower cervical levels: Increased risk of early dysphonia following anterior cervical spine surgery.

    Science.gov (United States)

    Zeng, Ji-Huan; Li, Xiao-Dan; Deng, Liang; Xiao, Qiang

    2016-10-01

    The present study aimed to re-evaluate the incidence of early dysphonia after anterior cervical spine surgery (ACSS) and to determine the related risk factors. Patients underwent ACSS between January 2011 and December 2013 at two sites were identified retrospectively from hospital's patient databases. A total of 233 cases were included in this study. Dysphonia developed 1 month postoperatively was recorded. Follow-up was conducted in all positive-response patients. Those reporting severe or persistent voice symptoms were referred to otolaryngologists for further assessments and (or) treatments. Pre and intraoperative factors were collected to determine their relationships with dysphonia one month postoperatively. 45 patients developed dysphonia at one month, including 23 males and 22 females, yielding to an incidence of 19.3%. 34 cases resolved themselves in 3 months, leaving the remaining 11 patients considered to be severe or persistent cases. However, 10 of them recovered spontaneously in the next 9 months, while the last case received vocal cord medialization and returned to almost normal speech function at 18 months. In univariate analysis, only approaching level involving C6-C7 or (and) C7-T1 was significantly associated with postoperative dysphonia (Pdysphonia following ACSS was relatively high and approaching at lower cervical levels was an independent predictive factor. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Effect of anterior cervical osteophyte in poststroke dysphagia: a case-control study.

    Science.gov (United States)

    Kim, Youngkook; Park, Geun-Young; Seo, Yu Jung; Im, Sun

    2015-07-01

    To investigate whether the concomitant presence of anterior cervical osteophytes can influence the severity and outcome of patients with poststroke dysphagia. Retrospective case-control study. Hospital. A total of 40 participants were identified (N=40). Patients with poststroke dysphagia with anterior cervical osteophytes (n=20) were identified and matched by age, sex, location, and laterality of the stroke lesion to a poststroke dysphagia control group with no anterior cervical osteophytes (n=20). Not applicable. Videofluoroscopic swallowing study, Functional Oral Intake Scale (FOIS), and Penetration-Aspiration Scale results assessed within the first month of stroke were analyzed. The FOIS at 6 months was recorded, and severity of dysphagia was compared between the 2 groups. The case group had larger degrees of postswallow residues in the valleculae and pyriform sinuses (P=.020 and Pdysphagia (OR=15.375; 95% CI, 3.195-infinity). The presence of anterior cervical osteophytes, which may cause mechanical obstruction and interfere with residue clearance at the valleculae and pyriform sinuses and result in more postswallow aspiration, may influence initial severity and outcome of poststroke dysphagia. The presence of anterior cervical osteophytes may be considered an important clinical condition that may affect poststroke dysphagia rehabilitation. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature.

    Science.gov (United States)

    Hershman, Stuart H; Kunkle, William A; Kelly, Michael P; Buchowski, Jacob M; Ray, Wilson Z; Bumpass, David B; Gum, Jeffrey L; Peters, Colleen M; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Currier, Bradford L; Rahman, Ra'Kerry K; Isaacs, Robert E; Smith, Justin S; Shaffrey, Christopher; Thompson, Sara E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Multicenter retrospective case series and review of the literature. To determine the rate of esophageal perforations following anterior cervical spine surgery. As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients' charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.

  17. LAPAROSCOPIC ANTERIOR PELVIC EXENTERATION FOR STAGE IVa CERVICAL CANCER (A CASE REPORT

    Directory of Open Access Journals (Sweden)

    S. V. Molchanov

    2017-01-01

    Full Text Available Recently, there has been an increasing use of laparoscopy in the surgical treatment of gynecologic cancer. We aimed to analyze the feasibility of performing laparoscopic pelvic extentaration for stage IVa cervical cancer. Case report. We present the case of a 61-year-old patient diagnosed with stage IVa (T4N0M0 cervical cancer. The examination revealed cervical cancer invading the bladder wall and extending to the mouth of uretersю The patient underwent laparoscopy and bilateral uretherocutaneostomy as the first line treatment. When creatinine and urea blood levels were in the normal range, the patient underwent laparoscopic anterior pelvic exentaration as the second line treatment. After surgery the patient received pelvic external beam radiation therapy. The follow-up period was 6 months. Conclusion. We have shown the feasibility of performing laparoscopic anterior pelvic exenteration for stage IVa cervical cancer complicated by complete obstruction of one kidney and partial obstruction of another kidney

  18. High anterior cervical approach to the clivus and foramen magnum: a microsurgical anatomy study.

    Science.gov (United States)

    Russo, Vittorio M; Graziano, Francesca; Russo, Antonino; Albanese, Erminia; Ulm, Arthur J

    2011-09-01

    Surgical exposure of lesions located along the ventral foramen magnum (FM) and clivus poses a unique set of challenges to neurosurgeons. Several approaches have been developed to access these regions with varying degrees of exposure and approach-related morbidity. To describe the microsurgical anatomy of the high anterior cervical approach to the clivus and foramen magnum, and describe novel skull base extensions of the approach. Eight adult cadaveric specimens were included in this study. The high anterior cervical approach includes a minimal anterior clivectomy and its lateral skull base extensions: the extended anterior far-lateral clivectomy and the inferior petrosectomy. The microsurgical anatomy and exposure of the various extensions of the approach were analyzed. In addition, the capability of complementary endoscopy was evaluated. With proper positioning, the minimal anterior clivectomy exposed the vertebrobasilar junction, proximal basilar artery, anteroinferior cerebellar arteries, and 6th cranial nerve. The lateral skull base extensions provided access to the anterior FM, mid-lower clivus, and petroclival region, up to the Meckel cave, contralateral to the side of the surgical approach. The high anterior cervical approach with skull base extensions is an alternative to the classic approaches to the ventral FM and mid-lower clivus. A minimal anterior clivectomy provides access to the midline mid-lower clivus. The addition of an extended anterior far-lateral clivectomy and an inferior petrosectomy extends the exposure to the anterior FM and cerebellopontine angle lying anterior to the cranial nerves. The approach is also ideally suited for endoscopic-assisted techniques.

  19. Criteria for preferring anterior approach in surgical treatment of cervical spondylotic myeloradiculopathy

    Directory of Open Access Journals (Sweden)

    Yurdal Gezercan

    2014-08-01

    Full Text Available Cervical spondylosis is a progressive, chronic and insidious degenerative disease, which origins from the cervical intervertebral disc and then diffuses to surrounding bony and soft tissues. If the spine and nerve roots are involved due to degenerative changes, this is called as cervical spondylotic myeloradiculopathy (CSMR and it is the most frequent cause of myelopathy over age of 50. Cases with progressive character and functional neurological deficits and cases with a prolonged course refractory to conservative therapy shall be treated surgically. The aim of the surgical treatment is to relieve the pressure on the spinal cord and nerve roots, to preserve the proper anatomical alignment of the cervical vertebrae or to reestablish correct anatomical positioning if it is distorted and lastly to increase the life quality by relieving patients neurological signs and complaints. While achieving these goals, complications shall be avoided as much as possible. These goals can be accomplished by anterior or posterior surgical approaches to the cervical vertebrae. The style of the surgical approach can only be decided by a detailed evaluation of the patient's clinical and radiological features. The utmost aim of the surgical procedure, which is to achieve sufficient neurological decompression and to preserve/establish proper cervical vertebral alignment, can be provided best by anterior approaches. In our current study, the criteria to prefer anterior approach in surgical treatment of CSMR will be reviewed. [Cukurova Med J 2014; 39(4.000: 669-678

  20. Risk factors for subsidence in anterior cervical fusion with stand-alone polyetheretherketone (PEEK) cages: a review of 82 cases and 182 levels.

    Science.gov (United States)

    Kao, Ting-Hsien; Wu, Chen-Hao; Chou, Yu-Ching; Chen, Hsien-Te; Chen, Wen-Hsien; Tsou, Hsi-Kai

    2014-10-01

    To determine risk factors for subsidence in patients treated with anterior cervical discectomy and fusion (ACDF) and stand-alone polyetheretherketone (PEEK) cages. Records of patients with degenerative spondylosis or traumatic disc herniation resulting in radiculopathy or myelopathy between C2 and C7 who underwent ACDF with stand-alone PEEK cages were retrospectively reviewed. Cages were filled with autogenous cancellous bone harvested from iliac crest or hydroxyapatite. Subsidence was defined as a decrease of 3 mm or more of anterior or posterior disc height from that measured on the postoperative radiograph. Eighty-two patients (32 males, 50 females; 182 treatment levels) were included in the analysis. Most patients had 1-2 treatment levels (62.2 %), and 37.8 % had 3-4 treatment levels. Treatment levels were from C2-7. Of the 82 patients, cage subsidence occurred in 31 patients, and at 39 treatment levels. Multivariable analysis showed that subsidence was more likely to occur in patients with more than two treatment levels, and more likely to occur at treatment levels C5-7 than at levels C2-5. Subsidence was not associated with postoperative alignment change but associated with more disc height change (relatively oversized cage). Subsidence is associated with a greater number of treatment levels, treatment at C5-7 and relatively oversized cage use.

  1. Surgical results and MRI findings of cervical myelopathy treated with anterior decompression and fusion

    International Nuclear Information System (INIS)

    Miyazato, Takenari; Teruya, Yoshimitsu; Kinjo, Yukio

    1995-01-01

    We reviewed 19 patients with cervical myelopathy treated with anterior decompression and fusion. Etiology of cervical myelopathy was cervical disc herniation (CDH) in 13 patients and cervical spondylosis (CSM) in 6. Clinical recovery rate (%) was calculated from preoperative cervical myelopathy score (JOA) and the score at follow-up. Correlation between the clinical recovery rate and MRI findings (area and flatness at the narrowest part of the spinal cord), age at surgery, duration of myelopathy and pre-operative clinical score were analyzed separately in the CDH and CSM groups. Clinical recovery rate averaged 69% in the CDH group and 75% in the CSM group. In the CDH group, average clinical recovery rate in patients younger than 60 years was 80 and in patients over 60 years was 60. There was a significant negative correlation between the clinical recovery rate and age at surgery (p<0.05). No significant correlation was found between the clinical recovery rate and other factors investigated. (author)

  2. Surgical results and MRI findings of cervical myelopathy treated with anterior decompression and fusion

    Energy Technology Data Exchange (ETDEWEB)

    Miyazato, Takenari; Teruya, Yoshimitsu [Chubu Tokushukai Hospital, Okinawa (Japan); Kinjo, Yukio [and others

    1995-09-01

    We reviewed 19 patients with cervical myelopathy treated with anterior decompression and fusion. Etiology of cervical myelopathy was cervical disc herniation (CDH) in 13 patients and cervical spondylosis (CSM) in 6. Clinical recovery rate (%) was calculated from preoperative cervical myelopathy score (JOA) and the score at follow-up. Correlation between the clinical recovery rate and MRI findings (area and flatness at the narrowest part of the spinal cord), age at surgery, duration of myelopathy and pre-operative clinical score were analyzed separately in the CDH and CSM groups. Clinical recovery rate averaged 69% in the CDH group and 75% in the CSM group. In the CDH group, average clinical recovery rate in patients younger than 60 years was 80 and in patients over 60 years was 60. There was a significant negative correlation between the clinical recovery rate and age at surgery (p<0.05). No significant correlation was found between the clinical recovery rate and other factors investigated. (author).

  3. Prognostic Value of Lordosis Decrease in Radiographic Adjacent Segment Pathology After Anterior Cervical Corpectomy and Fusion.

    Science.gov (United States)

    Liu, Yin; Li, Na; Wei, Wei; Deng, Jing; Hu, Yuequn; Ye, Bin; Wang, Wei

    2017-10-31

    While cervical lordosis alteration is not uncommon after anterior cervical arthrodesis, its influence on radiological adjacent segment pathology (RASP) is still unclear. Biomechanical changes induced by arthrodesis may contribute to ASP onset. To investigate the correlation between cervical lordosis decrease and RASP onset after anterior cervical corpectomy and fusion (ACCF) and to determine its biomechanical effect on adjacent segments after surgery, 80 CSM patients treated with ACCF were retrospectively studied, and a baseline finite element model of the cervical spine as well as post-operation models with normal and decreased lordosis were established and validated. We found that post-operative lordosis decrease was prognostic in predicting RASP onset, with the hazard ratio of 0.45. In the FE models, ROM at the adjacent segment increased after surgery, and the increase was greater in the model with decreased lordosis. Thus, post-operative cervical lordosis change significantly correlated with RASP occurrence, and it may be of prognostic value. The biomechanical changes induced by lordosis change at the adjacent segments after corpectomy may be one of the mechanisms for this phenomenon. Restoring a well lordotic cervical spine after corpectomy may reduce RASP occurrence and be beneficial to long-term surgical outcomes.

  4. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study.

    Science.gov (United States)

    Wu, Wen-Jian; Jiang, Lei-Sheng; Liang, Yu; Dai, Li-Yang

    2012-07-01

    Clinical outcomes of the stand-alone cage have been encouraging when used in anterior cervical discectomy and fusion (ACDF), but concerns remain regarding its complications, especially cage subsidence. This retrospective study was undertaken to investigate the long-term radiological and clinical outcomes of the stand-alone titanium cage and to evaluate the incidence of cage subsidence in relation to the clinical outcome in the surgical treatment of degenerative cervical disc disease. A total of 57 consecutive patients (68 levels) who underwent ACDF using a titanium box cage for the treatment of cervical radiculopathy and/or myelopathy were reviewed for the radiological and clinical outcomes. They were followed for at least 5 years. Radiographs were obtained before and after surgery, 3 months postoperatively, and at the final follow-up to determine the presence of fusion and cage subsidence. The Cobb angle of C2-C7 and the vertebral bodies adjacent to the treated disc were measured to evaluate the cervical sagittal alignment and local lordosis. The disc height was measured as well. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for cervical myelopathy, before and after surgery, and at the final follow-up. The recovery rate of JOA score was also calculated. The Visual Analogue Scale (VAS) score of neck and radicular pain were evaluated as well. The fusion rate was 95.6% (65/68) 3 months after surgery. Successful bone fusion was achieved in all patients at the final follow-up. Cage subsidence occurred in 13 cages (19.1%) at 3-month follow-up; however, there was no relation between fusion and cage subsidence. Cervical and local lordosis improved after surgery, with the improvement preserved at the final follow-up. The preoperative disc height of both subsidence and non-subsidence patients was similar; however, postoperative posterior disc height (PDH) of subsidence group was significantly greater than of non-subsidence group

  5. Management of Esophageal and Pharyngeal Perforation as Complications of Anterior Cervical Spine Surgery.

    Science.gov (United States)

    Kang, Moo Sung; Kim, Kyung Hyun; Park, Jeong Yoon; Kuh, Sung Uk; Chin, Dong Kyu; Jin, Byung Ho; Kim, Keun Su; Cho, Yong Eun

    2017-06-01

    To describe our experience in treating esophageal and pharyngeal perforation after anterior cervical spine surgery. Six patients with esophageal injury and one patient with pharyngeal injury after anterior cervical spinal surgery, managed at our department between 2000 and 2015, were analyzed retrospectively. During the study period, 7 patients (6 male and 1 female; mean age, 45 years) presented with esophageal perforation. The original anterior cervical spinal surgery was performed due to trauma in 2 patients and because of a degenerative cervical disorder in 5. Early esophageal perforation was diagnosed in 2 patients, and delayed esophageal injury due to chronic irritation with the cervical implants was noted in 5. Three of the five delayed perforation cases were related to cervical instrument displacement. Two patients showed no definite signs of infection, whereas 5 patients had various symptoms, including fever, neck pain, odynophagia, neck swelling, and upper extremity weakness. Two patients with a large defect underwent surgical repair and three with minimal perforation due to chronic irritation from the implants underwent instrument removal without direct repair of defect. Two asymptomatic patients received no intervention. Six patients with infection completely recovered from esophageal injury after treatment for a mean duration of 5.2 weeks (range, 4-8 weeks). One patient died because of postoperative pneumonia and sepsis after implant removal. Esophageal and pharyngeal injury after cervical spinal surgery may occur either directly due to spinal trauma and vigorous intraoperative retraction or due to chronic irritation with cervical implants. In cases of perforation associated with infection, various surgical modalities, including primary closure and reinforcement with a flap, could be considered depending on factors such as esophageal defect size, infection severity, and timing of recognition of injury. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Readmission Rates, Reasons, and Risk Factors Following Anterior Cervical Fusion for Cervical Spondylosis in Patients Above 65 Years of Age.

    Science.gov (United States)

    Puvanesarajah, Varun; Hassanzadeh, Hamid; Shimer, Adam L; Shen, Francis H; Singla, Anuj

    2017-01-15

    A retrospective database review. The aim of this study was to determine readmission reasons and rates following primary, elective anterior cervical spinal fusion surgery for cervical spondylosis and determine risk factors predicting increased risk of 30-day readmission in an exclusively elderly population. In the United States, there were almost 190,000 cervical spine procedures in 2009. Many cervical spine surgery patients are elderly, a demographic increasingly requiring surgery for degenerative cervical spine pathology. Unfortunately, this patient population is poorly studied, particularly concerning readmission rates. Medicare data from 2005 to 2012 were queried for elderly patients (65-84 years) who underwent primary one to two and ≥three-level anterior cervical spine fusion surgeries for cervical spondylosis. Forty-five thousand two hundred eighty-four patients treated with one to two-level and 12,103 patients with ≥three-level anterior cervical fusion (ACF) were identified and included in two study cohorts. Reasons for and rates of readmission were determined within 30 days, 90 days, and one-year postoperatively. Risk factors for medical, surgical, and all 30-day readmissions were also determined, selecting from various comorbidities, demographics, and surgical variables. Readmission rates of 1.0% to 1.4%, 2.7% to 3.6%, and 13.2% to 14.1% were observed within 30 days, 90 days, and one year. Within 30 days, over 30% of patients from both study cohorts were readmitted for surgical reasons. Of surgical reasons for 30-day readmission, hematoma/seroma diagnoses were the most frequent (11.4%-15.4% of all readmissions). Male gender, diabetes mellitus, chronic pulmonary disease, obesity, and smoking history were all found to be predictive of all-cause readmissions. Unplanned 30-day readmission rates following primary, elective ACF in elderly patients is low and often due to medical reasons. Frequent surgical reasons for 30-day readmission include hematoma

  7. Vertebral autograft used as bone transplant for anterior cervical corpectomy: technical note.

    Science.gov (United States)

    Rieger, Andreas; Holz, Carsten; Marx, Thomas; Sanchin, Lhagva; Menzel, Matthias

    2003-02-01

    In this prospective patient study, we used a surgical technique for autograft bone fusion during anterior cervical corpectomy (ACC) in patients experiencing cervical spondylotic myelopathy. We packed the resected bone material of the corpectomy into a titanium mesh cage. To evaluate the efficacy of our autograft technique, we analyzed the results according to neurological outcome, radiological outcome, and complications. Between 1995 and 1998, 27 ACC operations were performed for cervical spondylotic myelopathy caused by multisegmental cervical spondylosis. In all patients, decompression of the cervical canal and/or spinal nerve roots was performed by a median cervical corpectomy by an anterior approach. After the ACC was completed, a titanium mesh cage, which was variable in diameter and length, was filled with morselized and impacted bone material from the cervical corpectomy and was then implanted. An anterior cervical plate was placed in all patients to achieve primary stability of the cervical vertebral column. Age, sex, pre- and postoperative myelopathy, number of decompressed levels, radiological results, and complications were assessed. The severity of myelopathy was graded according to the scoring system of the Japanese Orthopaedic Association. Symptomatic improvement of neurological deficits was achieved in 80% of the patients. The mean preoperative Japanese Orthopaedic Association score improved from 13.1 to 15.2 postoperatively (P < 0.05). No patient demonstrated worsening of myelopathic symptoms. Radiological follow-up studies demonstrated complete bony fusion in all patients. A vertical movement of 2.25 +/- 0.43 mm of the titanium cage into the adjacent vertebral bodies was observed in 24 patients. In patients with either a lordotic or neutral cervical spinal axis postoperatively, the axis remained unchanged during the entire follow-up period. The results of this study demonstrate that transplantation of autograft bone material harvested during the

  8. Mechanical evaluation of posterior wiring as a supplement to anterior cervical plate fixation.

    Science.gov (United States)

    Rao, Raj D; Wang, Mei; Singrakhia, Manoj D; McGrady, Linda M

    2004-10-15

    An in vitro experimental study was performed to examine 3-dimensional biomechanical stability of cervical fixations. To determine whether posterior interspinous wiring contributes to the rigidity of a single-level motion segment that has been plated anteriorly, and to determine the effects of this combined fixation on intradiscal pressure and spinal motion at the adjacent segments. Combined anterior and posterior column fixation is being increasingly used in a variety of clinical situations that do not involve complete disruption of the motion segment. The biomechanical validity of combined anterior posterior fixation in the absence of overt posterior ligamentous disruption has not been studied. Six human fresh-frozen cadaveric cervical spines (C3-T1) were used. Three-dimensional intersegmental motion and intradiscal pressure were measured while the spine was loaded in flexion, extension, lateral bending, and torsion (up to 2.5 Nm). Fixation stability at the operative level (C5-C6) and influence of the fixation on adjacent segments were evaluated after an anterior plating procedure and combined anterior plating and posterior wiring. Comparing the combined approach with anterior plating alone, significant reductions in C5-C6 motion was noted: 49% in flexion (P torsion (P bending was not significant (18% and 12%, respectively). The improved fixation had minimal influence on the adjacent segments. Combined anterior posterior fixation further reduces the segmental motion by almost 50% in flexion and extension, 33% and 39% in torsion, and does not significantly alter intradiscal pressure and spinal motion at adjacent segments.

  9. MRI of anterior spinal artery syndrome of the cervical spinal cord

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, S. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Yamada, T. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Ishii, K. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Saito, H. (Dept. of Neurology, Tohoku Univ. School of Medicine, Sendai (Japan)); Tanji, H. (Dept. of Neurology, Tohoku Univ. School of Medicine, Sendai (Japan)); Kobayashi, T. (Inst. of Rehabilitation Medicine, Tohoku Univ. School of Medicine, Miyagi (Japan)); Soma, Y. (Div. of Neurology, Takeda Hospital, Aizuwakamatsu (Japan)); Sakamoto, K. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan))

    1992-12-01

    Cervical spinal cord lesions in the anterior spinal artery syndrome were delineated on magnetic resonance images (MRI) in four patients. The lesion was always seen anteriorly in the cervical cord. On T2-weighted images, the lesions appeared hyperintense relative to the normal spinal cord, while on T1-weighted images, two chronic lesions appeared hypointense, with local atrophy of the cord. In one case, repeated T1-weighted images showed no signal abnormality 4 days after the ictus, but the lesion became hypointense 18 days later, when contrast enhancement was also recognized after injection of Gd-DTPA; this sequence of intensity changes was similar to that of cerebral infarction. The extent of the lesion seen MRI correlated closely with neurological findings in all cases. Although the findings may not be specific, MRI is now the modality of choice for confirming the diagnosis in patients suspected of having an anterior spinal artery syndrome. (orig.)

  10. MRI of anterior spinal artery syndrome of the cervical spinal cord

    International Nuclear Information System (INIS)

    Takahashi, S.; Yamada, T.; Ishii, K.; Saito, H.; Tanji, H.; Kobayashi, T.; Soma, Y.; Sakamoto, K.

    1992-01-01

    Cervical spinal cord lesions in the anterior spinal artery syndrome were delineated on magnetic resonance images (MRI) in four patients. The lesion was always seen anteriorly in the cervical cord. On T2-weighted images, the lesions appeared hyperintense relative to the normal spinal cord, while on T1-weighted images, two chronic lesions appeared hypointense, with local atrophy of the cord. In one case, repeated T1-weighted images showed no signal abnormality 4 days after the ictus, but the lesion became hypointense 18 days later, when contrast enhancement was also recognized after injection of Gd-DTPA; this sequence of intensity changes was similar to that of cerebral infarction. The extent of the lesion seen MRI correlated closely with neurological findings in all cases. Although the findings may not be specific, MRI is now the modality of choice for confirming the diagnosis in patients suspected of having an anterior spinal artery syndrome. (orig.)

  11. A systematic study of techniques for elective cervical nodal irradiation with anterior or opposed anterior and posterior beams

    International Nuclear Information System (INIS)

    Nutting, Christopher M.; Normile, Peter S.; Bedford, James L.; Harrington, Kevin J.; Webb, Steve

    2003-01-01

    Purpose: To assess target coverage and dose homogeneity using conventional radiotherapy (RT) and intensity-modulated RT (IMRT) with anterior and posterior beams for elective irradiation of the cervical lymph nodes in patients with head and neck cancer. Materials and methods: A planning study was performed in six patients who had undergone radical RT for head and neck cancer. RT plans to irradiate the cervical lymph nodes using a single anterior field, or opposed anterior and posterior fields, with 6 or 10 MV photons were compared. Plans using IMRT for missing-tissue compensation were also studied. An algorithm was developed to guide clinicians to the most appropriate treatment technique depending on the nodal groups to be irradiated. Results: With 6 MV single field (SF) irradiation significant under-dose (minimum dose <70% of prescription dose) was seen in nodal groups II and V, due to their posterior position. With SF 10 MV the mean dose to level II was higher (p<0.001) and dose homogeneity to levels Ib and II was improved. Using opposed fields (OF), minimum doses to the nodes in levels II and V were improved. OF using 10 MV showed significant advantage over 6 MV with reduction of maximum doses to levels II, III and V. SF 10 MV IMRT improved maximum doses to levels Ib and II compared to SF 6 MV IMRT. OF IMRT gave the best dose distributions with optimal mean dose and dose homogeneity. Beam energy made no difference with OF IMRT. Conclusions: The optimal technique for elective cervical node irradiation depends on the lymph node levels within the PTV. If irradiation of the level II or V nodes is required, then the OF IMRT technique with either 6 or 10 MV gives the best dose distributions. In the absence of IMRT, then OF conventional techniques are best. If the aim is to irradiate levels III and IV or level IV only, then 6 MV SF non-IMRT is the simplest technique

  12. Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite.

    Science.gov (United States)

    Kim, Phong; Sarauw, Martin Toft; Sonnesen, Liselotte

    2014-03-01

    Cervical vertebral column morphology and head posture were examined and related to craniofacial morphology in preorthodontic children and adolescents with anterior open bite. One hundred eleven patients (ages, 6-18 years) with an anterior open bite of more than 0 mm were divided into 2 groups of skeletal or dentoalveolar open bite. The skeletal open-bite group comprised 38 subjects (19 girls, 19 boys). The dentoalveolar open-bite group comprised 73 subjects (43 girls, 30 boys). Visual assessment of the cervical column and measurements of craniofacial morphology and head posture were made on profile radiographs. Deviations in the cervical vertebral column morphology occurred in 23.7% of the subjects in the skeletal open-bite group and in 19.2% in the dentoalveolar open-bite group, but the difference was not significant. Head posture was significantly more extended in the skeletal open-bite group compared with the dentoalveolar open-bite group (craniovertical angle [Mx/VER], P open bite. No significant differences in the cervical vertebral column's morphologic deviations were found between the skeletal and the dentoalveolar open-bite groups. Significant differences were found in head posture between the groups and with regard to associations with craniofacial dimensions. This might indicate a respiratory etiologic component in children with anterior open bite. Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  13. Cervical disc arthroplasty: Pros and cons.

    Science.gov (United States)

    Moatz, Bradley; Tortolani, P Justin

    2012-01-01

    Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing.

  14. A Multicenter Review of Superior Laryngeal Nerve Injury Following Anterior Cervical Spine Surgery.

    Science.gov (United States)

    Tempel, Zachary J; Smith, Justin S; Shaffrey, Christopher; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel; Kanter, Adam S

    2017-04-01

    A retrospective multicenter case-series study; case report and review of the literature. The anatomy and function of the superior laryngeal nerve (SLN) are well described; however, the consequences of SLN injury remain variable and poorly defined. The prevalence of SLN injury as a consequence of cervical spine surgery is difficult to discern as its clinical manifestations are often inconstant and frequently of a subclinical degree. A multicenter study was performed to better delineate the risk factors, prevalence, and outcomes of SLN injury. A retrospective multicenter case-series study involving 21 high-volume surgical centers from the AO Spine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. A retrospective review of the neurosurgical literature on SLN injury was also performed. A total of 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened, and 1 case of SLN palsy was identified. The prevalence ranged from 0% to 1.25% across all centers. The patient identified underwent a C4 corpectomy. The SLN injury was identified after the patient demonstrated difficulty swallowing postoperatively. He underwent placement of a percutaneous gastrostomy tube and his SLN palsy resolved by 6 weeks. This multicenter study demonstrates that identification of SLN injury occurs very infrequently. Symptomatic SLN injury is an exceedingly rare complication of anterior cervical spine surgery. The SLN is particularly vulnerable when exposing the more rostral levels of the cervical spine. Careful dissection and retraction of the longus coli may decrease the risk of SLN injury during anterior cervical surgery.

  15. Graft Subsidence and Revision Rates Following Anterior Cervical Corpectomy: A Clinical Study Comparing Different Interbody Cages.

    Science.gov (United States)

    Weber, Michael H; Fortin, Maryse; Shen, Jian; Tay, Bobby; Hu, Serena S; Berven, Sigurd; Burch, Shane; Chou, Dean; Ames, Christopher; Deviren, Vedat

    2017-11-01

    Retrospective cohort study. To assess the subsidence and revision rates associated with different interbody cages following anterior cervical corpectomy and reconstruction. Different interbody cages are currently used for surgical reconstruction of the anterior and middle columns of the spine following anterior cervical corpectomy. However, subsidence and delayed union/nonunion associated with allograft and cage reconstruction are common complications, which may require revision with instrumentation. We reviewed the cases of 75 patients who underwent cervical corpectomy and compared the radiographic graft subsidence and revision rates for fibula allograft, titanium mesh cage, titanium expandable cage, and carbon fiber cages. Subsidence was calculated by comparing the immediate postoperative lateral x-ray films to those obtained during follow-up visits. The average graft subsidence was 3 mm and revision rate was 25% for fibula allograft versus 2.9 mm and 11.1%, 2.9 mm and 18.8% for titanium mesh cages and titanium expandable cages, respectively. The average graft subsidence for carbon fiber cages was 0.7 mm with no revision surgery in this subset. Our findings suggest that subsidence and revision rates following anterior corpectomy and interbody fusion could be minimized with the use of a carbon fiber cage.

  16. Relationship between the internal laryngeal nerve and the triticeal cartilage: a potentially unrecognized compression site during anterior cervical spine and carotid endarterectomy operations.

    Science.gov (United States)

    Tubbs, R Shane; Dixon, Joshua F; Loukas, Marios; Shoja, Mohammadali M; Cohen-Gadol, Aaron A

    2010-06-01

    The triticeal cartilage has received scant attention in the literature. To date, its relationship to the nearby internal laryngeal nerve has not been studied. Therefore, to elucidate further this anatomic relationship and its potential surgical implications, this study was performed. Eighty-six adult cadaveric sides underwent dissection of the internal laryngeal nerve near its penetration of the thyrohyoid membrane. The relationship of this nerve to the triticeal cartilage was documented. Measurements and histological analysis were performed on all cartilage specimens. We identified triticeal cartilage in 51% of the specimens and found it to be hyaline in nature. The triticeal cartilage was located in the upper, middle, and lower thirds of the thyrohyoid membrane in 14%, 66%, and 20% of sides, respectively. Regardless of the position of the triticeal cartilage within the thyrohyoid membrane, the internal laryngeal nerve crossed directly over the triticeal cartilage on 59% of sides. When present, the internal laryngeal nerve will cross over the triticeal cartilage in the majority of individuals. This relationship should be borne in mind during surgical manipulation in this area and when placing retractors during anterior neck operations including cervical discectomy/fusion and carotid endarterectomy. Compression of the internal laryngeal nerve against the solid triticeal cartilage can cause laryngeal nerve palsy and increase the risk of resultant postoperative aspiration.

  17. The fullendoscopic anterior cervical fusion: a new horizon for selective percutaneous endoscopic cervical decompression.

    Science.gov (United States)

    Hellinger, S

    2011-01-01

    As a bridge between open and percutaneous therapy, endoscopy of the cervical spine started to be used at the beginning of the 1990s, following good experiences on the lumbar spine. The principle of microsurgery is combined with the minimally invasive principles by bringing the optical level to the forefront of pathology. Access morbidity has been significantly reduced by the percutaneous access technique. However, this procedure cannot be applied in patients with cervical disc herniation accompanied by segmental instability.In further developing these endoscopic techniques, in view of the experiences with the classical "Cloward procedure", the aim was to do a bony fusion of the intervertebral space of the cervical spine by endoscopic access. A female patient with postraumatic instability of the cervical segments C4/5 underwent a fullendoscopic bony fusion. The technique will be described. The fusional process has been documented by CT and clinical assessment over 3 months. Having preoperative pain of VAS 8, it diminished to VAS 1 after surgery. The Ct-controls demonstrated a good placement of the bony dowel through the endoscopic sheath in the intervertebral space. After 3 months a bony fusion was documented by CT and in bending X-ray. The result of this method displays that a fullendoscopic fusion of the cervical spine with a bone dowel is possible. The clinical result seems to be comparable to the classical Cloward procedure. To the best of my knowledge, this is the first report of a fullendoscopic osseous fusion on the cervical spine.

  18. A case series on the technical use of three-dimensional image guidance in subaxial anterior cervical surgery.

    Science.gov (United States)

    Pirris, Stephen M; Nottmeier, Eric W

    2015-03-01

    Three dimensional (3D) image guidance has been used to improve the safety of complex spine surgeries, but its use has been limited in anterior cervical spine approaches. Twenty-two patients underwent complex anterior cervical spine surgeries in which 3D image guidance provided intraoperative assistance with the dissection, decompression and implant placement. One of two paired systems, the BrainLAB (BrainLAB, Westchester, Illinois) system, or Stealth (Medtronic Inc., Littleton, Massachusetts) system was used for 3D image guidance in this study. Image guidance was able to reliably locate pertinent anatomical structures in complex anterior cervical spine surgery involving re-exploration, dissection around vertebral arteries or deformity correction. No complications occurred, and no patients required a revision anterior surgery. This technical note describes the setup and technique for the use of cone beam computed tomography (cbCT)-based, 3D image guidance in subaxial anterior cervical surgery. The authors have found this technique to be a useful adjunct in revision anterior cervical procedures, as well as anterior cervical procedures involving corpectomy or tumor removal. Copyright © 2014 John Wiley & Sons, Ltd.

  19. Study protocol for a randomised controlled multicentre study: the Foraminotomy ACDF Cost-Effectiveness Trial (FACET) in patients with cervical radiculopathy

    NARCIS (Netherlands)

    Broekema, A.E.; Kuijlen, J.M.; Lesman-Leegte, G.A.; Bartels, R.H.M.A.; Asselt, A.D. van; Vroomen, P.C.; Dijk, J.M.C. van; Reneman, M.F.; Soer, R.; Groen, R.J.

    2017-01-01

    INTRODUCTION: Cervical radiculopathy due to discogenic or spondylotic stenosis of the neuroforamen can be surgically treated by an anterior discectomy with fusion (ACDF) or a posterior foraminotomy (FOR). Most surgeons prefer ACDF, although there are indications that FOR is as effective as ACDF, has

  20. Cervical facet dislocation adjacent to the fused motion segment

    OpenAIRE

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kuroiwa, Toshihiko

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7...

  1. Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite

    DEFF Research Database (Denmark)

    Kim, Phong; Sarauw, Martin Toft; Sonnesen, Liselotte

    2014-01-01

    INTRODUCTION: Cervical vertebral column morphology and head posture were examined and related to craniofacial morphology in preorthodontic children and adolescents with anterior open bite. METHODS: One hundred eleven patients (ages, 6-18 years) with an anterior open bite of more than 0 mm were...... posture were made on profile radiographs. RESULTS: Deviations in the cervical vertebral column morphology occurred in 23.7% of the subjects in the skeletal open-bite group and in 19.2% in the dentoalveolar open-bite group, but the difference was not significant. Head posture was significantly more...... extended in the skeletal open-bite group compared with the dentoalveolar open-bite group (craniovertical angle [Mx/VER], P posture was associated with craniofacial morphology: extended posture was associated with a large cranial base angle...

  2. Operative Techniques for Cervical Radiculopathy and Myelopathy

    Directory of Open Access Journals (Sweden)

    C. Moran

    2012-01-01

    Full Text Available The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970's. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.

  3. Operative techniques for cervical radiculopathy and myelopathy.

    LENUS (Irish Health Repository)

    Moran, C

    2012-02-01

    The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970\\'s. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.

  4. Risk factors for the development of adjacent segment disease following anterior cervical arthrodesis for degenerative cervical disease: comparison between fusion methods.

    Science.gov (United States)

    Song, Ji-Soo; Choi, Byung-Wan; Song, Kyung-Jin

    2014-05-01

    This study aimed to determine the risk factors for developing adjacent segment disease (ASDz) after anterior cervical arthrodesis for the treatment of degenerative cervical disease by analyzing patients treated with various fusion methods. We enrolled 242 patients who had undergone anterior cervical fusion for degenerative cervical disease, and had at least 5years of follow-up. We evaluated the development of ASDz and the rate of revision surgery. To identify the risk factors for ASDz, the sagittal alignment, spinal canal diameter, range of motion of the cervical spine, number of fusion segments, and fusion methods were evaluated. The patients were divided into three groups according to the fusion method: Group A contained patients who had received autogenous bone graft only (53 patients), Group B contained patients who received autogenous bone graft and plate augmentation (62 patients), and Group C contained patients who underwent cage and plate augmentation (127 patients). ASDz occurred in 33 patients, of whom 19 required additional surgery. The risk of developing ASDz was significantly higher in male patients (p=0.043), patients whose range of motion of the cervical spine was >30° (p=0.027), and patients with spinal canal stenosis (p=0.010). The rate of development of ASDz was not different depending on the number of fusion segments. The rate of development of ASDz was 41.5% in Group A, 9.6% in Group B, and 5.51% in Group C (p=0.03). In patients who underwent anterior cervical arthrodesis for degenerative disease, the occurrence of ASDz was related to age, the cervical spine range of motion, and spinal canal stenosis. Additional plate augmentation for anterior cervical arthrodesis surgery can lower the rate of ASDz development. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Subsidence as of 12 months after single-level anterior cervical inter-body fusion. Is it related to clinical outcomes?

    Science.gov (United States)

    Lee, Chang-Hyun; Kim, Ki-Jeong; Hyun, Seung-Jae; Yeom, Jin S; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2015-06-01

    Subsidence is a frequent phenomenon in the interbody fusion process in patients with anterior cervical discectomy and fusion (ACDF). There is little evidence of whether subsidence in the cervical spine has any impact on clinical outcomes. The purpose of this study is to investigate the correlation of subsidence and clinical outcomes after ACDF and to consider reasons subsidence might not cause unfavorable clinical outcomes. A total of 158 consecutive patients who underwent single-level ACDF were included. The patients were divided into a subsidence group (S-group) and a no subsidence group (N-group), with subsidence defined as a decrease by ≥3 mm in total intervertebral height (TIH). We analyzed outcomes resulting from subsidence, particularly focusing on clinical outcomes and subsequent global and segmental kyphosis using a repeated measure analysis of variance (RM-ANOVA). Subsidence occurred in 74 patients (46.8%) as of a 12-month follow-up. The S-group included 58.6% with a stand-alone cage for interbody fusion (p = 0.002). Clinical outcomes improved significantly over time (neck pain, RM-ANOVA: F(1.3, 205) = 125.1, p subsidence and clinical outcomes between the S- and N-group (neck pain, RM-ANOVA: F(2,153) = 1.04, p = 0.356, partial η(2) = 0.229; arm pain, RM-ANOVA: F(2,153) = 0.56, p = 0.571, partial η(2) = 0.142). Segmental angle increased in both groups over time and showed a statistically significant difference between the S- and N-groups (RM-ANOVA: F(3,143) = 6.148, p = 0.001, partial η(2) = 0.959). Although, global cervical angle decreased generally and displayed no statically significant difference between the S- and N-group (RM-ANOVA: F(3,119) = 2.361, p = 0.075, partial η(2) = 0.056). Radiographic subsidence after ACDF occurred in 46.8% patients as of 12 months after the single-level ACDF. The lack of correlation between bad clinical outcome and radiographic subsidence may be due to

  6. Long term results of anterior corpectomy and fusion for cervical spondylotic myelopathy.

    Directory of Open Access Journals (Sweden)

    Rui Gao

    Full Text Available BACKGROUND: Results showed good clinical outcomes of anterior corpectomy and fusion (ACCF for patients with cervical spondylotic myelopathy (CSM during a short term follow-up; however, studies assessing long term results are relatively scarce. In this study we intended to assess the long term clinical and radiographic outcomes, find out the factors that may affect the long term clinical outcome and evaluate the incidence of adjacent segment disease (ASD. METHODS: This is a retrospective study of 145 consecutive CSM patients on ACCF treatment with a minimum follow-up of 5 years. Clinical data were collected from medical and operative records. Patients were evaluated by using the Japanese Orthopedic Association (JOA scoring system preoperatively and during the follow-up. X-rays results of cervical spine were obtained from all patients. Correlations between the long term clinical outcome and various factors were also analyzed. FINDINGS: Ninety-three males and fifty-two females completed the follow-up. The mean age at operation was 51.0 years, and the mean follow-up period was 102.1 months. Both postoperative sagittal segmental alignment (SSA and the sagittal alignment of the whole cervical spine (SACS increased significantly in terms of cervical lordosis. The mean increase of JOA was 3.8 ± 1.3 postoperatively, and the overall recovery rate was 62.5%. Logistic regression analysis showed that preoperative duration of symptoms >12 months, high-intensity signal in spinal cord and preoperative JOA score ≤ 9 were important predictors of the fair recovery rate (≤ 50%. Repeated surgery due to ASD was performed in 7 (4.8% cases. CONCLUSIONS: ACCF with anterior plate fixation is a reliable and effective method for treating CSM in terms of JOA score and the recovery rate. The correction of cervical alignment and the repeated surgery rate for ASD are also considered to be satisfactory.

  7. Economic burden of routine hematologic tests and intensive care unit observation for elective anterior cervical discectomy and fusion

    Directory of Open Access Journals (Sweden)

    Ching-Kuo Lin

    2014-01-01

    Conclusion: Cost savings per admission amounted to approximately 10% of the hospitalization cost by the elimination of unnecessary postoperative routine laboratory blood studies and observational ICU stay without waiving patient care in the current volatile, cost-conscious healthcare environment in Taiwan.

  8. Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel.

    Science.gov (United States)

    Mohandas, Anita; Summa, Chris; Worthington, W Bradley; Lerner, Jason; Foley, Kevin T; Bohinski, Robert J; Lanford, Gregory B; Holden, Carol; Wohns, Richard N W

    2017-06-01

    Delphi Panel expert panel consensus and narrative literature review. To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)). Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings are lacking. A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Predetermined consensus was set at 70% for each best-practice statement. A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and subcategories) achieved consensus, including preoperative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6). This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same

  9. Bone Morphogenetic Proteins in Anterior Cervical Fusion: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Zadegan, Shayan Abdollah; Abedi, Aidin; Jazayeri, Seyed Behnam; Nasiri Bonaki, Hirbod; Jazayeri, Seyed Behzad; Vaccaro, Alexander R; Rahimi-Movaghar, Vafa

    2017-08-01

    Bone morphogenetic proteins (BMPs) have been commonly used as a graft substitute in spinal fusion. Although the U.S. Food and Drug Administration issued a warning on life-threatening complications of recombinant human BMPs (rhBMPs) in cervical spine fusion in 2008, their off-label use has been continued. This investigation aimed to review the evidence for the use of rhBMP-2 and rhBMP-7 in anterior cervical spine fusions. A comprehensive search was performed through Ovid (MEDLINE), PubMed, and Embase. The risk of bias assessment was according to the recommended criteria by the Cochrane Back and Neck group and MINORS (Methodological Index for Non-Randomized Studies). A wide array of radiographic and clinical outcomes including the adverse events were collated. Eighteen articles (1 randomized and 17 nonrandomized) were eligible for inclusion. The fusion rate was higher with use of rhBMP in most studies and our meta-analysis of the pooled data from 4782 patients confirmed this finding (odds ratio, 5.45; P fusion yields a significantly higher fusion rate with similar patient-reported outcomes, yet increased risk of life-threatening complications. Thus, we do not recommend the use of rhBMP in anterior cervical fusions. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. The value of intraoperative three dimensional fluoroscopy in anterior decompressive surgery of the cervical spine.

    Science.gov (United States)

    Baldauf, J; Müller, J-U; Fleck, S; Hinz, P; Chiriac, A; Schroeder, H W S

    2008-02-01

    Intraoperative use of the mobile Siremobil Iso-C3D C-arm (Siemens AG, Medical Solutions, Erlangen) considerably improves the information available during cervical spine surgery. We report our experiences with the Iso-C3D fluoroscopic unit during anterior decompressive surgery of the cervical spine. We used the mobile Siremobil Iso-C3D C-arm during decompressive cervical spine surgery. The study included 25 patients (22 males, 3 females) with degenerative cervical stenosis. Mean age was 55.9 years (42-73 years). Eighteen patients were surgically treated for one-level, six for two-level and one for three-level disease. Intraoperative 3D imaging was performed to evaluate the extent of bony decompression and to assist correct positioning of the cages when the surgeon believed that sufficient decompression had been achieved. Visualization of the extent of bone removal was good in all patients. In 3 patients, insufficient bony decompression with persisting dorsal osteophytic spurs was noticed on sagittal and axial images. In these patients, surgery had to be continued. Successful decompression was proved thereafter by a second scan. The quality of the images of the cervical spine was sufficient, although slightly inferior to that of a CT scan. The Siremobil Iso-C3D provides intraoperative 3D images of bony structures of the cervical spine. Although the imagine quality is inferior to that of a CT, in our series surgical revisions could be avoided in 12.5% of the patients on the basis of these intraoperative images of incomplete bony decompression. This means a reduction of additional costs which would arise with surgical revision.

  11. Anterior cervical decompression and fusion on neck range of motion, pain, and function: a prospective analysis.

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    Landers, Merrill R; Addis, Kate A; Longhurst, Jason K; Vom Steeg, Bree-lyn; Puentedura, Emilio J; Daubs, Michael D

    2013-11-01

    Intractable cervical radiculopathy secondary to stenosis or herniated nucleus pulposus is commonly treated with an anterior cervical decompression and fusion (ACDF) procedure. However, there is little evidence in the literature that demonstrates the impact such surgery has on long-term range of motion (ROM) outcomes. The objective of this study was to compare cervical ROM and patient-reported outcomes in patients before and after a 1, 2, or 3 level ACDF. Prospective, nonexperimental. Forty-six patients. The following were measured preoperatively and also at 3 and 6 months after ACDF: active ROM (full and painfree) in three planes (ie, sagittal, coronal, and horizontal), pain visual analog scale, Neck Disability Index, and headache frequency. Patients undergoing an ACDF for cervical radiculopathy had their cervical ROM measured preoperatively and also at 3 and 6 months after the procedure. Neck Disability Index and pain visual analog scale values were also recorded at the same time. Both painfree and full active ROM did not change significantly from the preoperative measurement to the 3-month postoperative measurement (ps>.05); however, painfree and full active ROM did increase significantly in all three planes of motion from the preoperative measurement to the 6-month postoperative measurement regardless of the number of levels fused (ps≤.023). Visual analog scale, Neck Disability Index, and headache frequency all improved significantly over time (ps≤.017). Our results suggest that patients who have had an ACDF for cervical radiculopathy will experience improved ROM 6 months postoperatively. In addition, patients can expect a decrease in pain, an improvement in neck function, and a decrease in headache frequency. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Diagnosis of anterior cervical spinal epidural abscess by US and MRI in a newborn

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    Gudinchet, F.; Chapuis, L. (University Hospital, Lausanne (Switzerland). Dept. of Radiology); Berger, D. (University Hospital, Lausanne (Switzerland). Dept. of Pediatric Surgery)

    1991-11-01

    A 10-day-old girl who initially presented with fever developed over five days a complete paresis of both upper arms and swallowing difficulty. After emergency drainage of a retropharyngeal abscess, cervical US demonstrated a cervical anterior epidural mass compressing the cord. MRI confirmed the diagnosis of spinal epidural abscess secondary to C4-C5 spondylodiscitis. Surgical removal of the abscess was followed by complete disappearance of the neurologic symptoms after six months of follow-up. This is the first case of spinal epidural abscess in a newborn to be diagnosed by US and MRI preoperatively. The advantages of these non-invasive imaging modalities are discussed, and compared to myelography. (orig.).

  13. Effect of Cervical Collar Removal on the Fracture Load of Anterior Zirconia Crowns.

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    Campos, Fernanda; Cardoso, Mayra; de Melo, Renata Marques; Bottino, Marco Antonio; Souza, Rodrigo Oa

    The objective of this study was to assess the influence of the extension of collar and fatigue cycling on the fracture load of anterior zirconia crowns. A total of 60 anterior full-crown preparations (central incisor) were machined in glass fiber-filled epoxy resin. Zirconia copings were designed and milled using computer-aided design/computer-assisted manufacture (thickness: buccal = 0.62 mm, lingual = 0.65 mm, incisal = 0.72 mm). The cervical collars (occlusogingival height = 0.8 mm, buccolingual width = 1.0 mm) were totally or partially (buccal face) removed for modified copings. They were randomly allocated to six groups according to the type of cervical collar design and the presence (or not) of fatigue cycling (n = 10). The veneering ceramic layer was pressed, and the crowns were cemented with resin cement. The samples were tested until fracture in a universal testing machine and analyzed by stereomicroscopy. Data were statistically analyzed by two-way analysis of variance and Tukey test (5%). Removal of the cervical collar significantly affected the fracture strength of zirconia crowns (P = .000), whereas fatigue cycling did not (P = .428). The mean failure load was lower in the groups with no collar. The most frequent failure modes were cracking of the veneer porcelain in collarless crowns and catastrophic failure in the others. The authors concluded that removal of the vestibular collar of zirconia copings in anterior crowns does not reduce the fracture load of the crowns. However, removal of the entire collar reduces the fracture load and cannot be recommended.

  14. Application of bioabsorbable screw fixation for anterior cervical decompression and bone grafting

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    Bo Zhao

    Full Text Available OBJECTIVES: To examine the application of bioabsorbable screws for anterior cervical decompression and bone grafting fixation and to study their clinical effects in the treatment of cervical spondylosis. METHODS: From March 2007 to September 2012, 56 patients, 36 males and 20 females (38-79 years old, average 58.3±9.47 years, underwent a novel operation. Grafts were fixed by bioabsorbable screws (PLLA, 2.7 mm in diameter after anterior decompression. The bioabsorbable screws were inserted from the midline of the graft bone to the bone surface of the upper and lower vertebrae at 45 degree angles. Patients were evaluated post-operatively to observe the improvement of symptoms and evaluate the fusion of the bone. The Japanese Orthopaedic Association (JOA score was used to evaluate the recovery of neurological functions. RESULTS: All screws were successfully inserted, with no broken screws. The rate of symptom improvement was 87.5%. All of the grafts fused well with no extrusion. The average time for graft fusion was 3.8±0.55 months (range 3-5 months. Three-dimensional reconstruction of CT scans demonstrated that the grafts fused with adjacent vertebrae well and that the screws were absorbed as predicted. The MRI findings showed that the cerebrospinal fluid was unobstructed. No obvious complications appeared in any of the follow-up evaluations. CONCLUSIONS: Cervical spondylosis with one- or two-level involvement can be effectively treated by anterior decompression and bone grafting with bioabsorbable screw fixation. This operative method is safe and can avoid the complications induced by metal implants.

  15. Percutaneous endoscopic cervical discectomy: 16 years of experience and literature review Discectomía endoscópica percutánea cervical: 16 años de experiência y revisión de la literatura Discectomia endoscópica percutânea cervical: 16 anos de experiência e revisão da literatura

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    Gun Choi

    2009-09-01

    Full Text Available The advancement of the percutaneous endoscopic lumbar discectomy (PECD and its clinical success have led to similar minimally invasive approaches to the cervical spine. The goal of PECD is the decompression of the cervical nerve root through a direct endoscopic visualization, removing the herniated mass and shrinking the nucleous pulposus with the use of microforceps and holmium: yttrium-aluminum-garnet (Ho:YAG laser. The senior author have performed PECD with cervical laser assisted endoscopy since 1993. The PECD is indicate to patients with constrained or unconstrained soft herniated cervical disc, positive provocative test, and no bony spur larger than 2 mm, regardless of the herniation size. The authors described the surgical technique of PECD and report their 16 years of experience in the endoscopic treatment of the herniated cervical disc.El avance en la discectomía endoscópica percutánea lumbar y su triunfo clínico llevaron a abordajes mínimamente invasivos en la columna cervical. El objetivo de la discectomía endoscópica percutánea cervical es descomprimir la raíz del nervio cervical, por una visualización endoscópica directa, eliminando el fragmento herniado y disminuyendo el núcleo pulposo, con el uso de fórceps y micro Holmio: itrio-aluminio-granada (Ho:YAG laser. La discectomía endoscópica percutánea cervical con laser ha sido utilizada desde 1993. Esta es indicada en pacientes con hernia discal contenida o no, test provocativo positivo, ausencia de osteofitos mayores que 2 mm, independientemente del tamaño de la hernia. Los autores describen la técnica quirúrgica de discectomía endoscópica percutánea cervical y relatan 16 años de experiencia en el tratamiento endoscópico de disco cervical herniado.O avanço da discectomia endoscópica percutânea lombar e seu sucesso clínico levaram a abordagens minimamente invasivas para a coluna cervical. O objetivo da discectomia endoscópica percutânea cervical é o de

  16. Multilevel noncontiguous cervical spine injury

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    Adetunji Mapaderun Toluse

    2017-01-01

    Full Text Available This case report highlights the successful combination of operative and nonoperative management of a patient with noncontiguous cervical spine fractures and incomplete spinal cord injury. A case report of a 40-year-old male victim of a motor vehicular accident who presented with noncontiguous cervical spine fractures (Anderson and D'Alonzo Type III odontoid fracture and traumatic spondylolisthesis of C4/C5 and incomplete spinal cord injury. The odontoid fracture was managed nonoperatively, whereas anterior cervical discectomy and fusion were done at the C4/C5 vertebral level. The patient made full neurologic recovery with radiologic evidence of successful fusion and fracture healing at 12 weeks postoperation in both levels of injuries. Operative and nonoperative modalities can be utilized to manage selected patients.

  17. What's the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial.

    Science.gov (United States)

    Donk, Roland D; Verbeek, André L M; Verhagen, Wim I M; Groenewoud, Hans; Hosman, Allard J F; Bartels, Ronald H M A

    2017-01-01

    To investigate the efficacy of adding supplemental fusion or arthroplasty after cervical anterior discectomy for symptomatic mono-level cervical degenerative disease (radiculopathy), which has not been substantiated in controlled trials until now. A randomized controlled trial is reported with 9 years follow up comparing anterior cervical anterior discectomy without fusion, with fusion by cage standalone, or with disc prosthesis. Patients suffering from symptomatic cervical disk degeneration at one level referred to spinal sections of department of neurosurgery or orthopedic surgery of a large general hospital with educational facilities were eligible. Neck Disability Index (NDI), McGill Pain Questionnaire Dutch language version (MPQ-DLV), physical-component summary (PCS), and mental-component summary (MCS) of the 36-item Short-Form Health Survey (SF-36), and re operation rate were evaluated. 142 patients between 18 and 55 years were allocated. The median follow-up was 8.9±1.9 years (5.6 to 12.2 years). The response rate at last follow-up was 98.5%. NDI at the last follow-up did not differ between the three treatment groups, nor did the secondary outcomes as MPQ-DLV and PCS or MCS from SF-36. The major improvement occurred within the first 6 weeks after surgery. Afterward, it remained stable. Eleven patients underwent surgery for recurrent symptoms and signs due to nerve root compression at the index or adjacent level. This randomized trial could not detect a difference between three surgical modalities for treating a single-level degenerative disk disease. Anterior cervical discectomy without implant seems to be similar to anterior cervical discectomy with fusion by cage stand-alone or with disk prosthesis. Due to the small study sample size, this statement should be considered as inconclusive so far. ISRCTN41681847.

  18. What's the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial.

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    Roland D Donk

    Full Text Available To investigate the efficacy of adding supplemental fusion or arthroplasty after cervical anterior discectomy for symptomatic mono-level cervical degenerative disease (radiculopathy, which has not been substantiated in controlled trials until now.A randomized controlled trial is reported with 9 years follow up comparing anterior cervical anterior discectomy without fusion, with fusion by cage standalone, or with disc prosthesis. Patients suffering from symptomatic cervical disk degeneration at one level referred to spinal sections of department of neurosurgery or orthopedic surgery of a large general hospital with educational facilities were eligible. Neck Disability Index (NDI, McGill Pain Questionnaire Dutch language version (MPQ-DLV, physical-component summary (PCS, and mental-component summary (MCS of the 36-item Short-Form Health Survey (SF-36, and re operation rate were evaluated.142 patients between 18 and 55 years were allocated. The median follow-up was 8.9±1.9 years (5.6 to 12.2 years. The response rate at last follow-up was 98.5%. NDI at the last follow-up did not differ between the three treatment groups, nor did the secondary outcomes as MPQ-DLV and PCS or MCS from SF-36. The major improvement occurred within the first 6 weeks after surgery. Afterward, it remained stable. Eleven patients underwent surgery for recurrent symptoms and signs due to nerve root compression at the index or adjacent level.This randomized trial could not detect a difference between three surgical modalities for treating a single-level degenerative disk disease. Anterior cervical discectomy without implant seems to be similar to anterior cervical discectomy with fusion by cage stand-alone or with disk prosthesis. Due to the small study sample size, this statement should be considered as inconclusive so far.ISRCTN41681847.

  19. What’s the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial

    Science.gov (United States)

    Donk, Roland D.; Verbeek, André L. M.; Verhagen, Wim I. M.; Groenewoud, Hans; Hosman, Allard J. F.

    2017-01-01

    Background To investigate the efficacy of adding supplemental fusion or arthroplasty after cervical anterior discectomy for symptomatic mono-level cervical degenerative disease (radiculopathy), which has not been substantiated in controlled trials until now. Methods A randomized controlled trial is reported with 9 years follow up comparing anterior cervical anterior discectomy without fusion, with fusion by cage standalone, or with disc prosthesis. Patients suffering from symptomatic cervical disk degeneration at one level referred to spinal sections of department of neurosurgery or orthopedic surgery of a large general hospital with educational facilities were eligible. Neck Disability Index (NDI), McGill Pain Questionnaire Dutch language version (MPQ-DLV), physical-component summary (PCS), and mental-component summary (MCS) of the 36-item Short-Form Health Survey (SF-36), and re operation rate were evaluated. Findings 142 patients between 18 and 55 years were allocated. The median follow-up was 8.9±1.9 years (5.6 to 12.2 years). The response rate at last follow-up was 98.5%. NDI at the last follow-up did not differ between the three treatment groups, nor did the secondary outcomes as MPQ-DLV and PCS or MCS from SF-36. The major improvement occurred within the first 6 weeks after surgery. Afterward, it remained stable. Eleven patients underwent surgery for recurrent symptoms and signs due to nerve root compression at the index or adjacent level. Conclusions This randomized trial could not detect a difference between three surgical modalities for treating a single-level degenerative disk disease. Anterior cervical discectomy without implant seems to be similar to anterior cervical discectomy with fusion by cage stand-alone or with disk prosthesis. Due to the small study sample size, this statement should be considered as inconclusive so far. Trial registration ISRCTN41681847 PMID:28850600

  20. Post laminoplasty cervical kyphosis—Case report

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    Dugoni, D.E.; Mancarella, C.; Landi, A.; Tarantino, R.; Ruggeri, A.G.; Delfini, R.

    2014-01-01

    INTRODUCTION Cervical kyphosis is a progressive cervical sagittal plane deformity that may cause a reduction in the ability to look horizontally, breathing and swallowing difficulties, sense of thoracic oppression and social isolation. Moreover, cervical kyphosis can cause myelopathy due to a direct compression by osteo-articular structures on the spinal cord or to a transitory ischaemic injury. The treatment of choice is surgery. The goals of surgery are: nervous structures decompression, cervical and global sagittal balance correction and vertebral stabilization and fusion. PRESENTATION OF CASE In October 2008 a 35 years old woman underwent surgical removal of a cervical-bulbar ependymoma with C1–C5 laminectomy and a C2–C5 laminoplasty. Five months after surgery, the patient developed a kyphotic posture, with intense neck and scapular girdle pain. The patients had a flexible cervical kyphosis. Therefore, we decided to perform an anterior surgical approach. We performed a corpectomy C4–C5 in order to achieve the anterior decompression; we placed a titanium expansion mesh. DISCUSSION Cervical kyphosis can be flexible or fixed. Some authors have reported the use of anterior surgery only for flexible cervical kyphosis as discectomy and corpectomy. This approach is useful for anterior column load sharing however it is not required for deformity correction. CONCLUSION The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability. PMID:25462050

  1. Recurrent anterior cervical wound abscesses following cervical corpectomy and fusion surgery from an odontogenic source mimicking an esophageal perforation: a case report.

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    Pan, Tiffany J; Neral, Mithun; Gordon, Zachary; Kang, James D

    2016-06-01

    Infection is an uncommon complication of anterior cervical spine surgery. Most deep postoperative infections are thought to be related to occult esophageal perforation. Direct inoculation from the oropharynx has not been previously reported in the literature. The purpose of this study is to report a case of recurrent infection after anterior cervical decompression and fusion suspected to have resulted from direct communication between the oropharynx and deep neck space. This study is a case report. This study included longitudinal clinical and radiological follow-up. A 48-year-old woman who underwent anterior cervical corpectomy and fusion from C3 to C6 and posterior spinal fusion from C3 to C7 presented at 2 weeks and 5 months postoperatively with a deep neck space infection. She underwent surgical debridement each time. Workup of the second infection found a subtle cortical breach in the mandible at the site of prior invasive dental work. This case describes the workup and management of a patient who presented with recurrent deep neck space infection following anterior cervical spine surgery. This is the first report of a postoperative infection related to direct communication between the oropharynx and deep neck space via a cortical breach of the mandible. Copyright © 2016. Published by Elsevier Inc.

  2. Topographical anatomy of the anterior cervical approach for c2-3 level.

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    Park, Soo-An; Lee, Je-Hun; Nam, Yong-Seok; An, Xiaochun; Han, Seung-Ho; Ha, Kee-Yong

    2013-07-01

    To develop a clinically relevant anterior cervical approach (ACA) to the C2-3 level. Frequently encountered nerves [hypoglossal (HyN), internal (ISLN) and external superior laryngeal nerves (ESLN)] and vessels [lingual (LiA), superior laryngeal (SLA) and superior thyroid arteries (STA)] in the field of high ACA and the anatomic spatial markers [submandibular gland (SMG); sling for digastrics muscle (SDG); hyoid bone (HyB), and thyroid cartilage (ThC)] were evaluated using 18 fresh cadavers. The vertical distance of each structure at the carotid sheath and larynx and each disc for cervical level were measured from the suprasternal notch. The cervical levels of SDG, SMG and HyB were mostly C3 and that of ThC was C5. The vertical locations of HyN and LiA were not significantly different and the levels corresponded to C2. The levels for ISLN and ESLN were C3 at carotid and C4 and C5 at larynx sides, respectively. The vertical locations of ISLN and HyN were significantly different at carotid (p = 0.001) and larynx (p < 0.001) sides. The vertical locations and cervical levels of SLA and STA at carotid and larynx sides were not significantly different with those of ISLN and ESLN, respectively. The HyN traversed C2 with accompanying LiA. The ISLN passed C3 and C4 from carotid to larynx sides and accompanied SLA. The C2-3 level can be exposed through the space between the HyN and the ISLN by retracting the LiA superiorly, the SLA inferiorly, the HyB medially, and the carotid sheath laterally.

  3. Artificial Cervical Disk Replacement for the Treatment of Adjacent Segment Disease After Anterior Cervical Decompression and Fusion.

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    Bin, Sheng; Xiangwang, Huang; Sheng, Xiao; Tiecheng, Xiang; Xiangyang, Liu; Yi, Zhang; Bin, Liu

    2017-06-01

    Retrospective study. To evaluate the outcome of artificial cervical disk replacement (ACDR) for the treatment of adjacent segment disease (ASD) after anterior cervical decompression and fusion (ACDF). ACDF is the useful procedure for degenerative cervical diseases. However, studies have reported accelerated degeneration of functional spinal units adjacent to the fusion site after ACDF. Between January 2004 and January 2011, 32 inpatients (18 male, 14 female; age, 38-61 y; mean, 48 y) underwent ACDR for the treatment of ASD after previous ACDF (single-level: n=12; 2-level: n=15; 3-level: n=5). In 22 patients, ASD occurred above the fusion site, and in 10 it occurred below the site. After ACDR, the patients were followed up for 30-62 months (mean, 49 mo). Before and after ACDR, patients were evaluated using the pain visual analog scale (VAS), the Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). In addition, the range of motion (ROM) of the replaced and adjacent unfused segments was measured by flexion/extension lateral radiography. Periprosthetic heterotopic ossification was detected using McAfee's classification. Degeneration of the adjacent unfused segment was evaluated using Goffin scale. All patients had successful surgery. Before ACDR, neck VAS, upper-limb VAS, JOA score, and NDI were 7.2±1.8, 6.9±1.1, 9.8±2.5, and 40.5±4.8, respectively. At the last follow-up, they were 1.2±0.3, 0.9±0.3, 14.5±1.1, and 9.0±2.5, respectively. Compared with presurgery, the improvements in VAS, JOA score, and NDI at the final follow-up were statistically significant (all P0.05). At the last follow-up, 2 patients had grade II heterotopic ossification; 3 patients had aggravated degeneration (vs. preoperative status) of the adjacent unfused segment. However, the reduction in Goffin grade was not statistically significant. Our follow-up shows that ACDR is an effective treatment for post-ACDF ASD. It can maintain the ROMs of the replaced segment as

  4. Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

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    Ali Sadrizadeh

    2015-03-01

    Full Text Available Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated.  Case Report:   Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem.  Conclusion:  In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.

  5. EFFICACY OF CAGE PLACEMENT WITHOUT PLATE IN PATIENTS WITH CERVICAL MYELOPATHY WITH SINGLE-LEVEL AFFECTION

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    CARLOS ALBERTO ZUÑIGA-MAZÓN

    Full Text Available ABSTRACT Objective: To determine the efficacy of PEEK (Poly-ether-ether-ketone cage without plate for the treatment of single-level cervical spondylosis. Methods: Ten patients with cervical myelopathy data, with a single-level root condition, seen at the outpatient clinic of the Neurosurgery Service, operated in 2016, mean age 53 years, 6 (60% female, 4 (40% obese, 3 (30% smokers. The Cloward technique was used by anterior approach, discectomy, and PEEK cage placement. Results: At six months of surgery, 100% of the patients had increased intervertebral space, with a 100% reduction in osteophytes; only one patient had dysphagia, no patient had lesion of the adjacent segment and 10% had persistent root pathology. Cervical lordosis was observed in 90% of the patients and arthrodesis in 100% of the cases. Conclusions: Anterior approach arthrodesis using PEEK cage without cervical plate is effective as a treatment of cervical myelopathy in a single level.

  6. Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication

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    Ravindranath Kapu

    2012-01-01

    Full Text Available We report a patient with congenital anomaly of cervical spine, who presented with clinical features suggestive of cervical compressive spondylotic myelopathy. He underwent C3 median corpectomy, graft placement, and stabilization from C2 to C4 vertebral bodies. Postoperative period was uneventful and he improved in his symptoms. Eight years later, he presented with a difficulty in swallowing and occasional regurgitation of feeds of 2 months duration and oral extrusion of screw while having food. On oral examination, there was a defect in the posterior pharyngeal wall through which the upper end of plate with intact self-locking screw and socket of missed fixation screw was seen. This was confirmed on X-ray cervical spine. He underwent removal of the plate system and was fed through nasogastric tube and managed with appropriate antibiotics. This case is presented to report a very rare complication of anterior cervical plate fixation in the form of very late-onset dislodgement, migration of anterior cervical plate, and oral extrusion of screw through perforated posterior pharyngeal wall.

  7. RESULTS OF TREATMENT OF CERVICAL DISCOPATHY WITH PEEK INTERBODY CAGES AT THREE LEVELS WITHOUT PLATE FIXATION

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    Amado González Moga

    Full Text Available ABSTRACT Objective: To present the results of treatment of patients with cervical discopathy by anterior cervical approach, discectomy and placement of a PEEK interbody cage without anterior plate fixation. Methods: Retrospective, cross-sectional study from March 2013 to March 2015. Sixteen patients with radiculopathy or clinical signs of myelopathy were included; all patients underwent cervical surgery through anterior approach, discectomy, and placement of PEEK cages on three levels. Decompression levels were determined according to the correlation between preoperative radiological and clinical findings. Results: Sixteen patients predominantly male were included, with mean age of 50 years at the onset of the condition. Ten patients had involvement of C4-C5, C5-C6, C6-C7 levels, and six patients C3-C4, C4-C5 and C5-C6. Fourteen patients had cervicobrachialgia and two myelopathy. The preoperative visual analog scale average was 8/10 and the average postoperative value at 6 months was 3/10. At 6 months, there was no radiological evidence of recurrence. One patient had non-fatal complications. Conclusions: The treatment of cervical discopathy by anterior approach with interbody fusion with PEEK cage on three levels, with no plate fixation seemed to be safe and effective with better long-term results in terms of pain and myelopathy. The clinical results compare favorably with other similar series and, most importantly, the complications associated with anterior fixation plate are avoided.

  8. Delayed surgical treatment for a traumatic bilateral cervical facet joint dislocation using a posterior-anterior approach: a case report

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    Shimada Takashi

    2013-01-01

    Full Text Available Abstract Introduction There have been few reports of patients with bilateral cervical facet dislocations that remain untreated for eight weeks or more. We report the case of a 76-year-old man with an old bilateral cervical facet joint dislocation fracture that was treated by posterior-anterior reduction and fixation. Case presentation A 76-year-old Asian man was involved in a road traffic accident. He presented with neck pain and arm pain on his right side, but motor weakness and paralysis were not observed. He was treated conservatively; however, instability and spondylolisthesis at the C5 to C6 joint increased eight weeks after the injury. We performed a posterior-anterior reduction and fixation. After surgery, bony union was achieved, and his neck pain and arm pain disappeared. Conclusion We recommend reduction and fixation surgery if a patient has an old bilateral facet joint dislocation fracture in the cervical spine.

  9. Misaligned Versus Straight Placement of Anterior Cervical Plates: A Clinical and Radiologic Outcomes Study.

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    Chin, Kingsley R; Pencle, Fabio J R; Francis, Shannon D; Francis, Chloe A; Seale, Jason A; Hothem, Elijah A

    2017-05-01

    In anterior cervical diskectomy and fusion (ACDF), misaligned plates are concerning because of the risk of screw-and-plate failure; however, these plates also hypothetically have the potential for asymmetric micromotion on the facet and uncovertebral joint. The aim of this study was to determine whether misaligned plate placement during ACDF had clinical benefits compared with straight plate placement. Postoperative AP radiographs of 128 consecutive patients who underwent ACDF with anterior cervical plate (ACP) fixation were reviewed, and plate alignment was assessed. Patients were separated into control group 1 (straight plates) or group 2 (misaligned plates). The mean age of patients was 51.5 ± 0.9 years, and women represented 51% of the total population. There was no significant difference between groups with regard to the preoperative visual analog scale (VAS) and Neck Disability Index (NDI) scores (P = 0.744 and P = 0.943, respectively). At 6 weeks postoperatively, the VAS scores for group 1 decreased from 7.6 ± 0.2 to 4.0 ± 0.2 compared with the scores in group 2, which decreased from 7.7 ± 0.2 to 2.1 ± 0.1, which demonstrated statistical significance (P = 0.019). At 2-year follow-up, no significant difference was demonstrated between the groups' VAS and NDI scores (P = 0.670 and P = 0.266). Misaligned plates have increased torsional strength and are associated with better clinical outcomes compared with those of straight plates in the early postoperative period. After fusion, no significant difference in clinical outcomes between the groups was noted, which may reduce the concerns regarding misaligned plates. Retrospective comparative study.

  10. Zero-Profile Spacer Versus Cage-Plate Construct in Anterior Cervical Diskectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy: Systematic Review and Meta-Analysis.

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    Tong, Min-Ji; Xiang, Guang-Heng; He, Zi-Li; Chen, De-Heng; Tang, Qian; Xu, Hua-Zi; Tian, Nai-Feng

    2017-08-01

    Anterior cervical diskectomy and fusion with plate-screw construct has been gradually applied for multilevel cervical spondylotic myelopathy in recent years. However, long cervical plate was associated with complications including breakage or loosening of plate and screws, trachea-esophageal injury, neurovascular injury, and postoperative dysphagia. To reduce these complications, the zero-profile spacer has been introduced. This meta-analysis was performed to compare the clinical and radiologic outcomes of zero-profile spacer versus cage-plate construct for the treatment of multilevel cervical spondylotic myelopathy. We systematically searched MEDLINE, Springer, and Web of Science databases for relevant studies that compared the clinical and radiologic outcomes of zero-profile spacer versus cage and plate for multilevel cervical spondylotic myelopathy. Risk of bias in included studies was assessed. Pooled estimates and corresponding 95% confidence intervals were calculated. On the basis of predefined inclusion criteria, 7 studies with a total of 409 patients were included in this analysis. The pooled data revealed that zero-profile spacer was associated with a decreased dysphagia rate at 2, 3, and 6 months postoperatively when compared with the cage-plate group. Both techniques had similar perioperative outcomes, functional outcome, radiologic outcome, and dysphagia rate immediately and at >1-year after operation. On the basis of available evidence, zero-profile spacer was more effective in reducing postoperative dysphagia rate for multilevel cervical spondylotic myelopathy. Both devices were safe in anterior cervical surgeries, and they had similar efficacy in improving the functional and radiologic outcomes. More randomized controlled trials are needed to compare these 2 devices. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Deep surgical site infection after anterior decompression and fusion with plate fixation for cervical spondylotic radiculopathy or myelopathy.

    Science.gov (United States)

    Guo, Qunfeng; Zhang, Mei; Wang, Liang; Lu, Xuhua; Ni, Bin

    2016-02-01

    To analyze the diagnosis and management of deep surgical site infection (SSI) with implant involved after anterior decompression and fusion for cervical spondylotic radiculopathy/myelopathy (CSR/CSM). Data of the patients who underwent anterior cervical decompression and fusion with plate fixation due to CSR/CSM were retrospectively reviewed. Cases with postoperative deep SSI with implant involved were identified and analyzed. A total of 1287 patients were finally included. Five patients (0.4%) were found to be with deep SSI. Bone fusion was not obtained when SSI was confirmed in each patient. Three cases were cured using one or two debridement and postoperative antibiotic therapy. Two cases with delayed diagnosis needed anterior implants removal, interbody fusion with autologous iliac bone and posterior lateral mass screw fixation at the first/second debridement. One of the two patients developed esophagus perforation after a second debridement and experienced one-month open drainage. All of the patients were cured without relapse of infection. For early deep SSI after anterior cervical decompression and fusion, surgical debridement was effective to eradicate infection. But for cases with delayed diagnosis, anterior debridement with prophylactic implant removal and posterior reconstruction was an ideal option. Esophagus perforation complicated with multiple debridements should be paid attention to and avoided. Copyright © 2015. Published by Elsevier B.V.

  12. Iatrogenic Vertebral Artery Injury During Anterior Cervical Spine Surgery: A Systematic Review.

    Science.gov (United States)

    Guan, Qing; Chen, Long; Long, Ye; Xiang, Zhou

    2017-10-01

    Iatrogenic vertebral artery injury (VAI) during anterior cervical surgery is rare but potentially catastrophic. Causes, presentation, diagnosis, management, prognosis, and prevention of VAI were reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English language studies and case reports published from 1980 to 2017 were retrieved. Data on diagnosis, surgical procedures and approach, site and cause of VAI, management, outcomes, and vertebral artery (VA) status were extracted. In 25 articles including 54 patients, VAI was diagnosed during or after surgery commonly indicated for cervical degenerative diseases (64%), tumors (14%), and trauma (9%). The incidence of VAI for each side was similar regardless of approach. Common presentations were unexpected copious surgical bleeding, delayed hemorrhage of pseudoaneurysm with neck swelling, dyspnea, hypotension, and cervical bruits caused by arteriovenous fistula. Causes included drilling (61%), instrumentation (16%), and soft tissue retraction (8%). Direct exposure or angiography confirmed VAI. Ten patients had VA anomalies; collateral status was verified in 9 before definitive treatment. Tamponade was adopted for urgent hemostasis in most cases but with a high incidence of pseudoaneurysm (48%). Unknown VA status increased occlusion risk and neurologic sequelae (41%). VA repair and stent placement had excellent outcomes. Extensive lateral decompression, loss of landmarks, and anatomic variations or pathologic status of VA increased VAI risk. Evaluation of collateral vessels before definitive treatment helped determine appropriate management and avoid neurologic sequelae. Tamponade was not recommended as definitive treatment. Meticulous preoperative evaluation, cautious intraoperative manipulation, and real-time radiographic guidance reduced VAI risk. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.

    LENUS (Irish Health Repository)

    Heneghan, Helen M

    2009-01-01

    BACKGROUND: Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications associated with iliac crest harvest when performed in the setting of Anterior Cervical Decompression (ACD). Also, to perform a comparative analysis of patient satisfaction and quality of life scores after ACD surgeries, when performed with and without iliac graft harvest. METHODS: All patients who underwent consecutive ACD procedures, with and without the use of autologous iliac crest graft, over a 48 month period were included (n = 53). Patients were assessed clinically at a minimum of 12 months postoperatively and administered 2 validated quality of life questionnaires: the SF-36 and Cervical Spine Outcomes Questionnaires (Response rate 96%). Primary composite endpoints included incidence of bone graft donor site morbidity, pain scores, operative duration, and quality of life scores. RESULTS: Patients who underwent iliac graft harvest experienced significant peri-operative donor site specific morbidity, including a high incidence of pain at the iliac crest (90%), iliac wound infection (7%), a jejunal perforation, and longer operative duration (285 minutes vs. 238 minutes, p = 0.026). Longer term follow-up demonstrated protracted postoperative pain at the harvest site and significantly lower mental health scores on both quality of life instruments, for those patients who underwent autologous graft harvest CONCLUSION: ACD with iliac crest graft harvest is associated with significant iliac crest donor site morbidity and lower quality of life at greater than 12 months post operatively. This is now avoidable by using alternatives to autologous bone without compromising clinical

  14. Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis.

    Science.gov (United States)

    Park, Moon Soo; Kelly, Michael P; Lee, Dong-Ho; Min, Woo-Kie; Rahman, Ra'Kerry K; Riew, K Daniel

    2014-07-01

    Postoperative malalignment of the cervical spine may alter cervical spine mechanics and put patients at risk for clinical adjacent segment pathology requiring surgery. To investigate whether a relationship exists between cervical spine sagittal alignment and clinical adjacent segment pathology requiring surgery (CASP-S) following anterior cervical fusion (ACF). Retrospective matched study. A total of 122 patients undergoing ACF between 1996 and 2008 were identified, with a minimum of 2 years of follow-up. Radiographs were reviewed to measure the sagittal alignment using C2 and C7 sagittal plumb lines, distance from the fusion mass plumb line to the C2 and C7 plumb lines, the alignment of the fusion mass, caudally adjacent disc angle, the sagittal slope angle of the superior end plate of the vertebra caudally adjacent to the fusion mass, T1 sagittal angle, overall cervical sagittal alignment, and curve patterns by Katsuura classification. A total of 122 patients undergoing ACF between 1996 and 2008 were identified, with a minimum of 1 year of follow-up. Patients were divided into groups according to the development of CASP (control/CASP-S) and by number/location of levels fused. Radiographs were reviewed to measure the sagittal alignment using C2 and C7 sagittal plumb lines, distance from the fusion mass plumb line to the C2 and C7 plumb lines, the alignment of the fusion mass, caudally adjacent disc angle, the sagittal slope angle of the superior end plate of the vertebra caudally adjacent to the fusion mass, T1 sagittal angle, overall cervical sagittal alignment, and curve patterns by Katsuura classification. Appropriate statistical tests were performed to calculate relationships between the variables and the development of CASP-S. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. The groups were similar with regard to

  15. Complications and Mortality Following One to Two-Level Anterior Cervical Fusion for Cervical Spondylosis in Patients Above 80 Years of Age.

    Science.gov (United States)

    Puvanesarajah, Varun; Jain, Amit; Shimer, Adam L; Singla, Anuj; Shen, Francis; Hassanzadeh, Hamid

    2017-05-01

    A retrospective database review. The aim of this study was to determine the complication and mortality rates in patients 80 years of age and older who were treated with anterior cervical fusion surgery and to compare these rates against those of other elderly patients. Cervical spondylosis is frequently observed in the elderly and is the most common cause of myelopathy in older adults. With increasing life expectancies, a greater proportion of patients are being treated with spine surgery at a later age. Limited information is available regarding outcomes following anterior cervical fusion surgery in patients 80 years of age or older. Medicare data from the PearlDiver Database (2005-2012) were queried for patients who underwent primary one to two-level anterior cervical spine fusion surgeries for cervical spondylosis. After excluding patients with prior spine metastasis, bone cancer, spine trauma, or spine infection, this cohort was divided into two study groups: patients 65 to 79 (51,808) and ≥80 years old (5515) were selected. A cohort of matched control patients was selected from the 65 to 79-year-old and 90-day complication rates and 90-day and 1-year mortality rates were compared between cohorts. The proportion of patients experiencing at least one major medical complication was relatively increased by 53.4% in patients aged ≥80 years [odds ratio (OR) 1.63]. Patients 80 years of age or older were more likely to experience dysphagia (OR 2.16), reintubation (OR 2.34), and aspiration pneumonitis (OR 3.17). Both 90-day (OR: 4.34) and 1-year (OR 3.68) mortality were significantly higher in the ≥80 year cohort. Patients 80 years of age or older are more likely to experience a major medical complication or mortality following anterior cervical fusion for cervical spondylosis than patients 65 to 79 years old. Dysphagia, aspiration pneumonitis, and reintubation rates are also significantly higher in patients 80 years of age or older. Although complication rates

  16. Rare Complications of Cervical Spine Surgery: Horner's Syndrome.

    Science.gov (United States)

    Traynelis, Vincent C; Malone, Hani R; Smith, Zachary A; Hsu, Wellington K; Kanter, Adam S; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Isaacs, Robert E; Rahman, Ra'Kerry K; Polevaya, Galina; Smith, Justin S; Shaffrey, Christopher; Tortolani, P Justin; Stroh, D Alex; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    A multicenter retrospective case series. Horner's syndrome is a known complication of anterior cervical spinal surgery, but it is rarely encountered in clinical practice. To better understand the incidence, risks, and neurologic outcomes associated with Horner's syndrome, a multicenter study was performed to review a large collective experience with this rare complication. We conducted a retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. Paired t test was used to analyze changes in clinical outcomes at follow-up compared to preoperative status. In total, 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened. Postoperative Horner's syndrome was identified in 5 (0.06%) patients. All patients experienced the complication following anterior cervical discectomy and fusion. The sympathetic trunk appeared to be more vulnerable when operating on midcervical levels (C5, C6), and most patients experienced at least a partial recovery without further treatment. This collective experience suggests that Horner's syndrome is an exceedingly rare complication following anterior cervical spine surgery. Injury to the sympathetic trunk may be limited by maintaining a midline surgical trajectory when possible, and performing careful dissection and retraction of the longus colli muscle when lateral exposure is necessary, especially at caudal cervical levels.

  17. Usefulness of polyetheretherketone (PEEK) cage with plate augmentation for anterior arthrodesis in traumatic cervical spine injury.

    Science.gov (United States)

    Song, Kyung-Jin; Choi, Byung-Wan; Kim, Gyu-Hyung; Song, Ji-Hun

    2010-01-01

    Even though many clinical reports about cages have been documented in patients with degenerative disorders, reports were scarce for traumatic injury cases, and those cases using metal cages were restricted to only one-level injury. To evaluate the usefulness of polyetheretherketone (PEEK) cage and plate construction in anterior interbody fusions (AIF) for traumatic cervical spine injuries by analyzing radiographic changes and clinical outcomes. Retrospective study. Fifty-eight patients (91 levels) underwent cage and plate construction for treatment of traumatic cervical spine injury. The fusion rate, fusion time, changes of Cobb angle, subsidence rate, and adjacent level changes were assessed as a radiographic outcome. Clinical analysis includes the recovery rate on the American Spinal Injury Association (ASIA) impairment scale and the presence of the complications. We evaluated 58 patients (91 levels) who underwent surgery and had at least 24 months in follow-up study. Radiographic evaluation included the assessment of interbody fusion rate, fusion time, changes of Cobb angle, subsidence rate, and adjacent level changes. Clinical assessment was done by analyzing recovery state of ASIA impairment scale from preoperative period to the last follow-up and by evaluating complications. Fifty-four cases showed bony fusion within 3 months after the surgery. The mean Cobb angle between the vertebral bodies was 2.54 degrees before operation, 9.13 degrees after operation, and 8.39 degrees at the latest follow-up. The mean intervertebral disc height was increased by 3.01 mm after the operation, but the mean height was 2.17 mm shorter at the last follow-up than after postoperation. In terms of clinical results, five Grade A cases and one Grade B case as assessed by the ASIA impairment scale were unchanged until the last follow-up. Twenty-three cases of Grade C, 16 cases of Grade D, and 13 cases of Grade E improved to seven cases, 26 cases, and 19 cases, respectively. Three

  18. A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis.

    Science.gov (United States)

    Albayrak, Ilknur; Bağcacı, Sinan; Sallı, Ali; Kucuksen, Sami; Uğurlu, Hatice

    2013-09-01

    Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

  19. Second-Trimester Anterior Cervical Angle in a Low-Risk Population as a Marker for Spontaneous Preterm Delivery.

    Science.gov (United States)

    Sepúlveda-Martínez, Alvaro; Díaz, Francisco; Muñoz, Hernán; Valdés, Enrique; Parra-Cordero, Mauro

    2017-01-01

    The aim of this article is to assess the use of the anterior cervical angle (ACA) as a predictor of spontaneous preterm delivery (sPTD) at 20+0-24+6 weeks of gestation in an unselected population. We conducted a nested case-control study that included 93 women who later delivered spontaneously history, CL and ACA at 20+0-24+6 weeks of gestation can predict approximately 40% of the severe preterm births. © 2016 S. Karger AG, Basel.

  20. Sagittal Alignment of a Strut Graft Affects Graft Subsidence and Clinical Outcomes of Anterior Cervical Corpectomy and Fusion.

    Science.gov (United States)

    Yamauchi, Koun; Fushimi, Kazunari; Miyamoto, Kei; Hioki, Akira; Shimizu, Katsuji; Akiyama, Haruhiko

    2017-10-01

    Retrospective study. The purpose of this study was to investigate the influence of sagittal alignment of the strut graft on graft subsidence and clinical outcomes after anterior cervical corpectomy and fusion (ACCF). ACCF is a common technique for the treatment of various cervical pathologies. Although graft subsidence sometimes occurs after ACCF, it is one cause for poor clinical results. Malalignment of the strut graft is probably one of the factors associated with graft subsidence. However, to the best of our knowledge, no prior reports have demonstrated correlations between the alignment of the strut graft and clinical outcomes. We evaluated 56 patients (33 men and 23 women; mean age, 59 years; range, 33-84 years; 45 with cervical spondylotic myelopathy and 11 with ossification of the posterior longitudinal ligament) who underwent one- or two-level ACCF with an autogenous fibular strut graft and anterior plating. The Japanese Orthopaedic Association (JOA) score recovery ratio for cervical spondylotic myelopathy was used to evaluate clinical outcomes. The JOA score and lateral radiograms were evaluated 1 week and 1 year postoperatively. Patients were divided into two groups (a straight group [group I] and an oblique group [group Z]) based on radiographic assessment of the sagittal alignment of the strut graft. Group I showed a significantly greater JOA score recovery ratio ( p subsidence than group Z ( p subsidence after ACCF. In contrast, an oblique strut graft can lead to significantly increased strut graft subsidence and poor clinical results.

  1. A Novel Anterior Transpedicular Screw Artificial Vertebral Body System for Lower Cervical Spine Fixation: A Finite Element Study.

    Science.gov (United States)

    Wu, Weidong; Chen, Chun; Ning, Jinpei; Sun, Peidong; Zhang, Jinyuan; Wu, Changfu; Bi, Zhenyu; Fan, Jihong; Lai, Xianliang; Ouyang, Jun

    2017-06-01

    A finite element model was used to compare the biomechanical properties of a novel anterior transpedicular screw artificial vertebral body system (AVBS) with a conventional anterior screw plate system (ASPS) for fixation in the lower cervical spine. A model of the intact cervical spine (C3-C7) was established. AVBS or ASPS constructs were implanted between C4 and C6. The models were loaded in three-dimensional (3D) motion. The Von Mises stress distribution in the internal fixators was evaluated, as well as the range of motion (ROM) and facet joint force. The models were generated and analyzed by mimics, geomagic studio, and ansys software. The intact model of the lower cervical spine consisted of 286,382 elements. The model was validated against previously reported cadaveric experimental data. In the ASPS model, stress was concentrated at the connection between the screw and plate and the connection between the titanium mesh and adjacent vertebral body. In the AVBS model, stress was evenly distributed. Compared to the intact cervical spine model, the ROM of the whole specimen after fixation with both constructs is decreased by approximately 3 deg. ROM of adjacent segments is increased by approximately 5 deg. Facet joint force of the ASPS and AVBS models was higher than those of the intact cervical spine model, especially in extension and lateral bending. AVBS fixation represents a novel reconstruction approach for the lower cervical spine. AVBS provides better stability and lower risk for internal fixator failure compared with traditional ASPS fixation.

  2. Subsidence of Cylindrical Cage (AMSLU™ Cage) : Postoperative 1 Year Follow-up of the Cervical Anterior Interbody Fusion

    Science.gov (United States)

    Joung, Young Il; Ko, Yong; Yi, Hyeong Joong; Lee, Seung Ku

    2007-01-01

    Objective There are numerous reports on the primary stabilizing effects of the different cervical cages for cervical radiculopathy. But, little is known about the subsidence which may be clinical problem postoperatively. The goal of this study is to evaluate subsidence of cage and investigate the correlation between radiologic subsidence and clinical outcome. Methods To assess possible subsidence, the authors investigated clinical and radiological results of the one-hundred patients who underwent anterior cervical fusion by using AMSLU™ cage during the period between January 2003 and June 2005. Preoperative and postoperative lateral radiographs were measured for height of intervertebral disc space where cages were placed. Intervertebral disc space was measured by dividing the sum of anterior, posterior, and midpoint interbody distance by 3. Follow-up time was 6 to 12 months. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Results Subsidence was found in 22 patients (22%). The mean value of subsidence was 2.21 mm, and mean subsidence rate was 22%. There were no cases of the clinical status deterioration during the follow-up period. No posterior or anterior migration was observed. Conclusion The phenomenon of subsidence is seen in substantial number of patients. Nevertheless, clinical and radiological results of the surgery were favorable. An excessive subsidence may result in hardware failure. Endplate preservation may enables us to control subsidence and reduce the number of complications. PMID:19096571

  3. Adjacent segment level disease in Klippel-Feil syndrome patients with congenital cervical fusion in the setting of anterolisthesis: Should management be altered in the presence of anterolisthesis?

    Directory of Open Access Journals (Sweden)

    Fernando Alonso

    2017-03-01

    Conclusion: Our follow-up was limited, but this study does not support the assumption that a congenitally fused segment predisposes a patient to a rate of adjacent segment level disease similar to patient who has undergone an anterior cervical discectomy and fusion. We found no increased risk of symptomatic adjacent segment level disease in KFS patients who had anterolisthesis adjacent to a congenitally fused segment.

  4. Anterior Transposition of Anomalous Tortuous Vertebral Artery Causing Cervical Radiculopathy: A Report of 2 Cases and Review of Literature.

    Science.gov (United States)

    Wang, Doris D; Burkhardt, Jan-Karl; Magill, Stephen T; Lawton, Michael T

    2017-05-01

    Cervical radiculopathy secondary to compression from vertebral artery (VA) tortuosity is a rare entity. We describe successful transposition through an anterolateral approach of tortuous VA loops causing cervical radiculopathy. Two patients with cervical radiculopathy (first case at C5-6 and second case at C3-4) secondary to anomalous VA loop compression underwent anterolateral approaches to the cervical spine for decompression and VA transposition. The anterior transverse foramina were drilled to unroof the VA loop, which was dissected free from the exiting nerve root. In both cases, the affected cervical nerve root was successfully decompressed with both radiographic and clinical improvements in radiculopathy symptoms. We found 8 other cases of VA transposition via either an anterolateral approach or a posterolateral approach described in the literature. Our second case of anterolateral VA transposition at the C3-4 level is the first case at this level and the highest level reported in the literature. Decompression using an anterolateral approach with direct microvascular transposition of the VA is a safe and effective treatment of this pathology and addresses the cause of radiculopathy more directly than the posterolateral approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Effect of different surgical methods on headache associated with cervical spondylotic myelopathy and/or radiculopathy.

    Science.gov (United States)

    Sun, Yuqing; Muheremu, Aikeremujiang; Yan, Kai; Yu, Jie; Zheng, Shan; Tian, Wei

    2015-09-23

    Anterior cervical discectomy and fusion, total disk replacement and open door laminoplasty have been widely used to treat patients with cervical spondylotic myelopathy and/or radiculopathy. In our clinical practice, many patients with cervical spondylosis also complain of headache, and wish to know if the surgical treatment for cervical spondylosis can also alleviate this symptom. Considering that there is no literature concerning this extra benefit of surgical manipulation on cervical spondylosis, we have carried out this retrospective study. Among the patients treated with anterior cervical discectomy and fusion, total disk replacement and open door laminoplasty in our institute for cervical spondylotic myelopathy and/or radiculopathy between February 2002 to March 2011, 108 of whom that have complained about headache at the same time were included in this study. Those patients were followed by 25 to 145 months. Severity of headache before the surgery and at the last follow up was recorded by VAS pain scores and compared among the patients with different surgical methods using SPSS17.0 software. One way ANOVA was used to compare VAS scores between the groups, paired sample t-tests were used to compare the differences in a group at different time points. Headache was significantly alleviated in all groups (P  0.05). No significant differences were found among the groups comparing the degree of alleviation of VAS scores before and after the surgery (P > 0.05). Considering that all the three procedures in the current study have achieved similar effect on alliviating headache in patients with cevical myelopathy, and that what they have in common was that was the decompression of spinal cord, it can be assumed that the headache associated with cervical spondylosis may be the result of compression on the spinal cord. Anterior cervical discectomy and fusion, total disk replacement and open door laminoplasty can all significantly alleviate headache in patients

  6. Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report

    Directory of Open Access Journals (Sweden)

    Yeung Jacky T

    2012-06-01

    Full Text Available Abstract Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

  7. Efficacy of cortico/cancellous composite allograft in treatment of cervical spondylosis.

    Science.gov (United States)

    Park, Jung-Ho; Bae, Yoon-Kwang; Suh, Seung-Woo; Yang, Jae-Hyuk; Hong, Jae-Young

    2017-08-01

    This was a prospective comparative study.The aim of this study was to compare the clinical and radiologic outcomes of patients treated with cortico/cancellous composite allograft or autoiliac bone graft in anterior cervical discectomy and fusion.Several methods have been developed to fuse the cervical spine for treatment of cervical spondylosis. Cortico/cancellous composite allograft might be another alternative.A total of 46 patients who underwent surgery for treatment of cervical spondylosis were evaluated between September 2010 and January 2015. The duration of operation, blood loss, perioperative complications, neck disability index (NDI), visual analogue scale (VAS), and fusion rates were compared between the 2 groups.There were no significant differences in clinical or radiologic outcomes between the patients treated with cortico/cancellous composite allograft and those treated with autoiliac bone graft. The 2 groups showed similar improvements in clinical symptoms and fusion rates. Although not statistically significant, the subsidence rate was lower in the cortico/cancellous composite group.Cortico/cancellous composite allograft is an effective alternative to conventional allograft or autograft in anterior cervical discectomy and fusion.

  8. Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs

    Science.gov (United States)

    Epstein, Nancy E.

    2012-01-01

    Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs. PMID:22905321

  9. Polyetheretherketone (PEEK) Spacers for Anterior Cervical Fusion: A Retrospective Comparative Effectiveness Clinical Trial.

    Science.gov (United States)

    Lemcke, Johannes; Al-Zain, Ferass; Meier, Ullrich; Suess, Olaf

    2011-01-01

    Anterior cervical decompression and fusion (ACDF) is the standard surgical treatment for radiculopathy and myelopathy. Polyetheretherketone (PEEK) has an elasticity similar to bone and thus appears well suited for use as the implant in ACDF procedures. The aim of this study is to examine the clinical and radiographic outcome of patients treated with standing alone PEEK spacers without bone morphogenic protein (BMP) or plating and to examine the influence of the different design of the two spacers on the rate of subsidence and dislocation. This retrospective comparative study reviewed 335 patients treated by ACDF in a specialized urban hospital for radiculopathy or myelopathy due to degenerative pathologies. The Intromed PEEK spacer was used in 181 patients from 3/2002 to 11/2004, and the AMT SHELL spacer was implanted in 154 patients from 4/2004 to 12/2007. The follow-up rate was 100% at three months post-op and 82.7% (277 patients) at one year. The patients were assessed with the Japanese Orthopedic Association (JOA) questionnaire and radiographically. At the one-year follow-up there were 118/277 patients with an excellent clinical outcome on the JOA, 112/277 with a good outcome, 20/277 with a fair outcome, and 27/277 with a poor outcome. Subsidence was observed in 13.3% of patients with the Intromed spacer vs 8.4% of the patients with the AMT SHELL. Dislocation of the spacer was observed in 10 of the 181 patients with Intromed spacers but in none of the 154 patients with Shell spacers. The study demonstrates that ACDF with standing alone PEEK cages leads to excellent and good clinical outcomes. The differences we observed in the subsidence rate between the two spacers were not significant and cannot be related to a single design feature of the spacers.

  10. Two-level cervical disc replacement: perspectives and patient selection

    Directory of Open Access Journals (Sweden)

    Narain AS

    2017-02-01

    Full Text Available Ankur S Narain, Fady Y Hijji, Daniel D Bohl, Kelly H Yom, Krishna T Kudaravalli, Kern Singh Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA Introduction: Cervical disc replacement (CDR is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature.Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored.Methods: The PubMed database was searched for all articles published on the subject of two-level CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri- and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two

  11. Mediastinotomía anterior y mediastinoscopia cervical en el diagnóstico de las lesiones tumorales mediastinales Anterior mediastinotomy and cervical mediastinoscopy in the diagnosis of mediastinal tumoral lesions

    Directory of Open Access Journals (Sweden)

    Edelberto Fuentes Valdés

    2005-03-01

    Full Text Available Para establecer el diagnóstico histológico y el tratamiento a emplear en los tumores mediastinales se necesita frecuentemente del acceso quirúrgico. Objetivo: Determinar el valor de la mediastinoscopia cervical y la mediastinotomía anterior en el diagnóstico de lesiones tumorales del mediastino. Métodos: Se presentan 32 pacientes con lesiones mediastinales expansivas, tratados entre enero de 2002 y junio de 2004 y a quienes se realizó una exploración mediastinal para obtener muestra tisular para biopsia. La intervención se consideró útil cuando la muestra fue suficiente para el estudio histológico. Resultados: Se realizaron 38 exploraciones del mediastino con fines diagnósticos, en las que se encontró predominio absoluto de los linfomas (75 %. En 26 pacientes (81,2 % se obtuvo el diagnóstico en la primera exploración y en 6 (18,8 % hubo que practicar una segunda exploración que, en 3 casos, consistió en una segunda mediastinotomía anterior, así como esternotomía media, nueva mediastinoscopia cervical y videotoracoscopia, un paciente cada una, para alcanzar el diagnóstico en el 100 %. La principal causa de especimenes no útiles para diagnóstico fue la muestra insuficiente. Se produjo lesión de vena mamaria interna en 3 ocasiones y neumotórax en 1 caso. La complicación posoperatoria que se encontramos fue la sepsis superficial de la herida en 2 casos. No hubo muertes relacionadas con el proceder. Conclusiones: La exploración mediastinal (mediastinoscopia cervical y mediastinotomía anterior resulta efectiva cuando se necesita establecer, con morbilidad mínima y sin mortalidad,el diagnóstico histológico de lesiones expansivas mediastinales, sobre todo ante la sospecha de linfomaIn order to establish the histological diagnosis and the treatment to be applied in the mediastinal tumors, the surgical access is frequently needed. Objective: to determine the value of the cervical mediastinoscopy and the anterior

  12. Spinous process wiring versus lateral mass fixation for the treatment of anterior cervical pseudarthrosis: a biomechanical comparison.

    Science.gov (United States)

    Murakami, Hideki; Jarrett, Claude; Rhee, John M; Tsai, Luke; Hutton, William

    2011-01-01

    Our objective was to compare the stiffness of lateral mass screws versus two different spinous process wiring constructs in a cadaveric model of plated anterior cervical pseudoarthrosis. When treating an anterior plated pseudoarthrosis via a posterior approach, it is unclear whether the added expense, muscle exposure, and risk of lateral mass fixation are justified biomechanically versus a simpler, cheaper, and potentially less morbid wiring technique, because the presence of the anterior plate likely reduces motion over the unplated situation. Seven cadaveric cervical spines were loaded in compression, flexion, extension, lateral bending, and torsion. Each load sequence was applied to: 1) the intact spine; 2) after application of a plated ACDF construct (pACDF); and 3) after the insertion of lateral mass (LM) screws, ``modified'' triple wiring (TW), or Roger's wiring (RW), in alternating order for each specimen. For each sequence, load deformation curves and stiffness were obtained. Supplemental LM fixation significantly (p ≤ 0.05) increased stiffness versus pACDF in all six modes tested. TW significantly increased stiffness versus pACDF in compression, flexion, and torsion, but not in extension, or lateral bending. RW significantly increased stiffness versus pACDF only in axial torsion. When comparing LM to the wiring constructs, LM fixation was significantly stiffer than RW in flexion, extension, and lateral bending; LM fixation was stiffer than TW in lateral bending. LM fixation produced the stiffest overall constructs in stabilizing a plated pseudarthrosis ACDF model. It was significantly stiffer in more modes versus RW than TW.

  13. A rare case of concomitant cervical disc herniation and intradural meningioma treated with one-stage posterior surgery.

    Science.gov (United States)

    Hu, Xiaojian; Chen, Zhong; Wang, Yue

    2017-12-14

    Case report. To present a rare case of cervical disc herniation concomitant with intradural meningioma which was successfully treated using a single one-stage posterior surgery of tumor resection and transdural discectomy. Coexistence of symptomatic disc herniation and intra-spinal tumor in the same cervical segment is extremely rare. Usually, two-stage anterior and posterior surgeries are needed to treat two conditions, respectively. One-stage posterior surgery to treat two pathologies simultaneously has not been reported in the literature. A 76-year-old man presented with leg weakness and numbness for 6 months and left arm pain for 2 months. Contrast MR imaging revealed C3/4 intervertebral disc herniation and a hyperintense intradural lesion at the right portion of C3 canal. A one-stage posterior surgery, including C3/4 laminectomy, intradural tumor resection, transdural C3/4 discectomy, and C3/4 lateral mass instrumentation and fusion, was performed to treat two distinct pathologies together. The patient's arm pain and numbness disappeared right after the surgery and symptoms of myelopathy fully recovered at 6-month follow-up. Histological studies confirmed a herniated disc and a meningioma. In rare case, intradural tumor coexists with cervical disc herniation. When suspicious findings were noticed, or clinical symptoms cannot be fully explained, contrast MR imaging is helpful in differential diagnosis. Microscopic transdural discectomy is safe, and could be used as an optional procedure for cervical disc herniation in some cases.

  14. Risk Factors for and Clinical Outcomes of Dysphagia After Anterior Cervical Surgery for Degenerative Cervical Myelopathy: Results from the AOSpine International and North America Studies.

    Science.gov (United States)

    Nagoshi, Narihito; Tetreault, Lindsay; Nakashima, Hiroaki; Arnold, Paul M; Barbagallo, Giuseppe; Kopjar, Branko; Fehlings, Michael G

    2017-07-05

    Although dysphagia is a common complication after anterior cervical decompression and fusion, important risk factors have not been rigorously evaluated. Furthermore, the impact of dysphagia on neurological and quality-of-life outcomes is not fully understood. The aim of this study was to determine the prevalence of and risk factors for dysphagia, and the impact of this complication on short and long-term clinical outcomes, in patients treated with anterior cervical decompression and fusion. Four hundred and seventy patients undergoing a 1-stage anterior or 2-stage anteroposterior cervical decompression and fusion were enrolled in the prospective AOSpine CSM (Cervical Spondylotic Myelopathy) North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of perioperative dysphagia. Preoperatively and at each follow-up visit, patients were evaluated using the modified Japanese Orthopaedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short Form-36 Health Survey (SF-36). A 2-way repeated-measures analysis of covariance was used to evaluate differences in outcomes at 6 and 24 months between patients with and those without dysphagia, while controlling for relevant baseline characteristics and surgical factors. The overall prevalence of dysphagia was 6.2%. Bivariate analysis showed the major risk factors for perioperative dysphagia to be a higher comorbidity score, older age, a cardiovascular or endocrine disorder, a lower SF-36 Physical Component Summary score, 2-stage surgery, and a greater number of decompressed levels. Multivariable analysis showed patients to be at an increased risk of perioperative dysphagia if they had an endocrine disorder, a greater number of decompressed segments, or 2-stage surgery. Both short and long-term improvements in functional, disability, and quality-of-life scores were comparable between patients with and those

  15. Survivorship Analysis of Clinical Adjacent-Segment Pathology After Single-Level Cervical Fusion.

    Science.gov (United States)

    Kong, Lingde; Ma, Qinghua; Yu, Kunlun; Cao, Junming; Wang, Linfeng; Shen, Yong

    2017-10-25

    BACKGROUND Clinical adjacent-segment pathology (CASP) is an important problem after anterior cervical surgery. The purpose of this study was to predict prevalence of CASP and determine the possible risk factors for CASP after single-level anterior cervical discectomy and fusion surgery. MATERIAL AND METHODS We retrospectively reviewed a series of patients who underwent single-level cervical discectomy and fusion surgery (ACDF). Both basic and radiographic data of patients were collected. Life-table method and Kaplan-Meier analysis were used to calculate prevalence of CASP and disease-free survival rate. Cox analysis was performed to determine the predictive factors for it. RESULTS A total of 256 patients were included in this study. The mean length of follow-up was 70.64 months. Among them, 31 patients were diagnosed as having CASP during follow-up. Nineteen of them were at the cephalad adjacent segment, and the other 12 were at the caudal segment. After ACDF procedures, 10.01% of patients developed new symptoms of CASP within 5 years, and the incidence increased to 23.89% after 10 years. The incidence rate of CASP was an average of 2.46% per year. Multivariate Cox regression analysis showed that congenital stenosis (hazard ratio [HR], 3.250; 95% confidence interval [CI], 1.538-6.867) and degeneration of adjacent segment (HR, 2.681; 95% CI, 1.259-5.709) were correlated with the incidence of CASP. CONCLUSIONS Patients with congenital stenosis and pre-existing degenerative changes of adjacent segments had a higher risk of developing CASP after single-level anterior cervical discectomy and fusion.

  16. Cervicitis

    Science.gov (United States)

    ... intercourse or during a cervical exam, and abnormal vaginal discharge. However, it's also possible to have cervicitis and ... symptoms, they may include: Large amounts of unusual vaginal discharge Frequent, painful urination Pain during intercourse Bleeding between ...

  17. Clinical and radiographic outcome of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease: a minimal five-year follow-up.

    Science.gov (United States)

    Wang, Lin-Nan; Hu, Bo-Wen; Wang, Lei; Song, Yue-Ming; Yang, Xi; Liu, Li-Min; Liu, Hao

    2018-04-04

    To evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease. From April 2010 to October 2010, 38 patients with single- or double-level cervical disc herniation underwent anterior cervical discectomy and DCI arthroplasty. The clinical results and radiographic outcomes of these 38 patients (42 levels) were retrospectively evaluated. The clinical results included the visual analogue scale, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey questionnaire, and incidences of complications and neurological deterioration. Radiographic results including cervical alignment, intervertebral height, cervical range of motion (ROM), ROM of the functional spinal unit, adjacent intervertebral ROM, migration, subsidence, and heterotopic ossification (HO) were assessed on plain radiography, three-dimensional computed tomography, and magnetic resonance imaging. The mean follow-up period was 72.3 months (range 68-78 months). During follow-up, all patients showed significant improvements in the visual analogue scale score, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey physical component summary score and mental component summary score. The ROM of the functional spinal unit was partly reduced. The DCI migrated forward in 10 of 42 (23.8%) cases, and HO was detected in 24 of the 42 (57.1%) DCI segments. Subsidence was observed in 14 of 42 (33.3%) DCI segments. Two patients experienced symptom recurrence, and were treated conservatively. The clinical efficacy of DCI arthroplasty was maintained during mid- to long-term follow-up. HO formation is a common phenomenon, leading to a substantial decrease in ROM at the index level and recurrence of neurological symptoms. The incidence of implant subsidence and migration is relatively high, leaving a potential risk

  18. Risk factors for non-fusion segment disease after anterior cervical spondylosis surgery: a retrospective study with long-term follow-up of 171 patients.

    Science.gov (United States)

    Wang, Ziqiang; Zhou, Liangliang; Lin, Bin; Song, Keran; Niu, Qinghe; Ren, Dongfeng; Tang, Jiaguang

    2018-02-02

    The purpose of this study was to investigate the incidence and causes of non-fusion segment disease (NFSD), both adjacent and non-adjacent to a fused segment, after anterior cervical arthrodesis. This is a single-center study. Between January 1998 and January 2011, two surgeons' 171 patients who had an anterior cervical decompression and fusion were followed clinically for more than 5 years. The correlation between the incidence of symptomatic non-fusion segment disease and the following clinical parameters (age at operation, fusion levels,) and radiological parameters (number of patients who had a plate, anterior cervical decompression and fusion (ACDF) or corpectomies, preoperative and postoperative cervical spine alignment, Pavlov's ratio at the C5 level, and preoperative existence of a non-fusion segment degeneration on magnetic resonance imaging) was evaluated. Of the 171 patients reviewed, 16 patients had non-fusion segment disease (9.36%), of which 12 had adjacent segment disease and 4 had non-adjacent segment disease. Postoperative cervical lordosis in the non-fusion segment disease group was significantly smaller than that of the disease-free group (P Fusion levels in the NFSD group were 1.69 whereas 2.26 in disease-free group (P = 0.005). The incidences of disc degeneration in unfused segments was more severe in the NFSD group than in the disease-free group (P = 0.004). The results of binary logistic regression showed that the major factor affecting NFSD is postoperative cervical lordosis (P = 0.000) followed by disc degeneration (P = 0.024). The other parameters did not show a statistically significant difference. The incidence of symptomatic non-fusion segment disease after anterior cervical arthrodesis has multifactorial causes. Postoperative cervical lordosis and disc degeneration in non-fusion segments were major factors in the incidence of NFSD.

  19. What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT.

    Science.gov (United States)

    Park, Jeong Yoon; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2013-05-01

    It is well known that arthrodesis is associated with adjacent segment degeneration (ASD). However, previous studies were performed with simple radiography or CT. MRI is most sensitive in assessing the degenerative change of a disc, and this is the first study about ASD by radiography, CT and MRI. We sought to factors related to ASD at cervical spine by an MRI and CT, after anterior cervical spine surgery. This is a retrospective cross-sectional study of cervical disc herniation. Patients of cervical disc herniation with only radiculopathy were treated with either arthroplasty (22 patients) or ACDF with cage alone (21 patients). These patients were required to undergo MRI, CT and radiography preoperatively, as well as radiography follow-up for 3 months and 1 year, and we conducted a cross-sectional study by MRI, CT and radiography including clinical evaluations 5 years after. Clinical outcomes were assessed using VAS and NDI. The fusion rate and ASD rate, and radiologic parameters (cervical lordosis, operated segmental height, C2-7 ROM, operated segmental ROM, upper segmental ROM and lower segmental ROM) were measured. The study groups were demographically similar, and substantial improvements in VAS (for arm) and NDI (for neck) scores were noted, and there were no significant differences between groups. Fusion rates were 95.2% in the fusion group and 4.5% in the arthroplasty group. ASD rates of the fusion and arthroplasty groups were 42.9 and 50%, respectively. Among the radiologic parameters, operated segmental height and operated segmental ROM significantly decreased, while the upper segmental ROM significantly increased in the fusion group. In a comparative study between patients with ASD and without ASD, the clinical results were found to be similar, although preexisting ASD and other segment degeneration were significantly higher in the ASD group. C2-7 ROM was significantly decreased in ASD group, and other radiologic parameters have no significant differences

  20. Spine surgeon's kinematics during discectomy, part II: operating table height and visualization methods, including microscope.

    Science.gov (United States)

    Park, Jeong Yoon; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2014-05-01

    Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope. We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position. Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method

  1. Transverse process anatomy as a guide to vertebral artery exposure during anterior cervical spine approach: A Cadaveric Study.

    Science.gov (United States)

    Nourbakhsh, Ali; Yang, Jinping; Mcmahan, Howard; Garges, Kim

    2017-05-01

    Safe exposure of the vertebral artery (VA) is needed during resection of tumors close to the artery and during repair of lacerations. We defined the anatomy of the anterior root of each transverse process (TP) from C3 to C6 for identification and exposure of the VA during the anterior approach. We examined the anatomy of the TP and assessed two approaches for safe identification of the VA, lateral to medial and medial to lateral dissection of the TP, in 20 cadavers. The safe zone at each level of the cervical spine was defined as an area in which the surgeon can start to dissect at the midline of that level on the TP and safely cross the VA laterally. For the lateral to medial approach the surgical safe zone lies between the mid axis of the TPs and a line 2 mm parallel to and above it. The average TP angle was 11 ± 10.2 degrees. The mean distance of the lateral border of the VA from the TP tip was 3.78-5.28 mm. For the medial to lateral approach, staying at the level of the upper vertebral end plate will lead the surgeon to the tip of the TP. From that point, dissection can be carried out as described above. This study examined the anatomy of the TP and defined the approach to expose the VA safely during anterior cervical spine exposure. Clin. Anat. 30:492-497, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  2. Clinical and radiological results of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis.

    Science.gov (United States)

    Kan, Lisheng; Kang, Jian; Gao, Rui; Chen, Xiongsheng; Jia, Lianshun

    2014-12-01

    To date, formulation of the optimal surgical protocol for noncontiguous multilevel cervical spondylosis remains controversial, and the corresponding clinical data continue to be limited. The purpose of this study was to compare the clinical and radiological outcomes of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis (2 contiguous disc levels and 1 "skip" disc level [nonoperated level between 2 operated levels]). The incidence of adjacent-segment degeneration (ASD) was also evaluated. Sixty-three consecutive patients with noncontiguous 3-level cervical spondylosis who underwent two different hybrid methods of treatment were retrospectively reviewed. The patients were divided into 2 groups, the fusion group and the arthroplasty group. A titanium mesh cage and an anterior cervical plate were used after the anterior cervical corpectomy, and then a stand-alone cage (the fusion group) or an artificial cervical disc (the arthroplasty group) was used after the discectomy. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score and the JOA scale score improvement rate preoperatively and during follow-up. Radiological results were assessed using global angle and global range of motion (ROM) of the cervical spine. The ASD was also evaluated. The JOA scores of the patients significantly improved postoperatively and were well maintained within the follow-up period, as did the JOA scale score improvement rate. The mean global angle of the cervical spine of the patients significantly increased postoperatively. At the last follow-up evaluation, the mean global ROM was retained by patients in the arthroplasty group (p > 0.05) but not by patients in the fusion group (p = 0.00). There was no significant difference in the incidence of ASD between the 2 groups (p = 0.114). However, at the skip levels, patients in the fusion group had a higher incidence of ASD than patients in the arthroplasty group (p = 0

  3. Biomechanical analysis of differential pull-out strengths of bone screws using cervical anterior transpedicular technique in normal and osteoporotic cervical cadaveric spines.

    Science.gov (United States)

    Wu, Changfu; Chen, Chun; Wu, Weidong; Zhao, Weidong; Sun, Peidong; Fan, Jihong; Bi, Zhenyu; Zhang, Jinyuan; Ouyang, Jun

    2015-01-01

    Biomechanical in vitro study. To determine whether the peak pull-out force (PPF) of cervical anterior transpedicular screw (ATPS) fixed in osteoporotic vertebrae positively influence screw stability or not before and after fatigue. Multilevel cervical spine procedures with osteoporosis can challenge the stability of current screw-and-plate systems. A second surgical posterior approach is coupled with potential risks of increased morbidity and complications. Hence, anterior cervical instrumentation that increases primary construct stability, while avoiding the need for posterior augmentation, would be valuable. Sixty formalin-fixed vertebrae at different levels were randomly selected. The vertebrae were divided into healthy controls (groups A1, A2), osteoporotic controls (B1, B2), healthy ATPS groups (C1, C2), osteoporotic ATPS groups (D1, D2), and osteoporotic restoration controls (E1, E2). The procedure of ATPS insertion was simulated with 2 pilot holes being drilled on each side of 20 vertebral bodies that were implanted with either vertebral screw or polymethylmethacrylate. Each side randomly received either instant PPF or PPF beyond fatigue (2.5 Hz; 20,000 times). The prefatigue PPFs were significantly higher than the postfatigue PPFs in all groups (group A: 366.06 ± 58.78 vs. 248.93 ± 57.21 N; group B: 275.58 ± 23.18 vs. 142.79 ± 44.78 N; group C: 635.99 ± 185.28 vs. 542.57 ± 136.58 N; group D: 519.22 ± 122.12 vs. 393.16 ± 192.07 N, and group E: 431.78 ± 75.77 vs. 325.74 ± 95.10 N). The postfatigue PPFs were reduced by 32.00% (group A), 48.19% (group B), 14.69% (group C), 24.28% (group D), and 24.72% (group E). The acute and postfatigue PPFs of both control groups were significantly lower than that of ATPS groups (P osteoporotic vertebrae.

  4. A 5- to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone.

    Science.gov (United States)

    Engquist, Markus; Löfgren, Håkan; Öberg, Birgitta; Holtz, Anders; Peolsson, Anneli; Söderlund, Anne; Vavruch, Ludek; Lind, Bengt

    2017-01-01

    OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than

  5. Relationship between screw sagittal angle and stress on endplate of adjacent segments after anterior cervical corpectomy and fusion with internal fixation: a Chinese finite element study.

    Science.gov (United States)

    Zhang, Yu; Tang, Yibo; Shen, Hongxing

    2017-12-01

    In order to reduce the incidence of adjacent segment disease (ASD), the current study was designed to establish Chinese finite element models of normal 3rd~7th cervical vertebrae (C3-C7) and anterior cervical corpectomy and fusion (ACCF) with internal fixation , and analyze the influence of screw sagittal angle (SSA) on stress on endplate of adjacent cervical segments. Mimics 8.1 and Abaqus/CAE 6.10 softwares were adopted to establish finite element models. For C4 superior endplate and C6 inferior endplate, their anterior areas had the maximum stress in anteflexion position, and their posterior areas had the maximum stress in posterior extension position. As SSA increased, the stress reduced. With an increase of 10° in SSA, the stress on anterior areas of C4 superior endplate and C6 inferior endplate reduced by 12.67% and 7.99% in anteflexion position, respectively. With an increase of 10° in SSA, the stress on posterior areas of C4 superior endplate and C6 inferior endplate reduced by 9.68% and 10.22% in posterior extension position, respectively. The current study established Chinese finite element models of normal C3-C7 and ACCF with internal fixation , and demonstrated that as SSA increased, the stress on endplate of adjacent cervical segments decreased. In clinical surgery, increased SSA is able to play important role in protecting the adjacent cervical segments and reducing the incidence of ASD.

  6. Dysphagia in the Elderly Following Anterior Cervical Surgery: A Multidisciplinary Approach

    LENUS (Irish Health Repository)

    Osuafor, C N.

    2017-11-01

    Dysphagia is a risk factor for adverse health outcomes like aspiration, recurrent chest infections and malnutrition. Here, we describe a case of an 82-year-old lady who presented with a two-month history of dysphagia after an anterior odontoid screw fixation for a type II odontoid process fracture. This case highlights the importance of a multidisciplinary approach to patient care.

  7. Percutaneous lumbar discectomy

    International Nuclear Information System (INIS)

    Xiao Chengjiang; Su Huanbin; Xu Sui; He Xiaofeng; Li Yanhao

    2004-01-01

    Objective: To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods: To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpiform nacleus forceps, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results: The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions: PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation. (authors)

  8. Treatment of cervical radiculopathy: A review of the evolution and economics.

    Science.gov (United States)

    Ament, Jared D; Karnati, Tejas; Kulubya, Edwin; Kim, Kee D; Johnson, J Patrick

    2018-01-01

    The surgical treatment of cervical radiculopathy has centered around anterior cervical discectomy and fusion (ACDF). Alternatively, the posterior cervical laminoforaminotomy/microdiscectomy (PCF/PCM), which results in comparable outcomes and is more cost-effective, has been underutilized. Here, we compared the direct/indirect costs, reoperation rates, and outcome for ACDF and PCF vs. PCM using PubMed, Medline, and Embase databases. There were no significant differences between the re-operative rates of PCF/PCM (2% to 9.8%) versus ACDF (2% to 8%). Direct costs of ACDF were also significantly higher; the 1-year cost-utility analysis demonstrated that ACDF had $131,951/QALY while PCM had $79,856/QALY. PCF/PCM for radiculopathy are safe and more cost-effective vs. ACDF, and have similar clinical outcomes.

  9. Cervical spondylotic myelopathy caused by violent motor tics in a child with Tourette syndrome.

    Science.gov (United States)

    Ko, Da-Young; Kim, Seung-Ki; Chae, Jong-Hee; Wang, Kyu-Chang; Phi, Ji Hoon

    2013-02-01

    We report a case of a 9-year-old boy with Tourette syndrome (TS) who developed progressive quadriparesis that was more severe in the upper extremities. He had experienced frequent and violent motor tics consisting of hyperflexion and hyperextension for years. Magnetic resonance imaging (MRI) revealed a focal high-signal intensity cord lesion and adjacent cervical spondylotic changes. Initially, the patient was observed for several months because of diagnostic uncertainty; his neurological status had improved and later worsened again. Anterior cervical discectomy of C3-4 and fusion immediately followed by posterior fixation were performed. After surgery, the neck collar was applied for 6 months. His neurological signs and symptoms improved dramatically. TS with violent neck motion may cause cervical spondylotic myelopathy at an early age. The optimal management is still unclear and attempts to control tics should be paramount. Circumferential fusion with neck bracing represents a viable treatment option.

  10. Cervicitis

    Science.gov (United States)

    ... a sexually transmitted infection, such as chlamydia or gonorrhea. Cervicitis can develop from noninfectious causes, too. Successful ... result from common sexually transmitted infections (STIs), including gonorrhea, chlamydia, trichomoniasis and genital herpes. Allergic reactions. An ...

  11. Comparison of Long terms Follow up Results in Patients with Cervical Disk DiseaseTreated With Anterior PEEK CageImplantation and Without it in Rasoul Akram Hospital

    Directory of Open Access Journals (Sweden)

    Mir Abolfazl Motiei

    2012-08-01

    Full Text Available Abstract Background: Anterior interbody fusion of the cervical spine have become the gold standard for treating spinal diseases, hence the aim of this study was to compare long term follow up results in patients with cervical disk disease treated with anterior PEEK cage implantation and without it in anterior approach. Methods: Retrospectively 63 patients with known cervical discogenic disorders who went under surgery with and without cage implantation were enrolled. The neurological examination and neurologic function were assessed by using the Japanese Orthopedic Association (JOA scoring system and neurological cervical spine scale (NCSS before and 8 years after surgery in each patient and at the end all complications were recorded. Results: In the first group, there were 15 males and 14 females (mean age: 49±10 years and in the second group there were 27 male and 7 female (mean age: 47±9 years. The NCSS score was significantly different between two groups after surgery (p=0.035 but there was no significant difference before surgery (p=0.163. No statistical significance difference was also observed in JOA score and complications before and after procedure, but JOA post surgery score between two groups had significant difference (p=0.047 . Conclusion: In conclusion, present study showed that PEEK cage implantation is a highly useful alternative to the conventional treatment methods.

  12. Vertebral artery injury during foraminal decompression in "low-risk" cervical spine surgery: incidence and management.

    Science.gov (United States)

    Obermüller, Thomas; Wostrack, Maria; Shiban, Ehab; Pape, Haiko; Harmening, Kathrin; Friedrich, Benjamin; Prothmann, Sascha; Meyer, Bernhard; Ringel, Florian

    2015-11-01

    Vertebral artery injury (VAI) during foraminal decompression in cervical spine surgery in the absence of repositioning or screw stabilization is rare. Without immediate recognition and treatment, it may have disastrous consequences. We aimed to describe the incidence and management of iatrogenic VAI in low-risk cervical spine surgery. The records of all patients who underwent surgical procedures of the cervical spine between January 2007 and May 2012 were retrospectively consecutively evaluated. Anterior cervical discectomy and fusion or arthroplasty as well as dorsal foraminal decompression through the Frykholm approach in degenerative diseases were defined as low-risk surgeries (n = 992). VAI occurred in 0.3 % (n = 3) of 992 procedures: in one case during a dorsal foraminal decompression, and in two cases during the anterior cervical discectomy and fusion (ACDF) of two or four levels, respectively. In the first case, the VAI was intraoperatively misdiagnosed. Despite an initially uneventful course, the patient suffered hemorrhage from a pseudoaneurysm of the injured VA 1 month after surgery. The aneurysm was successfully occluded by endovascular coiling. In both ACDF cases, angiography and endovascular stenting of the lacerated segment proceeded immediately after the surgery. All three patients suffered no permanent deterioration. In a high-volume surgical center, the incidence of VAI during low-risk cervical spine surgery is extremely low, comprising 0.3 % of all cases. The major risks are delayed sequels of the vessel wall laceration. In cases of VAI, immediate angiographic diagnostics and generous indications for endovascular treatment are obligatory.

  13. [The clinical value of end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion surgery].

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    He, Lei; Qian, Yu; Jin, Yi-Jun; Fan, Liang; Lü, Zuo

    2014-09-01

    To evaluate the clinical results of using end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion (ACCF) surgery. The clinical data of 71 patients with cervical spondylotic myelopathy underwent ACCF in single segment from February 2008 to February 2011 were retrospectively analyzed. There were 38 males and 33 females, aged from 39 to 74 years old with a mean of 53.8 years. Thirty-three were used end plate rings and thirty-eight were not used (end plate rings group and no end plate ring group, respectively). The Japanese Orthopaedic Association (JOA) score, Odom's scale, imaging data were used to evaluate the clinical effects. Imaging data including Cobb angle of fusion segment, intervertebral height of anterior border (Da) and posterior border (Dp), the mean intervertebral height (Dm). All patients were followed up from 13 to 34 months with an average of 19.5 months. Between two groups, there was no significant difference in Cobb angle of fusion segment and the mean intervertebral height (Dm) before surgery and one week after surgery. Whereas, one year after surgery, the Cobb angle of end plate ring group was (9.4 ± 3.8) degrees, and contral group was (7.5 ± 3.9) degrees, which was significantly lower than that of end plate ring group. Meanwhile, the Dm of end plate ring group was (57.3 ± 2.2) mm, and no end ring group was (55.2 ± 2.6) mm which was significantly lower than that of end plate ring group. The subsidence in end plate ring group was 57.6%, and was 78.9% in no end plate ring group. There was no significant difference in JOA score before and after surgery between two groups. At 1 year after operation, 90.9% (30/33) got excellent or good results in end plate ring group, 89.5% (33/38) got excellent or good results in contral group. The use of end plate rings could not completely prevent the subsidence of titanium cage, however, which can decrease the occurrence rate of the subsidence and lessen its degree.

  14. Clinical Features of Herniated Disc at Cervicothoracic Junction Level Treated by Anterior Approach.

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    Lee, Jun Gue; Kim, Hyeun Sung; Ju, Chang Il; Kim, Seok Won

    2016-06-01

    The anterior approach for C7-T1 disc herniation may be challenging because of obstruction by the manubrium and the narrow operative field. This study aimed to investigate the clinical and neurological outcomes of anterior approach for C7-T1 disc herniation. We retrospectively evaluated 13 patients who underwent the anterior approach for C7-T1 disc herniation by a single surgeon within a period of 11 years (2003-2014). The minimum follow-up duration was 6 months. We describe the clinical presentation, radiographic findings, neurological outcome, and related complications. Of 372 patients with single-level anterior discectomy and fusion or artificial disc replacement for cervical disc herniation, 13 (3.5%) had C7-T1 disc herniation. The main clinical presentation was unilateral motor weakness in intrinsic hand muscles (11 patients), along with numbness, pain, and tingling sensation that radiate down the arm to the little finger. Most of the patients improved after surgery via the anterior approach. Ten patients underwent successful anterior discectomy and fusion by the standard supramanubrial Smith-Robinson approach, but 2 needed additional manubriotomy and sternotomy. In 1 patient, we performed surgery at a wrong level because the correct level was difficult to identify intraoperatively. Two patients had transient vocal dysfunction, but none had major complications related to injuries of the great vessels such as the thoracic duct or esophagus. For patients who require direct anterior decompression for C7-T1 disc herniation, the anterior approach is relatively feasible. However, care should be taken to overcome physical constraints by the manubrium and slope.

  15. [Results to 4-year follow-up of the treatment of the cervical stenosis by corpectomy, titanium mesh cage and anterior plate fixation].

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    Reyes Sánchez, Alejandro Antonio; Gameros Castañeda, Luis Alberto; Obil Chavarría, Claudia; Alpizar Aguirre, Armando; Zárate Kalfópulos, Barón; Rosales-Olivares, Luis Miguel

    Cervical spondylotic myelopathy is caused by cervical stenosis. Several techniques have been described for the treatment of multilevel disease, such as the anterior corpectomy with titanium mesh cage and anterior cervical plate placement, which has the advantage of performing a wider decompression and using the same bone as graft. However, it has caused controversy since the collapse of the mesh cage continues being a major limitation of this procedure. A prospective 4-year follow-up study was conducted in 7 patients diagnosed with cervical stenosis, who were treated surgically by one level corpectomy with titanium mesh cage and anterior cervical plate placement, evaluating them by radiographs and clinical scales. 7 patients, 5 women and 2 males were studied. The most common level was C5 corpectomy (n=4). The Neck Disability Index (NDI) preoperative average was 30.01±24.32 and 4-year postoperative 16.90±32.05, with p=0.801. The preoperative and 4-year postoperative Nürick was 3.28± 48 and 3.14±1.21 respectively, with p=0.766. Preoperative lordosis was 14.42±8.03 and 4-year postoperative 17±11.67 degrees, with p=0.660. The immediate postoperative and 4-year postoperative subsidence was 2.69±2.8 and 6.11±1.61 millimeters respectively, with p=0.0001. Despite the small sample, the subsidence of the mesh cage is common in this procedure. No statistically significant changes were observed in the lordosis or Nürick scale and NDI. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  16. Risks for Vascular Injury During Anterior Cervical Spine Surgery: Prevalence of a Medial Loop of Vertebral Artery and Internal Carotid Artery.

    Science.gov (United States)

    Wakao, Norimitsu; Takeuchi, Mikinobu; Nishimura, Manabu; Riew, K Daniel; Kamiya, Mitsuhiro; Hirasawa, Atsuhiko; Imagama, Shiro; Kawanami, Katsuhisa; Murotani, Kenta; Takayasu, Masakazu

    2016-02-01

    Observational study using a retrospective single-institute database. To investigate the prevalence of a medial loop (ML) of the vertebral artery (VA) and internal carotid artery (ICA), which might be an anatomical risk factor for arterial injury in anterior cervical surgeries. Anterior cervical spine surgeries are generally considered to be safe and effective. VA injury is one of the most serious complications during anterior procedures. Several articles have reported this complication, which might be because of the anomalous course of VA at V2 segment. The prevalence and anatomical features of those high-risk cases were, however, not investigated. Consecutive Japanese subjects, who underwent contrast-enhanced computed tomography (CT) or computed tomographic angiography (CTA) for reasons other than evaluation of cervical artery disease from November 2011 to October 2012 in our institution, were reviewed. Exclusion criteria included poor images, past surgery, and endovascular intervention of cervical spine and its vessels. The definition of ML was set as the course of VA and ICA extended medially inside the uncovertebral joint. We also investigated whether those anomalous courses were detectable by plain CT. A total of 1251 subjects with age ranging from 14 to 93 years with a mean of 56.1 years were surveyed. Among them, 1054 subjects were eligible and the others were excluded. A total of 421 subjects were male, and 633 were female. There were 10 cases (1%) with an ML of the VA, and 2 (0.2%) cases with a medial loop of internal carotid artery. Five of the 10 cases with a medial loop of vertebral artery were aberrant into the vertebral body, which were detectable by plain CT. Importantly, the other five cases could not be seen on the CT. One percent of all subjects showed higher anatomical risk for VA and ICA injury during anterior surgery, half of which were undetectable by plain CT. Preoperative evaluation for vascular anatomy may be necessary for safer surgical

  17. [Forestier-Rotes-Querol's disease. Ossification of the anterior cervical longitudinal ligament as a cause of dysphagia].

    Science.gov (United States)

    Alcázar, L; Jerez, P; Gómez-Angulo, J C; Tamarit, M; Navarro, R; Ortega, J M; Aragonés, P; Salazar, F; Del Pozo, J M

    2008-08-01

    Forestier's disease or diffuse idiophatic skeletal hyperostosis is a systemic reumathological abnormality of unknown etiology. It produces calcificationossification of the anterior longitudinal ligament. The low dorsal region is the most affected in the raquis. These patients are tipically asymptomatic or with few symptoms (minimal joint pain, spinal pain, stiffness). Dysphagia is the most common symptom when the disease affects the cervical spine; less frequent is dyspnea, both secondary to extrinsic compression of the esophagus and trachea. Neurological complaints are quite rare. In the 1970s Resnick described specific radiological criteria for the diagnosis of Forestier's disease that are still used today. It affects men more frequently than women (2:1); the peak occurrence is in patients in their 60s. We present two cases diagnosed by severe difficulty with deglution, a 84 years-old woman and a 54 years-old man; we operated on them for surgical decompression of the esophagus with resection of osteophytes C3-C4 and C5-C6 respectively through a conventional anterolateral neck approach. Relief of difficulty in swallowing was immediately ensued.

  18. Clinical outcomes of additional surgery for adjacent segment disease after single-level anterior cervical decompression and fusion.

    Science.gov (United States)

    Li, Jia; Lei, Tao; Liu, Yaming; Wei, Jingchao; Shen, Yong

    2017-01-01

    Adjacent segment disease (ASD) is one of the problematic complications following anterior cervical decompression and fusion (ACDF). The impact of additional surgery with instruments is still unknown. The objective of this study was to investigate the surgical outcomes of additional ACDF with instruments for symptomatic ASD after an initial ACDF using autogenous iliac grafts without instruments. A total of 56 patients who underwent an additional ACDF with instruments for symptomatic new radicular or myelopathic symptoms from ASD between 2006 and 2012. In this study, subjects were 30 men and 26 women with a mean age of 59.2 ± 9.7 years (range, 50-70 years) at revision surgery. Clinical evaluations were performed preoperatively and repeated at 3 years after operation. There were no cases of intraoperative complications, major neurological or vascular, pseudoarthrosis or wound complications. All of them reported significant improvements in JOA, NDI and VAS on arm pain and neck pain from the preoperative means (P< 0.05). According to our study, additional ACDF with instruments had achieved favorable clinical results on patients who underwent initial ACDF using autogenous iliac grafts without instruments for symptomatic new radiculopathy or myelopathy.

  19. Functional outcome of corpectomy in cervical spondylotic myelopathy

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    Williams Kanishka

    2009-01-01

    Full Text Available Background : Cervical spondylotic myelopathy (CSM is serious consequence of cervical intervertebral disk degeneration. Morbidity ranges from chronic neck pain, radicular pain, headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincter dysfunction. Surgical treatment remains the mainstay of treatment once myelopathy develops. Compared to more conventional surgical techniques for spinal cord decompression, such as anterior cervical discectomy and fusion, laminectomy, and laminoplasty, patients treated with corpectomy have better neurological recovery, less axial neck pain, and lower incidences of postoperative loss of sagittal plane alignment. The objective of this study was to analyze the outcome of corpectomy in cervical spondylotic myelopathy, to assess their improvement of symptoms, and to highlight complications of the procedure. Materials and Methods: Twenty-four patients underwent cervical corpectomy for cervical spondylotic myelopathy during June 1999 to July 2005.The anterior approach was used. Each patient was graded according to the Nuricks Grade (1972 and the modified Japanese Orthopaedic Association (mJOA Scale (1991, and the recovery rate was calculated. Results: Preoperative patients had a mean Nurick′s grade of 3.83, which was 1.67 postoperatively. Preoperative patients had a mean mJOA score of 9.67, whereas postoperatively it was 14.50. The mean recovery rate of patients postoperatively was 62.35% at a mean follow-up of 1 year (range, 8 months to 5 years.The complications included one case (4.17% of radiculopathy, two cases (8.33% of graft displacement, and two cases (8.33% of screw back out/failure. Conclusions: Cervical corpectomy is a reliable and rewarding procedure for CSM, with functional improvement in most patients.

  20. Estudo experimental da influência da altura do enxerto ósseo intersomático na estabilidade da fixação monossegmentar anterior da coluna cervical Experimental study of the impact of intersomatic bone graft height on the stability of anterior monosegmental fixation of the cervical spine

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    Jorge Alfredo Léo

    2008-06-01

    Full Text Available OBJETIVO: Estudar experimentalmente a influência da altura do enxerto ósseo intersomático da coluna cervical na estabilidade mecânica da fixação cervical anterior. MÉTODOS: Foram realizados ensaios mecânicos utilizando a coluna cervical de suínos (C3-C4. Foram formados três grupos experimentais compostos por 20 segmentos da coluna cervical (C3-C4, de acordo com o grau de instabilidade produzido e a fixação do segmento vertebral. Grupo I: retirada do disco intervertebral e colocação de enxerto intersomático. Grupo II: retirada do disco intervertebral, colocação de enxerto intersomático e fixação anterior com placa. Grupo III: retirada do disco intervertebral, secção dos ligamentos posteriores e cápsulas articulares bilateralmente, colocação do enxerto intersomático e fixação anterior com placa. Cada grupo experimental foi dividido em dois subgrupos, de acordo com a altura do enxerto ósseo utilizado (3,0mm ou 6,0mm. Os segmentos vertebrais foram submetidos a ensaios mecânicos de flexão, flexão lateral e torção em máquina universal de ensaio. Os parâmetros analisados foram força máxima (N e o momento (Nm para produzir uma deflexão preestabelecida. RESULTADOS: Não foi observada em todos os grupos experimentais diferença estatística dos valores da força máxima (N e do momento (Nm, entre as diferentes alturas (3,0mm e 6,0mm do enxerto ósseo intersomático. Conclusões: A estabilidade mecânica imediata da artrodese cervical monossegmentar anterior não sofreu influência da altura do enxerto ósseo intersomático nos ensaios de flexão, flexão lateral e torção.OBJECTIVE: To perform an experimental study of the impact of intersomatic bone graft height of the cervical spine on the mechanical stability of anterior cervical fixation. METHODS: Mechanical assays were performed using swine cervical spine (C3-C4. Three experimental groups were formed with 20 cervical spine segments (C3-C4 according to the degree

  1. Resultados clínicos e radiológicos en serie de artrodesis cervical anterior con caja de fusión intersomática y placa Resultados clínicos e radiológicos em série de artrodese cervical anterior com dispositivo de fusão intersomática e placa Clinical and radiologica outcomes in series of anterior cervical fusion with intersomatic cage and plate

    Directory of Open Access Journals (Sweden)

    Lyonel Beaulieu Lalanne

    2012-06-01

    Full Text Available OBJETIVOS: Analizar los resultados clínicos e radiológicos de una serie de pacientes sometidos a artrodesis cervical anterior con caja de fusión intersomática (CAGE y placa. MÉTODOS: Análisis retrospectivo de serie de pacientes sometidos a artrodesis cervical anterior con caja de fusión intersomática y placa entre los años 2004 y 2009. Revisión de fichas clínicas y radiografías, registro de edad, sexo, diagnósticos, nivel operado, complicaciones, evolución clínica y radiológica. Técnica quirúrgica de Smith-Robinson. Las cajas de fusión intersomática fueron llenadas con sustitutos de huesos. Deambulación 12 horas después de la cirugía, alta a las 48 horas, collar cervical intermitente por 2 semanas. Evaluación clínica mediante criterios de Odom. Seguimiento 17 a 78 meses. RESULTADOS: Diagnósticos: Hernia del núcleo pulposo (HNP cervical, 44 (71%, mielopatía, 11 (17,7%, fracturas, 7 (11,3%. Nivel 1: 44 (71%, Nivel 2: 15 (24,2%, Nivel 3: (4,8%. El nivel C5-C6 incluyó 92% de los casos. Alivio del dolor radicular: 60 (97%. Recuperación del déficit neurológico: 59 (95,2%. Alivio de la mielopatía: 8/11 pacientes (73%. Alivio del dolor cervical: 56 (90%. Resultados clínicos: 91,9% excelentes y buenos. Complicaciones (12,9%: 4 disfagias transitorias (6,5%, 1 disfagia permanente (1,6%, 2 disfonías transitorias (3,3%, 1 subcidencia con aflojamiento del implante y fractura asintomática de placa (1,6%. No hubo pseudoartrosis. CONCLUSIONES: Esta serie presenta buenos resultados clínicos, com alivio del dolor y recuperación neurológica comparables con los hallazgos en la literatura. El uso de la caja de fusión intersomática evita complicaciones de la zona dadora y, cuando es asociado a placa cervical anterior permite fijación intersomática inmediata, dando soporte estructural adecuado, con buenos resultados y sin complicaciones a largo plazo.OBJETIVOS: Analisar os resultados clínicos e radiológicos de uma série de

  2. One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior-posterior approach.

    Science.gov (United States)

    He, Axiang; Xie, Dong; Cai, Xiaomin; Qu, Bo; Kong, Qin; Xu, Chenhui; Yang, Lili; Chen, Xiongsheng; Jia, Lianshun

    2017-07-01

    The aim of the article is to investigate the efficacy and safety of 1-stage surgical therapy via combined anterior-posterior approach on cervical spine fracture in patients with ankylosing spondylitis (AS).We retrospectively analyzed profiles of 12 AS patients with severe fracture-dislocation of cervical spine received 1-stage combined anterior-posterior surgery in our hospital from October, 2013, to October, 2015, including clinical characteristics, follow-up data, and imaging records. We compared the parameters before and after surgery on the basis of neurological function, bone fusion, Cobb angles of operation segment, Barthel index (BI) score, and incidence rate of complications.A total of 12 patients received 1-stage surgery via combined anterior-posterior approach within 3 days after injury. No severe complications and death occurred. All patients received the successfully anatomical reduction of fracture-dislocation, in which 9 achieved function restoration. The latest follow-up showed the neurological function status of patients was improved. The Cobb angles of operation segments were recovered; the rate of bone fusion was 66.7% at 3 months and 100% at 6 months post-operation. The BI score was improved, 4 cases of moderate dependence and 8 of slight dependence at the latest follow-up compared to 10 of severe dependence and 2 of moderate dependence preoperation. In no cases did severe complications from implanted instrumentation occur.It was high efficacy and safety that the surgical therapy was performed on cervical fracture-dislocation in AS patients by the 1-stage combined anterior-posterior approach. The key of the surgery is the robust stabilization and full decompression of fracture spine at early stage. In addition, if spinal anatomical reduction of fracture segments is difficult to be achieved, the functional restoration should be adopted during the surgery.

  3. Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia.

    Science.gov (United States)

    Yang, Hai-song; Chen, De-yu; Lu, Xu-hua; Yang, Li-li; Yan, Wang-jun; Yuan, Wen; Chen, Yu

    2010-03-01

    Ossification of the posterior longitudinal ligament (OPLL) is a common spinal disorder that presents with or without cervical myelopathy. Furthermore, there is evidence suggesting that OPLL often coexists with cervical disc hernia (CDH), and that the latter is the more important compression factor. To raise the awareness of CDH in OPLL for spinal surgeons, we performed a retrospective study on 142 patients with radiologically proven OPLL who had received surgery between January 2004 and January 2008 in our hospital. Plain radiograph, three-dimensional computed tomography construction (3D CT), and magnetic resonance imaging (MRI) of the cervical spine were all performed. Twenty-six patients with obvious CDH (15 of segmental-type, nine of mixed-type, two of continuous-type) were selected via clinical and radiographic features, and intraoperative findings. By MRI, the most commonly involved level was C5/6, followed by C3/4, C4/5, and C6/7. The areas of greatest spinal cord compression were at the disc levels because of herniated cervical discs. Eight patients were decompressed via anterior cervical discectomy and fusion (ACDF), 13 patients via anterior cervical corpectomy and fusion (ACCF), and five patients via ACDF combined with posterior laminectomy and fusion. The outcomes were all favorable. In conclusion, surgeons should consider the potential for CDH when performing spinal cord decompression and deciding the surgical approach in patients presenting with OPLL.

  4. Descrição de técnica de redução cirúrgica das luxações facetárias da coluna cervical baixa por via anterior Descripción de la técnica quirúrgica para reducción de las luxaciones facetarias de la columna cervical baja por acceso anterior Description of surgical technique for reduction of facet dislocations of the lower cervical spine by anterior approach

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    André Rafael Hübner

    2012-12-01

    Full Text Available O trabalho descreve uma técnica cirúrgica de redução anterior das luxações facetárias da coluna cervical e discute as indicações para cirurgia por via anterior para as luxações da coluna cervical baixa. A técnica descrita neste artigo oferece excelentes resultados, conforme revisão bibliográfica e dos resultados do Serviço, tendo sido aplicada em até 95% dos casos de fraturas-luxações. Não será abordada a apresentação de resultados neste trabalho, apenas a descrição e discussão da técnica aberta por via anterior. Observações de quarenta e um pacientes tratados nos últimos dez anos por esta técnica demonstram bons resultados quanto a pós-operatório menos doloroso, recuperação funcional extremamente rápida e complicações pouco frequentes.El artículo describe una técnica quirúrgica para las luxaciones facetarias de la columna cervical y discute las indicaciones para la cirugía de luxación de la columna cervical baja por lo acceso anterior. La técnica descrita en este artículo proporciona excelentes resultados según la revisión de la literatura y los resultados del Servicio, después de haber sido aplicado a 95% de los casos de fracturas-luxaciones. No serán abordados resultados, sino que únicamente la descripción y discusión de la técnica de reducción abierta por acceso vía anterior. Las observaciones en cuarenta y un pacientes operados en los últimos diez años por esta técnica muestran resultados sorprendentes con respecto a un pos operatorio menos doloroso, con recuperación funcional extremadamente rápida y complicaciones menos frecuentes.This paper describes a surgical technique for anterior reduction of the spinal facets dislocations and discusses its indications for surgery of lower cervical dislocations by anterior approach. The technique described in this article provides excellent results according to literature review and the results of the Service, having been applied to 95% of

  5. Sporadic lower motor neuron disease with a snake eyes appearance on the cervical anterior horns by MRI.

    Science.gov (United States)

    Sasaki, Shoichi

    2015-09-01

    Lower motor neuron disease (LMND) is the term generally used to describe diseases in which only lower motor neuron signs are detected. A snake eyes appearance on magnetic resonance imaging (MRI) is associated with a wide spectrum of neurological conditions including LMND. The author reports on three unique LMND patients with upper limb muscle weakness and atrophy who show a snake eyes appearance by MRI. The patients were aged 18, 40 and 52 years, respectively, at the onset of the disease and had a longstanding clinical course (more than 10 years for two patients and 8 years for one patient). They were followed up for more than 6 years. Clinical manifestations were characterized by (1) longstanding slow progression or delayed spontaneous arrest of asymmetric lower motor neuron signs localized exclusively in the upper extremities with unilateral predominance and distal or proximal preponderance; (2) the absence of upper motor neuron signs, bulbar signs, sensory disturbances and respiratory involvement; (3) a snake eyes appearance on the anterior horns of the cervical cord over more than 3 vertebrae by axial T2-weighted MRI and a longitudinal linear-shaped T2-signal hyperintensity by sagittal MRI; (4) neurogenic change with fasciculation and denervation potentials (fibrillation and a positive sharp wave) confined to the affected muscles by needle electromyogram; and (5) normal cerebrospinal fluid and a normal creatine kinase level. These cases did not fall into any existing category of LMND, such as progressive muscular atrophy, flail arm syndrome or Hirayama disease. These patients should be classified as sporadic LMND with snake eyes on MRI with a relatively benign prognosis. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Incidence and risk factors for pneumonia following anterior cervical decompression and fusion procedures: an ACS-NSQIP study.

    Science.gov (United States)

    Bohl, Daniel D; Ahn, Junyoung; Rossi, Vincent J; Tabaraee, Ehsan; Grauer, Jonathan N; Singh, Kern

    2016-03-01

    Postoperative pneumonia has important clinical consequences for both patients and the health-care system. Few studies have examined pneumonia following anterior cervical decompression and fusion (ACDF) procedures. This study aimed to determine the incidence and risk factors for development of pneumonia following ACDF procedures. A retrospective cohort study of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program was carried out. This study comprised 11,353 patients undergoing ACDF procedures during 2011-2013. The primary outcome was diagnosis of pneumonia in the first 30 postoperative days. Independent risk factors for the development of pneumonia were identified using multivariate regression. Readmission rates were compared between patients who did and did not develop pneumonia using multivariate regression that adjusted for all demographic, comorbidity, and procedural characteristics. The incidence of pneumonia was 0.45% (95% confidence interval=0.33%-0.57%). In the multivariate analysis, independent risk factors for the development of pneumonia were greater age (prisk [RR]=5.3, ppneumonia following discharge had a higher readmission rate than other patients (72.7% vs. 2.4%, adjusted RR=24.5, ppneumonia. Pneumonia occurs in approximately 1 in 200 patients following ACDF procedures. Patients who are older, are functionally dependent, or have chronic obstructive pulmonary disease are at greater risk. These patients should be counseled, monitored, and targeted with preventative interventions accordingly. Greater operative duration is also an independent risk factor. Approximately three in four patients who develop pneumonia following hospitalization for ACDF procedures are readmitted. This elevated readmission rate has implications for bundled payments and hospital performance reports. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Cervical Laminoplasty

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    ... Nerve Tests: EMG, NCV and SEEP Alternative Medicine Acupuncture Herbal Supplements Surgical Options Anterior Cervical Fusion Artifical ... tasks. A NASS physician can perform a thorough history to evaluate your symptoms and any recent changes. ...

  8. Construction and accuracy assessment of patient-specific biocompatible drill template for cervical anterior transpedicular screw (ATPS insertion: an in vitro study.

    Directory of Open Access Journals (Sweden)

    Maoqing Fu

    Full Text Available BACKGROUND: With the properties of three-column fixation and anterior-approach-only procedure, anterior transpedicular screw (ATPS is ideal for severe multilevel traumatic cervical instabilities. However, the accurate insertion of ATPS remains challenging. Here we constructed a patient-specific biocompatible drill template and evaluated its accuracy in assisting ATPS insertion. METHODS: After ethical approval, 24 formalin-preserved cervical vertebrae (C2-C7 were CT scanned. 3D reconstruction models of cervical vertebra were obtained with 2-mm-diameter virtual pin tracts at the central pedicles. The 3D models were used for rapid prototyping (RP printing. A 2-mm-diameter Kirschner wire was then inserted into the pin tract of the RP model before polymethylmethacrylate was used to construct the patient-specific biocompatible drill template. After removal of the anterior soft tissue, a 2-mm-diameter Kirschner wire was inserted into the cervical pedicle with the assistance of drill template. Cadaveric cervical spines with pin tracts were subsequently scanned using the same CT scanner. A 3D reconstruction was performed of the scanned spines to get 3D models of the vertebrae containing the actual pin tracts. The deviations were calculated between 3D models with virtual and actual pin tracts at the middle point of the cervical pedicle. 3D models of 3.5 mm-diameter screws were used in simulated insertion to grade the screw positions. FINDINGS: The patient-specific biocompatible drill template was constructed to assist ATPS insertion successfully. There were no significant differences between medial/lateral deviations (P = 0.797 or between superior/inferior deviations (P = 0.741. The absolute deviation values were 0.82±0.75 mm and 1.10±0.96 mm in axial and sagittal planes, respectively. In the simulated insertion, the screws in non-critical position were 44/48 (91.7%. CONCLUSIONS: The patient-specific drill template is biocompatible, easy

  9. Prevalence and Outcomes in Patients Undergoing Reintubation After Anterior Cervical Spine Surgery: Results From the AOSpine North America Multicenter Study on 8887 Patients.

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    Nagoshi, Narihito; Fehlings, Michael G; Nakashima, Hiroaki; Tetreault, Lindsay; Gum, Jeffrey L; Smith, Zachary A; Hsu, Wellington K; Tannoury, Chadi A; Tannoury, Tony; Traynelis, Vincent C; Arnold, Paul M; Mroz, Thomas E; Gokaslan, Ziya L; Bydon, Mohamad; De Giacomo, Anthony F; Jobse, Bruce C; Massicotte, Eric M; Riew, K Daniel

    2017-04-01

    A multicenter, retrospective cohort study. To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery. A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey. Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life. Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.

  10. Cervical Radiculopathy: Incidence and Treatment of 1,420 Consecutive Cases

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    Nemani, Venu M.; Piyaskulkaew, Chaiwat; Vargas, Samuel Romero; Riew, K. Daniel

    2016-01-01

    Study Design Retrospective case series. Purpose To determine the incidence of cervical radiculopathy requiring operative intervention by level and to report on the methods of treatment. Overview of Literature Cervical radiculopathy is a common cause of pain and can result in progressive neurological deficits. Although the pathology is well understood, the actual incidence of cervical radiculopathy at particular spinal levels ultimately requiring operative intervention is unknown. Methods A large consecutive series of patients operated on by a single surgeon were retrospectively analyzed. The incidence of cervical radiculopathy at each level was defined for every patient. Procedures used for operative treatment were noted. Health related quality of life (HRQL) scores were collected both pre-operatively and postoperatively. Results There were 1305 primary and 115 revision operations performed. The most common primary procedures performed were anterior cervical discectomy and fusion (ACDF, 50%) and anterior cervical corpectomy and fusion (ACCF, 28%). The most commonly affected levels were C6 (66%) and C7 (62%). Reasons for revision were pseudarthrosis (27%), clinical adjacent segment pathology (CASP, 63%), persistent radiculopathy (11%), and hardware-related (2.6%). The most common procedures performed in the revision group were posterior cervical decompression and fusion (PCDF, 42%) and ACDF (40%). The most commonly affected levels were C7 (43%) and C5 (30%). Among patients that had their index surgery at our institution, the revision rate was 6.4%. In both primary and revision cases there was a significant improvement in Neck Disability Index and visual analogue scale scores postoperatively. Postoperative HRQL scores in the revision cases were significantly worse than those in the primary cases (p cervical radiculopathy by level and operative outcomes in patients undergoing cervical decompression. The incidence of CASP was 4.2% in 3.3 years in this single

  11. Artificial Cervical Disc Arthroplasty (ACDA): tips and tricks

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    Khadivi, Masoud; Rahimi Movaghar, Vafa; Abdollahzade, Sina

    2012-01-01

    Abstract: Background: Anterior cervical discectomy and fusion (ACDF) is currently treatment of choice for managing medical therapy refractory cervical degenerative disc disease. Numerous studies have demonstrated the effectiveness of ACDF; patients generally experience rapid recoveries, and dramatic improvement in their pain and quality of life. However, as several studies reported symptomatic adjacent segment disease attributed to fusions’ altered kinematics, cervical disc arthroplasty emerged as a new motion-sparing alternative to fusion. Fusion at one level increases motion at adjacent levels along with increased intradiscal pressures. This phenomenon can result in symptomatic adjacent level degeneration, which can necessitate reoperation at these levels. The era of cervical arthroplasty began in Europe in the late 1990s. In recent years, artificial cervical disc arthroplasty (ACDA) has been increasingly used by spine surgeons for degenerative cervical disc disease. There have been several reports of safety, efficacy and indications of ACDA. Cervical arthroplasty offers several theoretical advantages over anterior cervical discectomy and fusion (ACDF) in the treatment of selected patients with medically refractory cervical radiculopathy. Preserving motion at the operated level, cervical TDR has the potential to decrease the occurrence of adjacent segment degeneration. There are a few studies on the efficacy and effectiveness of ACDA compared to cervical fusion. However, the true scenery of cervical arthroplasty yet to be identified. Objective: This study is intended to define patients' characteristics and outcomes of ACDA by a single surgeon in Iran. Methods: This retrospective study was performed in two general Hospitals in Tehran, Iran from 2005 To 2010. All patients were operated by one senior neurospine surgeon. One hundred fifty three patients were operated in this period. All patients signed the informed consent form prior to surgery. All patients

  12. A novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its use on the anterior upper cervical screw fixation

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    Ai-Min Wu

    2016-02-01

    Full Text Available Purpose. To investigate a novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its potential use on the anterior upper cervical screw fixation. Methods. We have used the reverse engineering software (image-processing software and computer-aided design software to create the approximate and optimal digital interarticular channel of atlas for 60 participants. Angles of channels, diameters of inscribed circles, long and short axes of ellipses were measured and recorded, and gender-specific analysis was also performed. Results. The channels provided sufficient space for one or two screws, and the parameters of channels are described. While the channels of females were smaller than that of males, no significant difference of angles between males and females were observed. Conclusion. Our study demonstrates the radiological features of approximate digital interarticular channels, optimal digital interarticular channels of atlas, and provides the reference trajectory of anterior transarticular screws and anterior occiput-to-axis screws. Additionally, we provide a protocol that can help make a pre-operative plan for accurate placement of anterior transarticular screws and anterior occiput-to-axis screws.

  13. A novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its use on the anterior upper cervical screw fixation.

    Science.gov (United States)

    Wu, Ai-Min; Wang, Wenhai; Xu, Hui; Lin, Zhong-Ke; Yang, Xin-Dong; Wang, Xiang-Yang; Xu, Hua-Zi; Chi, Yong-Long

    2016-01-01

    Purpose. To investigate a novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its potential use on the anterior upper cervical screw fixation. Methods. We have used the reverse engineering software (image-processing software and computer-aided design software) to create the approximate and optimal digital interarticular channel of atlas for 60 participants. Angles of channels, diameters of inscribed circles, long and short axes of ellipses were measured and recorded, and gender-specific analysis was also performed. Results. The channels provided sufficient space for one or two screws, and the parameters of channels are described. While the channels of females were smaller than that of males, no significant difference of angles between males and females were observed. Conclusion. Our study demonstrates the radiological features of approximate digital interarticular channels, optimal digital interarticular channels of atlas, and provides the reference trajectory of anterior transarticular screws and anterior occiput-to-axis screws. Additionally, we provide a protocol that can help make a pre-operative plan for accurate placement of anterior transarticular screws and anterior occiput-to-axis screws.

  14. Aortic arch origin of the left vertebral artery: An Anatomical and Radiological Study with Significance for Avoiding Complications with Anterior Approaches to the Cervical Spine.

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    Tardieu, Gabrielle G; Edwards, Bryan; Alonso, Fernando; Watanabe, Koichi; Saga, Tsuyoshi; Nakamura, Moriyoshi; Motomura, Mayuko; Sampath, Raghuram; Iwanaga, Joe; Goren, Oded; Monteith, Stephen; Oskouian, Rod J; Loukas, Marios; Tubbs, R Shane

    2017-09-01

    Complications from anterior approaches to the cervical spine are uncommon with normal anatomy. However, variant anatomy might predispose one to an increased incidence of injury during such procedures. We hypothesized that left vertebral arteries that arise from the aortic arch instead of the subclavian artery might take a more medial path in their ascent making them more susceptible to iatrogenic injury. Fifty human adult cadavers were examined for left vertebral arteries having an aortic arch origin and these were dissected along their entire cervical course. Additionally, two radiological databases of CTA and arteriography procedures were retrospectively examined for cases of aberrant left vertebral artery origin from the aortic arch over a two-year period. Two cadaveric specimens (4%) were found to have a left vertebral artery arising from the aortic arch. The retrospective radiological database analysis identified 13 cases (0.87%) of left vertebral artery origin from the aortic arch. Of all cases, vertebral arteries that arose from the aortic arch were much more likely to not only have a more medial course (especially their preforaminal segment) over the cervical vertebral bodies but also to enter a transverse foramen that was more cranially located than the normal C6 entrance of the vertebral artery. Spine surgeons who approach the anterior cervical spine should be aware that an aortic origin of the left vertebral artery is likely to be closer to the midline and less protected above the C6 vertebral level. Clin. Anat. 30:811-816, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  15. White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF: A “no reflow phenomenon”?

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    Giuseppe Roberto Giammalva

    2017-03-01

    Conclusions: Despite the pathophysiology of non-reflow phenomenon is not widely known, we suspect that an improper blood flow after the double-level discectomy could have led to the changes in medullar hemodynamics.

  16. Avaliação do tratamento da discopatia degenerativa cervical pela artrodese via anterior utilizando placas associadas a cages ou cages em peek isoladamente Evaluación del tratamiento de la enfermedad degenerativa del disco cervical por la artrodesis anterior utilizando placas asociadas con jaulas o jaulas en peec, aisladamente Evaluation of cervical degenerative disc disease treatment by anterior arthrodesis using plates associated with cages or cages in peek alone

    Directory of Open Access Journals (Sweden)

    André Rafael Hübner

    2011-01-01

    Full Text Available OBJETIVOS: Avaliar comparativamente o tratamento da discopatia degenerativa cervical por discectomia e artrodese cervical via anterior utilizando placas associadas a cages ou cages em PEEK isoladamente. MÉTODOS: Foi realizado um estudo retrospectivo comparativo entre dois grupos de pacientes operados pela técnica de discectomia e artrodese cervical via anterior. Foram selecionados aleatoriamente 70 pacientes, 35 operados com o método de fixação com placas associadas a cages - denominado Grupo I - e 35 com o cage em PEEK isoladamente - Grupo II. Realizou-se anamnese, exame físico, escores de dor (escala visual e analógica da dor e função (critérios de Odom's, SF-36, Indice de incapacidade do pescoço o pré e pós-operatório e exames de imagem. RESULTADOS: Houve predominância de pacientes do sexo feminino em ambos os grupos, com média de idade de 55 anos no Grupo I e 47 no Grupo II. Ambos os grupos apresentaram distribuição semelhante quanto ao número de níveis operados, assim como nas complicações encontradas e escores de dor, cervicalgia e SF36 no pré e pós-operatório. Houve 97.1% de fusão com 94.3% de bons resultados no Grupo I e 100% de fusão, com 97 % de bons resultados no Grupo II. CONCLUSÕES: O estudo comparativo da utilização de placas com cages e cages em PEEK isoladamente apresentou resultados semelhantes e satisfatórios para os grupos estudados, não se constatando superioridade ou inferioridade de um método com relação ao outro.OBJETIVOS: Evaluar comparativamente el tratamiento de la enfermedad degenerativa del disco cervical por discectomía y artrodesis cervical vía anterior, utilizando placas asociadas con el uso de jaulas o estas en PEEK [Poliéster-Éter-Éter-Cetona], aisladamente. MÉTODOS: fue realizado un estudio retrospectivo comparativo de dos grupos de pacientes tratados con la técnica de discectomía y artrodesis cervical vía anterior. Se seleccionaron al azar 70 pacientes, 35 operados

  17. Segmental kyphosis after cervical interbody fusion with stand-alone polyetheretherketone (PEEK) cages: a comparative study on 2 different PEEK cages.

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    Kim, Chi Heon; Chung, Chun Kee; Jahng, Tae-Ahn; Park, Sung Bae; Sohn, Seil; Lee, Sungjoon

    2015-02-01

    Retrospective comparative study. Two polyetheretherketone (PEEK) cages of different designs were compared in terms of the postoperative segmental kyphosis after anterior cervical discectomy and fusion. Segmental kyphosis occasionally occurs after the use of a stand-alone cage for anterior cervical discectomy and fusion. Although PEEK material seems to have less risk of segmental kyphosis compared with other materials, the occurrence of segmental kyphosis for PEEK cages has been reported to be from 0% to 29%. There have been a few reports that addressed the issue of PEEK cage design. A total of 41 consecutive patients who underwent single-level anterior discectomy and fusion with a stand-alone cage were included. Either a round tube-type (Solis; 18 patients, S-group) or a trapezoidal tube-type (MC+; 23 patients, M-group) cage was used. The contact area between the cage and the vertebral body is larger in MC+ than in Solis, and anchoring pins were present in the Solis cage. The effect of the cage type on the segmental angle (SA) (lordosis vs. kyphosis) at postoperative month 24 was analyzed. Preoperatively, segmental lordosis was present in 12/18 S-group and 16/23 M-group patients (P=0.84). The SA was more lordotic than the preoperative angle in both groups just after surgery, with no difference between groups (P=0.39). At 24 months, segmental lordosis was observed in 9/18 S-group and 20/23 M-group patients (P=0.01). The patients in M-group were 7.83 times more likely than patients in S-group (P=0.04; odds ratio, 7.83; 95% confidence interval, 1.09-56.28) not to develop segmental kyphosis. The design of the PEEK cage used may influence the SA, and this association needs to be considered when using stand-alone PEEK cages.

  18. Cervical facet dislocation adjacent to the fused motion segment

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    Kunio Yokoyama

    2016-01-01

    Full Text Available This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B. Cervical computed tomography (CT indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D. In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation.

  19. Incidence and Risk Factors of Postoperative Adjacent Segment Degeneration Following Anterior Decompression and Instrumented Fusion for Degenerative Disorders of the Cervical Spine.

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    Wang, Hui; Ma, Lei; Yang, Dalong; Yang, Sidong; Ding, Wenyuan

    2017-09-01

    To explore incidence and risk factors of postoperative adjacent segment degeneration (ASD) following anterior decompression and instrumented fusion for degenerative disorders of the cervical spine. Medical records from January 2005 to September 2011 of 283 patients were retrospectively reviewed. Patients were divided into 2 groups based on occurrence of ASD at follow-up: ASD group and no ASD group. To investigate risk for occurrence of ASD, 3 sets of factors were analyzed statistically: patient characteristics, surgical variables, and radiographic parameters. Postoperative ASD developed in 68 of 283 patients. There was no statistically significant difference between the 2 groups in patient characteristics or the surgical variables of surgical strategy, surgical time, and blood loss. The number of patients receiving 2-level spinal fusion was higher in the ASD group. Upper instrumented vertebra at C5 was more common in the ASD group. There was no difference between groups in all but 1 of the radiographic parameters; the plate-to-disc distance was much smaller in the ASD group. Logistic regression analysis revealed that upper instrumented vertebra at C5, plate-to-disc distance fusion were independently associated with ASD. Patients with degenerative disorders of the cervical spine who receive 2-level cervical fusion and with upper instrumented vertebra at C5 are at high potential risk of ASD. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. A safe approach to explore/identify the V(2) segment of the vertebral artery during anterior approaches to cervical spine and/or arterial repairs: anatomical study.

    Science.gov (United States)

    Nourbakhsh, Ali; Yang, Jinping; Gallagher, Sean; Nanda, Anil; Vannemreddy, Prasad; Garges, Kim J

    2010-01-01

    The purpose of this study was to find a landmark according to which the surgeon can dissect the cervical spine safely, with the lowest possibility of damaging the vertebral artery (VA) during anterior approaches to the cervical spine or the VA. The "safe zone" for each level of the cervical spine was described as an area where the surgeon can start from the midline in that zone and dissect the soft tissue laterally to end up on the transverse process and cross the VA while still on the transverse process. In other words, safe zone signifies the narrowest width of the transverse process at each level. In such an approach, the VA is protected from the inadvertent deep penetration of the instruments by the transverse process. The surgical safe zone for each level was the common area among at least 95% of the safe zones for that level. For the purpose of defining the upper and lower borders of the safe zone for each level, the line passing from the upper vertebral border perpendicular to the midline (upper vertebral border line) was used as a reference. Cervical spines of 64 formalin-fixed cadavers were dissected. The soft tissue in front of the transverse process and intertransverse space was removed. Digital pictures of the specimens were taken before and after removal of the transverse processes, and the distance to the upper and lower border of the safe zone from the upper vertebral border line was measured on the digital pictures with Image J software. The VA diameter and distance from the midline at each level were also measured. To compare the means, the authors used t-test and ANOVA. The surgical safe zone lies between 1 mm above and 1 mm below the upper vertebral border at the fourth vertebra, 2 mm above and 1 mm below the upper vertebral border at the fifth vertebra, and 1 mm above and 2 mm below the upper vertebral border of the sixth vertebra. The VA was observed to be tortuous in 13% of the intertransverse spaces. There is a positive association between

  1. [Early outcome of using Zero-profile implant system in treatment of cervical spondylosis].

    Science.gov (United States)

    Fang, Ming; Lu, Jianmeng; Wei, Yongli; Yu, Wuliang; Wang, Xingwu; Ouyang, Jia

    2013-10-01

    To evaluate the early outcome of anterior cervical discectomy and fusion (ACDF) using a Zero-profile implant system (Zero-P) for interbody fusion in the treatment of cervical spondylosis. Between March 2010 and June 2011, 25 patients with cervical spondylosis underwent ACDF with Zero-P. There were 13 males and 12 females with an average age of 44.2 years (range, 26-67 years), including 14 cases of nerve root cervical spondylosis, 6 cases of spinal cervical spondylosis, and 5 cases of mixed cervical spondylosis. The disease duration was 3-120 months (median, 25 months). Single segment was involved in 20 cases, 2 segments in 4 cases, and 3 segments in 1 case. A total of 31 Zero-P were implanted (3 at C3, 4, 8 at C4, 5, 12 at C5, 6, and 8 at C6, 7). Primary cervical operation was performed in 23 cases and re-operation in 2 cases. Before and after operation, the height of intervertebral space and the cervical Cobb angle were measured; clinical outcome was evaluated using visual analogue scale (VAS) score for pain in the neck and upper limb, and Japanese Orthopaedic Association (JOA) score for myelopathy; and intervertebral fusion and the incidence of dysphagia were also observed. All incisions healed by first intention. All the patients were followed up 12-16 months (mean, 13.9 months). Interbody bone fusion was obtained, and the fusion time was 2.7-6.0 months (mean, 3.8 months). Three patients had dysphagia after operation; symptom disappeared at 1 week and 3 months after operation in 2 cases and 1 case, respectively. No fixation loosening, subsidence, or breakage occurred. The height of intervertebral space was significantly improved (P 0.05). The VAS score was significantly reduced (P spondylosis is satisfactory and reliable, and it can restore and maintain the cervical alignment and disc height, and disc has low incidence of postoperative dysphagia.

  2. [Clinical observation of dynamic cervical implant (DCI) internal fixation in the surgical treatment of cervical spondylosis].

    Science.gov (United States)

    Li, Zhong-hai; Hou, Shu-xun; Li, Li; Yu, Shun-zhi; Hou, Tie-sheng

    2014-12-01

    To investigate the early clinical effects and radiological outcome of dynamic cervical implant (DCI) internal fixation in treating cervical spondylosis, and evaluate its safety and efficiency. From June 2009 to December 2011, 19 patients with cervical spondylosis correspond to the indication of DCI internal fixation in the study, including 5 cases of cervical spondylotic myelopathy and 14 cases of cervical spondylotic radiculopathy. There were 8 males and 11 females, aged from 35 to 54 years with a mean of 43.2 years. Pathological segments included C3,4 in 1 case, C4,5 in 6, C5,6 in 6, C6,7 in 4, C3,4 and C5,6, C6,7 in 2. All patients were treated with anterior discectomy and decompression and DCI internal fixation, meanwhile, 2 cases of them with anterior cervical corpectomy and fusion plate fixation. Clinical evaluation included Modified Japanese orthopedics association (mJOA), neck disability index (NDI), visual analogue scale (VAS) score and patient satisfaction index (PSI) at pre-operation and final follow-up. Radiographic evaluation included flexion/extension lateral view at operative level and adjacent segment. The adjacent level degeneration was analyzed according to Miyazaki classification on MRI images. All patients were followed up from 12 to 42 months with an average of 19.8 months. Preoperative mJOA score was 13.6±1.1 and at final follow-up was 16.3±1.2 with improvement rate of 85.0%. Preoperative VAS,NDI was 6.6± 1.4, 17.1±7.4 and at final follow-up was 1.4±0.8, 6.1±3.9, respectively; there was statistical significance in all above-mentioned results between preoperative and final follow-up (P0.05). Preoperative DHI at operation level was (6.3±1.1) mm and final follow-up was (7.1±0.8) mm, there was statistical significance in DHI between preoperative and final follow-up (Pspondylosis with dynamic cervical implant can got satisfactory outcome in early follow-up. Activity of operative segment obtain reservation in some degree. The incidence of

  3. Cervical corpectomy with preserved posterior vertebral wall for cervical spondylotic myelopathy: a randomized control clinical study.

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    Ying, Zhang; Xinwei, Wang; Jing, Zhang; Shengming, Xu; Bitao, Lv; Tao, Zhang; Wen, Yuan

    2007-06-15

    Cervical corpectomy with preserved posterior vertebral wall (CPW) had been performed by the senior author (Y.W.) since 1999. A prospective study had been conducted to evaluate the efficacy of CPW since 2001. To validate the clinical outcome of CPW against conventional corpectomy (CC). Anterior surgical managements of cervical spondylotic myelopathy (CSM) include discectomy and corpectomy. Both have significant disadvantages, including low fusion rates and residual symptoms. A procedure incorporating multilevel discectomy, corpectomy with preserved posterior vertebral wall, autograft and plating was described. By keeping the posterior vertebral wall (PW), infringement of the vein plexus and spinal canal was avoided and more fusion site was available. From March 2001 to March 2004, 178 cases of CSM were randomized to undergo CPW (n = 89) or CC (n = 89). Arthrodesis was done with autogenous iliac bone graft or titanium cage supplemented with anterior self-lock plates in both groups. Operation time, blood loss, days of hospitalization, the numbers and types of complications, and preoperative and postoperative JOA scores were recorded. Fusion rate, segmental lordosis, and disc height were assessed by roentgenography. Three-dimensional reconstructions of CT scan were used to confirm fusion evidence. Average operation time and blood loss decreased significantly in the CPW group (98.06 +/- 19.42 minutes, and 131.69 +/- 62.41 mL) as compared with those in the CC group (108.45 +/- 22.35 minutes, and 181.57 +/- 82.10 mL) (P < 0.05). There were 2 cases of epidural bleeding and 1 case of CSF leak in the CC group. Other complications were minor. JOA improvement scores were similar in both groups. Roentgenograms showed that the fusion rate was 100% at 6 months postoperatively in both groups. CT scans showed that PW fused with grafts and bone dust in cages. Improvement in segmental lordosis and disc height was similar in both groups. CPW is a feasible procedure for anterior

  4. Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up.

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    Peolsson, Anneli; Söderlund, Anne; Engquist, Markus; Lind, Bengt; Löfgren, Håkan; Vavruch, Ludek; Holtz, Anders; Winström-Christersson, Annelie; Isaksson, Ingrid; Öberg, Birgitta

    2013-02-15

    Prospective randomized study. To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program. No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging-verified nerve compression due to cervical disc disease. Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging-verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups. There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17-0.91). Both groups showed improvements over time in neck muscle endurance (P ≤ 0.01), manual dexterity (P ≤ 0.03), and right-handgrip strength (P = 0.01). Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery. 2.

  5. Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography.

    Science.gov (United States)

    Anderst, William

    2016-01-01

    Arthrodesis is the standard of care for numerous pathologic conditions of the cervical spine and is performed over 150,000 times annually in the United States. The primary long-term concern after this surgery is adjacent segment disease (ASD), defined as new clinical symptoms adjacent to a previous fusion. The incidence of adjacent segment disease is approximately 3% per year, meaning that within 10 years of the initial surgery, approximately 25% of cervical arthrodesis patients require a second procedure to address symptomatic adjacent segment degeneration. Despite the high incidence of ASD, until recently, there was little data available to characterize in vivo adjacent segment mechanics during dynamic motion. This manuscript reviews recent advances in our knowledge of adjacent segment mechanics after cervical arthrodesis that have been facilitated by the use of dynamic biplane radiography. The primary observations from these studies are that current in vitro test paradigms often fail to replicate in vivo spine mechanics before and after arthrodesis, that intervertebral mechanics vary among cervical motion segments, and that joint arthrokinematics (i.e., the interactions between adjacent vertebrae) are superior to traditional kinematics measurements for identifying altered adjacent segment mechanics after arthrodesis. Future research challenges are identified, including improving the biofidelity of in vitro tests, determining the natural history of in vivo spine mechanics, conducting prospective longitudinal studies on adjacent segment kinematics and arthrokinematics after single and multiple-level arthrodesis, and creating subject-specific computational models to accurately estimate muscle forces and tissue loading in the spine during dynamic activities. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  6. Reappraisal of the diagnosis in cervical disc disease: The posterior longitudinal ligament perforated or not

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    Isu, Toyohiko; Iwasaki, Yoshinobu; Abe, Hiroshi; Tashiro, Kunio; Miyasaka, Kazuo; Ito, Terufumi

    1986-05-01

    Herniated nuclear material of the cervical disc often perforates the posterior longitudinal ligament. Of 22 patients who were operated on by an anterior approach, 10 were of this type (the subligamentous type of cervical disc protrusion), while in the remaining 12 patients and 15 discs the protruded disc caused no tear in the ligament (the epiligamentous type). Myelography and CT myelography of these patients were reviewed. On CT myelography a localized and sharply demarcated excavation of the metrizamide ring was commonly found in the subligamentous type. Myelographic lateral view in this group shows a moderate or large indentation of the metrizamide column, since the herniated nucleus pulposus sometimes migrates caudally or cephalically. A small myelographic deformity coupled with diffuse excavation of the metrizamide ring on a CT myelogram leads us to the diagnosis of the epiligamentous type of cervical disc protrusion. In such cases, excision of the ligament is unnecessary during exploration of the discs, except when there is marked depression in the posterior longitudinal ligament. Presurgical recognition of both anatomical processes must be stressed for anterior discectomy.

  7. Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up.

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    Fay, Li-Yu; Huang, Wen-Cheng; Wu, Jau-Ching; Chang, Hsuan-Kan; Tsai, Tzu-Yun; Ko, Chin-Chu; Tu, Tsung-Hsi; Wu, Ching-Lan; Cheng, Henrich

    2014-09-01

    radiculopathy group (p = 0.995). At a mean of over 3 years postoperatively, no secondary surgery was reported in either group. The severity of myelopathy improves after cervical arthroplasty in patients with CSM caused by DDD. At 3-year follow-up, the clinical and radiographic outcomes of cervical arthroplasty in DDD patients with CSM are similar to those patients who have only cervical radiculopathy. Therefore, cervical arthroplasty is a viable option for patients with CSM caused by DDD who require anterior surgery. However, comparison with the standard surgical treatment of anterior cervical discectomy and fusion is necessary to corroborate the outcomes of arthroplasty for CSM.

  8. Posterior endoscopic discectomy: Results in 300 patients

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    Mohinder Kaushal

    2012-01-01

    Full Text Available Background: Posterior endoscopic discectomy is an established method for treatment of lumbar disc herniation. Many studies have not been reported in literature for lumbar discectomy by Destandau Endospine System. We report a series of 300 patients operated for lumbar dissectomy by Destandau Endospine system. Materials and Methods: A total of 300 patients suffering from lumbar disc herniations were operated between January 2002 and December 2008. All patients were operated as day care procedure. Technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision. Endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route. The results were evaluated by Macnab′s criteria after a minimum followup of 12 months and maximum up to 24 months. Results: Based on modified Macnab′s criteria, 90% patients had excellent to good, 8% had fair, and 2% had poor results. The complications observed were discitis and dural tear in five patients each and nerve root injury in two patients. 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months. Conclusion: Edoscopic discectomy provides a safe and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return to work.

  9. Use of stand-alone anchored intervertebral cage in the surgical treatment of patients with symptomatic cervical spondylosis

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    Tilen Žele

    2015-03-01

    Full Text Available Background:One of the most common surgical operations for treatment of cervical spondylosis is anterior cervical discectomy with fusion (ACDF. In order to achieve stable fusion after discectomy and avoid dysphagia the artificial stand-alone zero-profile cages with integrated screws were developed and introduced into clinical practice. Outcome and complications after ACDF with such cages were not adequately assessed yet.Methods:We analyzed 20 consecutive patients with cervical spondylosis treated in our institution with ACDF with stand-alone zero-profile cage Zero-P. Before and after surgery and then 6, 12 and 24 months after surgery we assessed the level of pain with VAS scale, severity of myelopathy with mJOA scale and dysphagia with four level scale. Treatment outcome was assessed after 2 years according to Odom's criteria.Results:No complications occurred during surgery or recovery after surgery. The VAS score after surgery and then after 6, 12 and 24 months was statistically significantly lower than before surgery (p<0.05. The mJOA scores were 6, 12 and 24 months after surgery statistically significantly higher than before surgery (p<0.05. Transient and mild dysphagia was present after surgery in 15% (3/20 of patients and 6, 12 or 24 months after surgery in none. Outcome after 2 years was excellent in 9 patients and good in 11 patients.Conclusions:Operative treatment of symptomatic cervical spondylosis with ACDF using stand-alone zero-profile cage with integrated screws is safe and efficient. Incidence of dysphagia after surgery is low and generally transient.

  10. Cervical subluxation associated with posterior cervical hemivertebra.

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    Otero-López, R; Rivero-Garvía, M; Márquez-Rivas, J; Valencia, J

    2016-02-01

    Hemivertebrae, associated with a failure in the formation and fusion of vertebral body ossification nuclei, are a common cause of thoracic or lumbar scoliosis. A cervical location is rare and even rarer as a cause of cervical subluxation in flexion and extension (for which only one previous case has been found). We report on the case of a 7-year-old female patient, who was examined for a cervical fusion defect, consisting of a posterior C4 hemivertebra and a left hemiblock from C5 to C7. After performing surgery consisting of a C4 corpectomy and anterior fixation with intersomatic graft and plate, adequate cervical stabilization with only a self-limiting left C6 brachialgia and ipsilateral Horner syndrome occurs in the postoperative period. Posterior cervical hemivertebra associated with instability is a very rare finding. The anterior approach with corpectomy and anterior plate enables suitable stabilization.

  11. Can the results 6 months after anterior cervical decompression and fusion identify patients who will have remaining deficit at long-term?

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    Peolsson, Anneli; Vavruch, Ludek; Oberg, Birgitta

    2006-01-30

    There is no knowledge if short-term outcome in patients after anterior cervical decompression and fusion (ACDF) can be used to identify which patients have remaining deficit in long term. This study investigates if 6-month outcome with a broad assessment after ACDF with a cervical intervertebral fusion cage can be a guide for the 3-years outcome. A prospective study. Questions about background data, pain, numbness, neck specific disability, distress, sick leave, health, symptom satisfaction and effect of and satisfaction with surgery were asked 28 patients 3 years after ACDF. Measurements have earlier been obtained before and 6 and 12 months after ACDF. Compared with the results before surgery patients had improved in pain intensity (p = 0.001), neck pain (0.001), numbness (p = 0.02) and were more 'satisfied' with having their neck problems (p = 0.01). Except for a worsening in expectations of surgery fulfilled (p = 0.04) there were no significant differences between 6-month and 3-year outcome. Three years after ACDF about two-thirds of the patients had remaining deficit with regard to pain intensity, Neck Disability Index, Distress and Risk Assessment Method and general health. According to the parameters studied 50 - 78% of those who at the 6-month follow-up were without deficit were still healthy at the 3-year follow-up. For patients with deficit at 6-month follow-up, still 83 - 100% had deficit 3 years after surgery. Despite a rather small study obtained the stability of 6-month and 3-year results indicates that short-term results might be sufficient for evaluating effects of the treatment. Since the patients in this study clearly demonstrate broad problems array of development of more structured multi-professional rehabilitation models including exercises which improve neck muscle strength, endurance and proprioception need to be introduced.

  12. The incidence of adjacent segment disease requiring surgery after anterior cervical diskectomy and fusion: estimation using an 11-year comprehensive nationwide database in Taiwan.

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    Wu, Jau-Ching; Liu, Laura; Wen-Cheng, Huang; Chen, Yu-Chun; Ko, Chin-Chu; Wu, Ching-Lan; Chen, Tzeng-Ji; Cheng, Henrich; Su, Tung-Ping

    2012-03-01

    The incidence of symptomatic adjacent segment disease (ASD) after anterior cervical diskectomy and fusion (ACDF) was reported as 2.9%/y in a previous cohort of 374 patients. Few other data corroborate the incidence and natural history of ASD. To calculate the incidence of ASD after ACDF that required secondary fusion surgery. The retrospective study used an 11-year nationwide database to analyze the incidences. All patients who underwent ACDF for cervical disk diseases were identified through diagnostic and procedure codes. Kaplan-Meier and Cox regression analyses were performed. From 1997 to 2007, covering 241 800 725.8 person-years, 19 385 patients received ACDF and 568 had ≥ 2 ACDF operations. The incidence of secondary ACDF operations was 7.6 per 1000 person-years. At the end of the 10-year cohort, 94.4% of patients who had received 1 ACDF remained free from secondary ACDF. The average time interval between the first and second ACDF was 23.3 months. After adjustment for comorbidities and socioeconomic status, secondary ACDF operations were more likely performed on male patients (hazard ratio = 1.27; P = .008) 15 to 39 years of age (hazard ratio = 1.45; P = .009) and 40 to 59 years of age (hazard ratio = 1.41, P = .002, respectively). Repeat ACDF surgery for ASD cumulated steadily in an annual incidence of approximately 0.8%, much lower than the reported incidence of symptomatic ASD. However, at the end of this 10-year cohort, a considerable portion of patients (5.6%) received a second operation. Younger and male patients are more likely to receive such second operations.

  13. Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter "PIERCE-PEEK" study.

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    Suess, Olaf; Schomaker, Martin; Cabraja, Mario; Danne, Marco; Kombos, Theodoros; Hanna, Michael

    2017-01-01

    Anterior cervical diskectomy and fusion (ACDF) is a well-established surgical treatment for radiculopathy and myelopathy. Previous studies showed that empty PEEK cages have lower radiographic fusion rates, but the clinical relevance remains unclear. This paper's aim is to provide high-quality evidence on the outcomes of ACDF with empty PEEK cages and on the relevance of radiographic fusion for clinical outcomes. This large prospective multicenter clinical trial performed single-level ACDF with empty PEEK cages on patients with cervical radiculopathy or myelopathy. The main clinical outcomes were VAS (0-10) for pain and NDI (0-100) for functioning. Radiographic fusion was evaluated by two investigators for three different aspects. The median (range) improvement of the VAS pain score was: 3 (1-6) at 6 months, 3 (2-8) at 12 months, and 4 (2-8) at 18 months. The median (range) improvement of the NDI score was: 12 (2-34) at 6 months, 18 (4-46) at 12 months, and 22 (2-44) at 18 months. Complete radiographic fusion was reached by 126 patients (43%) at 6 months, 214 patients (73%) at 12 months, and 241 patients (83%) at 18 months. Radiographic fusion was a highly significant ( p  PEEK cages is slow and insufficient. Lack of complete radiographic fusion leads to less improvement of pain and disability. We recommend against using empty uncoated pure PEEK cages in ACDF. ISRCTN42774128. Retrospectively registered 14 April 2009.

  14. Vertebral artery injuries in cervical spine surgery.

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    Lunardini, David J; Eskander, Mark S; Even, Jesse L; Dunlap, James T; Chen, Antonia F; Lee, Joon Y; Ward, Timothy W; Kang, James D; Donaldson, William F

    2014-08-01

    Vertebral artery injuries (VAIs) are rare but serious complications of cervical spine surgery, with the potential to cause catastrophic bleeding, permanent neurologic impairment, and even death. The present literature regarding incidence of this complication largely comprises a single surgeon or small multicenter case series. We sought to gather a large sample of high-volume surgeons to adequately characterize the incidence and risk factors for VAI, management strategies used, and patient outcomes after VAI. The study was constructed as a cross-sectional study comprising all cervical spine patients operated on by the members of the international Cervical Spine Research Society (CSRS). All patients who have undergone cervical spine surgery by a current member of CSRS as of the spring of 2012. For each surgeon surveyed, we collected self-reported measures to include the number of cervical cases performed in the surgeon's career, the number of VAIs encountered, the stage of the case during which the injury occurred, the management strategies used, and the overall patient outcome after injury. An anonymous 10-question web-based survey was distributed to the members of the CSRS. Statistical analysis was performed using Student t tests for numerical outcomes and chi-squared analysis for categorical variables. One hundred forty-one CSRS members (of 195 total, 72%) responded to the survey, accounting for a total of 163,324 cervical spine surgeries performed. The overall incidence of VAI was 0.07% (111/163,324). Posterior instrumentation of the upper cervical spine (32.4%), anterior corpectomy (23.4%), and posterior exposure of the cervical spine (11.7%) were the most common stages of the case to result in an injury to the vertebral artery. Discectomy (9%) and anterior exposure of the spine (7.2%) were also common time points for an arterial injury. One-fifth (22/111) of all VAI involved an anomalous course of the vertebral artery. The most common management of VAI was by

  15. Corpectomia cervical anterior e fixação com placa: análise retrospectiva Corporectomía cervical anterior y fijación con placa: un análisis retrospectivo Anterior cervical corpectomy and plate fixation: a retrospective analysis

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    Marcos André Sonagli

    2012-09-01

    Full Text Available OBJETIVO: Avaliar os resultados clínicos e radiográficos de pacientes submetidos à corpectomia e fixação com placa cervical, com seguimento de dois anos. MÉTODOS: Análise retrospectiva de 2003 a 2009. Avaliaram-se o tipo de fratura (classificação AO, o grau de déficit neurológico (inicial e após dois anos - escala de Frankel, a taxa de complicações e a taxa de incorporação do enxerto ósseo (de acordo com radiografias dois anos depois da cirurgia. RESULTADOS: Vinte e um pacientes foram avaliados. De acordo com a classificação AO, 14 eram grupo A, 3 B e 4 C. Ao todo, sete pacientes apresentaram déficit neurológico inicial completo (Frankel A e permaneceram com o déficit neurológico completo após dois anos. Dos seis pacientes que apresentaram déficit neurológico inicial incompleto (Frankel B, C e D, 33% (2 de 6 apresentaram melhora de um nível na escala de Frankel e 50% (3 de 6 deles evoluíram para recuperação completa (Frankel E. Os oito pacientes que não apresentaram lesão neurológica inicial (Frankel E permaneceram sem déficit neurológico após dois anos. Três complicações clínicas foram verificadas: uma fístula esofágica, uma soltura asséptica do implante e uma infecção no sítio doador de enxerto. Todos os pacientes obtiveram consolidação do enxerto ósseo. CONCLUSÃO: A corpectomia cervical no tratamento da fratura-explosão permite a recuperação neurológica nos pacientes com lesão neurológica incompleta e apresenta baixos índices de complicações.OBJETIVO: Evaluar los resultados clínicos y radiográficos de los pacientes sometidos a corporectomía y fijación con placa cervical con dos años de seguimiento. MÉTODOS: Análisis retrospectivo desde 2003 hasta 2009. Se evaluó el tipo de fractura (Clasificación AO, el grado de déficit neurológico (inicial y después de 2 años - escala de Frankel, la tasa de complicaciones y la tasa de incorporación del injerto óseo (de acuerdo a los

  16. Abnormal cervical vestibular-evoked myogenic potential in anterior inferior cerebellar artery territory infarction: frequency, pattern, and a determinant.

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    Ahn, Byung-Hoon; Kim, Hyun-Ah; Yi, Hyon-Ah; Oh, Sun-Young; Lee, Hyung

    2011-08-15

    There has been no systematic study that carefully investigates the characteristic features of abnormal cervical vestibular-evoked myogenic potential (cVEMP) response associated with the AICA territory infarction. To investigate the frequency, the characteristic patterns of abnormal cVEMP associated with AICA territory infarction, and the crucial site for producing abnormal cVEMP response in the AICA territory infarction. We studied 16 consecutive cases of unilateral AICA territory infarction diagnosed by brain MRI. VEMP was induced by a short click sound and was recorded in contracting sternocleidomastoid muscle. Each patient underwent a quantitative audiovestibular evaluation, including bithermal caloric test and pure tone audiogram. Eight patients (50%) exhibited abnormal cVEMP response on the side of the AICA territory infarction. All patients with abnormal cVEMP showed an absent or decreased response in amplitude but no difference in latency. Patients with abnormal VEMP were significantly more likely to have canal paresis (CP), sensorineural hearing loss, or both compared with patients who had normal cVEMP. Conversely, abnormal cVEMP was more frequently observed among patients with CP than among those without CP. There was no difference in lesion sites according to brain MRI among patients with or without abnormal cVEMP response. Our findings suggest that the peripheral vestibular structure with the inner ear probably plays a crucial role in producing abnormal cVEMP response associated with AICA territory infarction. Copyright © 2011 Elsevier B.V. All rights reserved.

  17. Comparison of a Stand-Alone Anchored Spacer Versus Plate-Cage Construct in the Treatment of Two Noncontiguous Levels of Cervical Spondylosis: A Preliminary Investigation.

    Science.gov (United States)

    Shi, Sheng; Zheng, Shuang; Li, Xin-Feng; Yang, Li-Li; Liu, Zu-De; Yuan, Wen

    2016-05-01

    The application of stand-alone anchored spacer (SAAS) in anterior cervical discectomy and fusion (ACDF) has been proven to be safe and effective to treat cervical spondylosis. Skip-level ACDF with SAAS, fusing only the involved levels without anterior plates, may be the optimal treatment. The aim of the study was to compare the clinical outcomes, radiologic results of SAAS, and plate-cage construct in the treatment of 2 noncontiguous levels of cervical spondylosis. A total of 65 patients with 2 noncontiguous levels of cervical spondylosis were included in the retrospective review of prospective collected data. The clinical and radiologic outcomes were assessed with the Japanese Orthopaedic Association score, Neck Disability Index, cervical alignment, and range of motion and disc height of intermediate segment, respectively. All the aforementioned parameters were compared before and after surgery in the respective group, which also were compared between the 2 groups. Complications also were recorded, and correlations between the surgical outcome and various factors were analyzed. No significant differences existed in clinical results between the 2 groups (P > 0.05). In addition, no statistical significance was observed in fusion rate, cervical alignment, and range of motion and disc height of intermediate segment, dysphagia, and hoarseness (P > 0.05). Preoperative Japanese Orthopaedic Association score and high-intensity signal in T2-weighted images were important predictors for surgical outcome. Skip-level ACDF with SAAS is a safe and effective treatment of 2 noncontiguous levels of cervical spondylosis without obvious contraindications, which can keep the IS intact, and have a low impact on the IS. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Spinal cord edema with contrast enhancement mimicking intramedullary tumor in patient with cervical myelopathy: A case report and a brief literature review.

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    Gkasdaris, Grigorios; Chourmouzi, Danai; Karagiannidis, Apostolos; Kapetanakis, Stylianos

    2017-01-01

    Cervical myelopathy (CM) is a clinical diagnosis that may be associated with hyperintense areas on T2-weighted magnetic resonance imaging (MRI) scan. The use of contrast enhancement in such areas to differentiate between neoplastic and degenerative disease has rarely been described. We present a 41-year-old female with a 5-month course of progressive CM. The cervical MRI revealed spinal cord swelling, stenosis, and a hyperintense signal at the C5-C6 and C5-C7 levels. Both the neurologic and radiologic examinations were consistent with an intramedullary cervical cord tumor. To decompress the spinal canal, an anterior cervical discectomy and fusion was performed from C5 to C7 level. This resulted in immediate and significant improvement of the myelopathy. Postoperatively, over 1.5 years, the hyperintense, enhancing intramedullary lesion gradually regressed on multiple postoperative MRI scans. Spinal cord edema is occasionally seen on MR studies of the cervical spine in patients with degenerative CM. Contrast-enhanced MR studies may help differentiate hyperintense cord signals due to edema vs. atypical intramedullary tumors. Routine successive postoperative MRI evaluations are crucial to confirm the diagnosis of degenerative vs. neoplastic disease.

  19. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

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    Alzamora, M.G.; Klisch, J. [Section of Neuroradiology, Neurocenter, University of Freiburg (Germany); Rosahl, S.K.; Lehmberg, J. [Department of Neurosurgery, Neurocenter, University of Freiburg (Germany)

    2005-04-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel.

  20. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    International Nuclear Information System (INIS)

    Alzamora, M.G.; Klisch, J.; Rosahl, S.K.; Lehmberg, J.

    2005-01-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel

  1. Venous hypertensive myelopathy associated with cervical spondylosis.

    Science.gov (United States)

    Okada, Seiji; Chang, Charles; Chang, Geraldine; Yue, James J

    2016-11-01

    Venous hypertensive myelopathy (VHM) results from spinal vascular malformations of arteriovenous shunting that increases spinal venous pressure, leading to congestive edema and neurologic dysfunction. There has been no report of VHM associated with cervical spondylotic myelopathy (CSM). The aim of this study was to report an extremely rare case of VHM likely due to CSM. This study is a case report and review of the literature. The patient was a 51-year-old man with CSM exhibiting relatively rapid neurologic deterioration with an abnormal expansion of a centromedullary hyperintense lesion on T2-weighted magnetic resonance imaging (MRI) in the absence of traumatic injury. Neurologic examination and radiologic imaging were taken by various means. The patient developed a cervical radiculopathy, followed by gait disturbance and motor weakness. The MRI of the cervical spine demonstrated spinal canal stenosis due to disc bulging and flavum hypertrophy at the C5/C6 and C6/C7 levels as well as hyperintense area over the C5-C7 levels on T2-weighted images. Although decompression surgery was planned, an acute inflammatory process such as transverse myelitis or demyelinating disease other than cord compression was also considered, and the patient received intravenous steroids. His walking improved for several days. However, his symptoms then became significantly worse, and he had difficulty walking. Subsequent MRI demonstrated marked progression of the T2 hyperintense lesion over the C4-T1 vertebral levels. Flow voids were also noted on the dorsal surface of the upper cervical cord on T2-weighted MRI. His lab work, medical history, and the local enhancement on contrast-enhanced MRI indicated low probability of spinal inflammatory diseases. Therefore, the decision was made to perform anterior cervical discectomy and fusion surgery on two levels. Following surgery, his symptoms improved promptly. Our case indicates that VHM could be caused by spondylotic cord compression in the

  2. Long Term Effect on Adjacent Segment Motion after Posterior Cervical Foraminotomy

    Science.gov (United States)

    Cho, Tack Geun; Park, Seung Won

    2014-01-01

    Objective Posterior cervical foraminotomy (PCF) is a motion-preserving surgical technique. The objective was to determine whether PCF alter cervical motion as a long-term influence. Methods Thirty one patients who followed up more than 36 months after PCF for cervical radiculopathy from January 2004 to September 2008 were enrolled in this study. The range of motion (ROM) of whole cervical spine, the operated segment, the cranial and the caudal adjacent segment were obtained. The clinical result and the change of ROMs were compared with those in the patients performed anterior cervical discectomy and fusion (ACDF) during the same period. Results In PCF group, the ROM of whole cervical spine had no significant difference in statistically at preoperative and last follow up. The operated segment ROM was significantly decreased from 11.02±5.72 to 8.82±6.65 (padjacent segment was slightly increased from 10.42±5.13 to 11.02±5.41 and the ROM of caudal adjacent segment was decreased from 9.44±6.26 to 8.73±5.92, however these data were not meaningful statistically. In ACDF group, the operated ROM was decreased and unlike in PCF group, especially the ROM of caudal adjacent segment was increased from 9.39±4.21 to 11.33±5.07 (padjacent segment did not increase after PCF. PCF, by maintaining the motion of the operated segment, imposes less stress on the adjacent segments. This may be one of its advantages. PMID:24891864

  3. Comparison of Anterior and Posterior Surgery for Degenerative Cervical Myelopathy: An MRI-Based Propensity-Score-Matched Analysis Using Data from the Prospective Multicenter AOSpine CSM North America and International Studies.

    Science.gov (United States)

    Kato, So; Nouri, Aria; Wu, Dongjin; Nori, Satoshi; Tetreault, Lindsay; Fehlings, Michael G

    2017-06-21

    Surgeons often choose between 2 different approaches (anterior and posterior) for surgical treatment of degenerative cervical myelopathy on the basis of imaging features of spinal cord compression, the number of levels affected, and the spinal alignment. However, there is a lack of consensus on which approach is preferable. The objective of the present study was to use magnetic resonance imaging (MRI)-based propensity-score-matched analysis to compare postoperative outcomes between the anterior and posterior surgical approaches for degenerative cervical myelopathy. A total of 757 patients were enrolled in 2 prospective multicenter AOSpine studies, which involved 26 international sites. Preoperative MRIs were reviewed to characterize the causes of the cord compression, including single-level disc disease, multilevel disc disease, ossification of the posterior longitudinal ligament, enlargement of the ligamentum flavum, vertebral subluxation/spondylolisthesis, congenital fusion, number of compressed levels, or kyphosis. The propensity to choose anterior decompression was calculated using demographic data, preoperative MRI findings, and the modified Japanese Orthopaedic Association (mJOA) scores in a logistic regression model. We then performed 1-to-1 matching of patients who had received anterior decompression with those who had the same propensity score but had received posterior decompression to compare 2-year postoperative outcomes and 30-day perioperative complication rates between the 2 groups after adjustment for background characteristics. A total of 435 cases were included in the propensity score calculation, and 1-to-1 matching resulted in 80 pairs of anterior and posterior surgical cases; 99% of these matched patients had multilevel compression. The anterior and posterior groups did not differ significantly in terms of the postoperative mJOA score (15.1 versus 15.3, p = 0.53), Neck Disability Index (20.5 versus 24.1, p = 0.44), or Short Form-36 (SF-36

  4. Nursing review section of surgical neurology international: Evaluation of cervical disc disease and when surgery is warranted

    Science.gov (United States)

    Epstein, Nancy E.; Hollingsworth, Renee D.

    2017-01-01

    Background: Patients with cervical disc disease may present with radiculopathy (root compression), myelopathy (cord compression), or myeloradiculopathy. These complaints must be correlated with x-ray, magnetic resonance (MR) imaging, and computed tomographic (CT) scans. Although most patients can be managed nonsurgically, those with significant neurological deficits and larger disc herniations may require surgery. Methods: The symptoms of cervical radiculopathy include pain radiating down one or both arms, while myelopathy may result in more diffuse numbness tingling or weakness in the upper and/or lower extremities. The neurological signs for cervical discs include; focal or diffuse loss of motor strength changes in reflexes (hyporeflexic, normal reflexes, or hyperreflexia), a loss of sensation (e.g., to pin, vibration, touch, and position), and cerebellar dysfunction (e.g., loss of coordination). Patients’ symptoms and signs must correlate with focal nerve root and/or spinal cord compression seen on MR and/or CT studies. Results: MR examinations best document soft disc herniations, while CT scans most readily demonstrate calcification/ossification of cervical discs and accompanying arthritic changes. Bulging/protruding can typically be managed nonsurgically. Alternatively, significantly extruded or sequestrated discs, resulting in moderate/marked spinal cord and/or nerve root compression may warrant surgery. Most operations from front of the neck for cervical discs are called anterior cervical discectomy/fusion (ACDF), while those performed from the back of the neck are called laminoforaminotomies. Conclusion: Patients with cervical radiculopathy (root compression) and/or myelopathy (cord compression) with disc herniations on MR/CT studies may or may not require surgery. PMID:28781913

  5. The Incidence of Adjacent Segment Degeneration after Cervical Disc Arthroplasty (CDA): A Meta Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Yang, Baohui; Li, Haopeng; Zhang, Ting; He, Xijing; Xu, Siyue

    2012-01-01

    Background Cervical disc arthroplasty is being used as an alternative degenerative disc disease treatment with fusion of the cervical spine in order to preserve motion. However, whether replacement arthoplasty in the spine achieves its primary patient centered objective of lowering the frequency of adjacent segment degeneration is not verified yet. Methodology We conducted a meta-analysis according to the guidelines of the Cochrane Collaboration using databases including PubMed, Cochrane Central Register of Controlled Trials and Embase. The inclusion criteria were: 1) Randomized, controlled study of degenerative disc disease of the cervical spine involving single segment or double segments using Cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF) as controls; 2) A minimum of two-year follow-up using imaging and clinical analyses; 3) Definite diagnostic evidences for “adjacent segment degeneration” and “adjacent segment disease”; 4) At least a minimum of 30 patients per population. Two authors independently selected trials; assessed methodological quality, extracted data and the results were pooled. Results No study has specifically compared the results of adjacent segment degenerative; Two papers describing 140 patients with 162 symptomatic cervical segment disorders and compared the rate of postoperative adjacent segment disease development between CDA and ACDF treatments, three publications describing the rate of adjacent-segment surgery including 1273 patients with symptomatic cervical segments. The result of the meta-analysis indicates that there were fewer the rate of adjacent segment disease and the rate for adjacent-segment surgery comparing CDA with ACDF, but the difference was not statistically significant. Conclusions Based on available evidence, it cannot be concluded, that CDA can significantly reduce the postoperative rate of the adjacent segment degenerative and adjacent segment disease. However, due to some

  6. The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA: a meta analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Baohui Yang

    Full Text Available Cervical disc arthroplasty is being used as an alternative degenerative disc disease treatment with fusion of the cervical spine in order to preserve motion. However, whether replacement arthoplasty in the spine achieves its primary patient centered objective of lowering the frequency of adjacent segment degeneration is not verified yet.We conducted a meta-analysis according to the guidelines of the Cochrane Collaboration using databases including PubMed, Cochrane Central Register of Controlled Trials and Embase. The inclusion criteria were: 1 Randomized, controlled study of degenerative disc disease of the cervical spine involving single segment or double segments using Cervical disc arthroplasty (CDA with anterior cervical discectomy and fusion (ACDF as controls; 2 A minimum of two-year follow-up using imaging and clinical analyses; 3 Definite diagnostic evidences for "adjacent segment degeneration" and "adjacent segment disease"; 4 At least a minimum of 30 patients per population. Two authors independently selected trials; assessed methodological quality, extracted data and the results were pooled.No study has specifically compared the results of adjacent segment degenerative; Two papers describing 140 patients with 162 symptomatic cervical segment disorders and compared the rate of postoperative adjacent segment disease development between CDA and ACDF treatments, three publications describing the rate of adjacent-segment surgery including 1273 patients with symptomatic cervical segments. The result of the meta-analysis indicates that there were fewer the rate of adjacent segment disease and the rate for adjacent-segment surgery comparing CDA with ACDF, but the difference was not statistically significant.Based on available evidence, it cannot be concluded, that CDA can significantly reduce the postoperative rate of the adjacent segment degenerative and adjacent segment disease. However, due to some limitations, the results of this meta

  7. Tratamento cirúrgico por via anterior na mielopatia cervical espondilótica com seguimento mínimo de dez anos Tratamiento quirúrgico por vía anterior en la mieolopatía cervical espondilótica con seguimiento mínimo de diez años Anterior decompression and fusion for spondilotic cervical mielopathy with a minimal ten-year follow-up

    Directory of Open Access Journals (Sweden)

    Rui Peixoto Pinto

    2010-06-01

    Full Text Available OBJETIVO: a mielopatia cervical espondilótica (MEC é uma causa frequente de disfunção da medula espinhal na população adulta. O tratamento implica em descompressão cirúrgica precoce. O objetivo foi apresentar um estudo retrospectivo da descompressão anterior e artrodese para MEC com um seguimento mínimo de dez anos. MÉTODOS: pacientes operados entre Janeiro de 1990 e Dezembro de 1994 foram avaliados por sexo, idade, número de níveis operados, avaliação funcional pela escala de Nurick pré-operatória um ano após cirurgia e após a revisão final que ocorreu em 2004, evidência de consolidação e complicações. RESULTADOS: foram avaliados 91 pacientes, 69 do sexo masculino, 22 do sexo feminino, com uma média de idade de 56,6 anos (42-86 e um seguimento médio de 11,9 anos. Ocorreram cinco óbitos: três pacientes no pós-operatório imediato, um no primeiro ano e um durante o restante período. Em média, foram operados 2,7±1,0 níveis por paciente (1-4. O valor médio de Nurick pré-operatório foi de 3,8±0,9. Houve uma melhoria significativa do estado neurológico um ano após a cirurgia (2,2±1,1; pOBJETIVO: la mielopatía cervical espondilótica (MEC es una causa frecuente de disfunción de la médula espinal en la población adulta. El tratamiento implica una descompresión quirúrgica precoz. El objetivo es presentar un estudio retrospectivo de la descompresión anterior y artrodesis para MEC con un seguimiento mínimo de diez años. MÉTODOS: pacientes operados entre Enero de 1990 y Diciembre de 1994 fueron evaluados según el sexo, la edad, el número de niveles operados, la evaluación funcional por la escala de Nurick pre operatoria un año después de la cirugía y después de la revisión final que fue en el 2004, evidencia de consolidación y complicaciones. RESULTADOS: fueron evaluados 91 pacientes, 69 del sexo masculino, 22 del sexo femenino, con un promedio de edades de 56.6 años (42 a 86 y un seguimiento

  8. Dysphagia after anterior cervical spine surgery: a prospective study using the swallowing-quality of life questionnaire and analysis of patient comorbidities.

    Science.gov (United States)

    Siska, Peter A; Ponnappan, Ravi K; Hohl, Justin B; Lee, Joon Y; Kang, James D; Donaldson, William F

    2011-08-01

    Prospective study of 29 patients who underwent anterior cervical (AC) or posterior lumbar (PL) spinal surgery. A validated measure of dysphagia, the Swallowing-Quality of Life (SWAL-QOL) survey, was used to assess the degree of postoperative dysphagia. To determine the degree of dysphagia preoperatively and postoperatively in patients undergoing AC surgery compared with a control group that underwent PL surgery. Dysphagia is a well-known complication of AC spine surgery and has been shown to persist for up to 24 months or longer. A total of 18 AC patients and a control group of 11 PL patients were prospectively enrolled in this study and were assessed preoperatively and at 3 weeks and 1.5 years postoperatively using a 14-item questionnaire from the SWAL-QOL survey to determine degree of dysphagia. Other patient factors and anesthesia records were examined to evaluate their relationship to dysphagia. There were no significant differences between the AC and PL groups with respect to age, sex, body mass index, or length of surgery. The SWAL-QOL scores at 3 weeks were significantly lower for the AC group than for the PL group (76 vs. 96; P = 0.001), but there were no differences between the groups preoperatively or at final follow-up. Smokers, patients with chronic obstructive pulmonary disease, and women had lower SWAL-QOL scores at one or more time point. Patients undergoing AC surgery had a significant increase in the degree of dysphagia 3 weeks after surgery compared with patients undergoing PL surgery. By final follow-up, swallowing in the AC group recovered to a level similar to preoperative and comparable to that in patients undergoing lumbar surgery at 1.5 years. Smoking, chronic obstructive pulmonary disease, and female sex are possible factors in the development of postoperative dysphagia.

  9. Modular cervical plate system for adjacent segment disease.

    Science.gov (United States)

    Hawasli, Ammar H; Cashin, John L; Wright, Neill M

    2018-02-23

    Adjacent-level disease after anterior cervical discectomy and fusion (ACDF) occurs in a significant proportion of patients and frequently requires revision operation. Methods using traditional plates typically require removal of the plate with anecdotally increased operative-time and morbidity. We review our experience in treating symptomatic adjacent-segment disease using both traditional plate removal and modular- plate system which allows for add-on plate components rather than removal of the entire plate. Authors compared 64 patients with revision surgery using modular-plate system for adjacent- segment disease compared to 2-cohorts: (1) patients with traditional plate-removal and (2) patients with no prior plate. Clinical data included demographics, original surgery, presentation, current surgery, use of modular system, need for preoperative computed-topography, operative-time, blood loss, hospital stay, complications, length of dysphagia, neck disability index and time-until-fusion. Modular cervical plate system was utilized to prevent exposure and removal of the entire plate. The terminal portion of the plate was exposed and the distal module was removed. Following the discectomy/arthrodesis, a module-plate extension was added onto the previous plate for extension of the prior instrumentation. Preoperative planning computed-topography was required in 26% of plate-removal and 17% of modular-plate cases. Revision surgery with no prior plate had reduced operative-time (77.0±18.1 min) when compared with plate removal (103.8±46.2 min; p<0.01). Blood-loss was lower for modular-plate system (38.3±20.4 mL) and no prior plate (38.4±12.6 mL) versus plate removal (78.2±65.9 mL, p<0.01). Hospital stay was similar for all groups. No complications were experienced with modular-plate revision but plate removal and revision after no prior plate carried 7.7% and 10.5% complication rates, respectively. There was a trend towards lower dysphagia and neck disability index

  10. Biomechanical comparison of the stable efficacy of two anterior plating systems.

    Science.gov (United States)

    Yang, Saiwei; Wang, Lee-Wei

    2003-07-01

    To compare the immediate stable efficacy and load sharing effect of two types of anterior cervical screw-plating instrumentations: the Morscher Synthes titanium locking screw-plate system and the Caspar trapezoidal screw-plate system. Fresh porcine cervical spines with intact, two surgery unstable models, and then reconstructed with or without screw-plating instruments were compared in three physiological loading conditions. Two markedly instrumentation systems--Morscher Synthes titanium cervical locking screw-plate and Caspar trapezoidal screw-plate systems are commonly used in management of complex cervical spine disorders. Although the biomechanical study showed that the lower cost Caspar system performed superior in extension before and after plate fatigue, the clinic evaluations of two systems were contradictory. So (1) does the titanium cervical locking plate system pay for its higher cost? and (2) what is the load sharing character of strut graft in one level corpectomy? Eight fresh ligamentous porcine cervical spines from C3 to C7 were undergone axial compression, rotation and sagittal flexion tests. The biomechanical experiment was sequentially repeated for the intact, C5-6 discectomy, C5 corpectomy, and then stabilized by either type of plate fixation devices with or without polymethylmethacrylate bone cement grafting. Strains measured by an extensometer across the operated motion segment were used as the index of stability. Analysis of the strain data showed both types of anterior fixation plate systems provided adequate-restored stability for the spinal column only aided with polymethylmethacrylate construction. Statistically, there was no significant difference in biomechanical evaluation for the stability effect between much cost Morscher Synthes plate and Caspar plate system (pfailure. Statistically both systems showed similar stable efficacy, however, the Morscher Synthes cervical locking plate system might provide better stable effect in higher

  11. Management of C2-C3 fracture subluxation by anterior cervical approach and C2-C3 trans-cortical screw placement

    Directory of Open Access Journals (Sweden)

    Agrawal Amit

    2018-03-01

    Full Text Available Cervical spine injuries are the major cause of morbidity and mortality in trauma victims. Upper cervical spine injuries account for about 24% of acute fractures and dislocations and one third of fractures occur at the level of C2, while one half of injuries occur at the C6 or C7 levels. In contrast to this approach we used the transverse cervical, platysma splitting incision at a lower (C3-C4 disc to expose the upper cervical spine particularly lower border of C3 (entry point for the screw.

  12. Minimally invasive discectomy versus microdiscectomy/ discectomy for symptomatic lumbar disc herniation

    OpenAIRE

    Rahimi-Movaghar, Vafa; Rasouli, Mohammad; Shokraneh, Farhad; Moradi-lakeh, Maziyar; Vakaro, Alex; Sadeghi-Naini, Mohsen

    2012-01-01

    Abstract: Background: Lumbar discectomy is a surgery to remove all or part of a disc cushion that helps protect the spinal column. These cushions, called disks, separate the spinal vertebrae/bones. When one of the disks herniates (moves out of place) in patients with protruded disc, the soft gel inside pushes through the wall of the disk. The disk may then place pressure on the spinal cord and nerves that are coming out of the spinal column. The lumbar discectomy procedure remained basically ...

  13. Post laminoplasty cervical kyphosis—Case report

    Directory of Open Access Journals (Sweden)

    D.E. Dugoni

    2014-01-01

    CONCLUSION: The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability.

  14. Análise de fatores associados à lesão do nervo laríngeo recorrente em cirurgias de discectomia cervical via anterior Análisis de factores asociados a la lesión del nervio laríngeo recurrente en cirugías de discectomía cervical por vía anterior Analysis of factors associated with laryngeal nerve injury in anterior disc herniation surgery

    Directory of Open Access Journals (Sweden)

    Erasmo Abreu Zardo

    2011-01-01

    Full Text Available OBJETIVO: Estudar os possíveis fatores associados com lesão do NLR após cirurgia de hérnia discal cervical com abordagem anterior. MÉTODOS: No período de junho/2009 a junho/2010, avaliamos 30 pacientes submetidos a tratamento cirúrgico de hérnia discal via anterior no Hospital São Lucas da PUC-RS. No pré-operatório, foi realizada a medida da circunferência cervical (ao nível da cartilagem cricóide e da altura cervical (do ângulo da mandíbula à borda superior da clavícula. No perioperatório, avaliamos o tempo e a dificuldade de entubação, o tempo cirúrgico, o lado da abordagem, o número de níveis operados, bem como o tipo de incisão (transversa/longitudinal e o uso de halo craniano. Realizou-se uma avaliação videoendoscópica da laringe (VEL, em busca de lesão do NLR, no pré-operatório e no décimo dia após a cirurgia. Pacientes que apresentaram resultado anormal na VEL foram considerados com lesão do NLR e submetidos à reavaliação mensal até a recuperação espontânea ou no período máximo de seis meses quando a lesão foi considerada definitiva. RESULTADOS: Encontramos 3/30 (10% casos de lesões não definitivas do NLR que se recuperaram em até 120 dias pós-operatórios. Os pacientes com lesão do NLR apresentaram uma maior circunferência do pescoço, tempo cirúrgico e número de níveis operados em relação aos pacientes sem lesão do NLR. Também, pacientes com lesão do NLR apresentaram um menor comprimento do pescoço. Duas lesões ocorreram na abordagem pelo lado direito e uma pelo lado esquerdo. Todos os pacientes com lesão tiveram incisão transversa e não fizeram uso de halo craniano. CONCLUSÃO: A abordagem pelo lado direito apresentou maior índice de complicações com o NLR. Apesar de o número limitado de pacientes não permitir conclusões estatisticamente significativas, fatores anatômicos intrínsecos do paciente como pescoço curto e diâmetro do pescoço aumentado, bem como tempo

  15. Cervical disc arthroplasty for symptomatic cervical disc disease: Traditional and Bayesian meta-analysis with trial sequential analysis.

    Science.gov (United States)

    Kan, Shun-Li; Yuan, Zhi-Fang; Ning, Guang-Zhi; Liu, Fei-Fei; Sun, Jing-Cheng; Feng, Shi-Qing

    2016-11-01

    Cervical disc arthroplasty (CDA) has been designed as a substitute for anterior cervical discectomy and fusion (ACDF) in the treatment of symptomatic cervical disc disease (CDD). Several researchers have compared CDA with ACDF for the treatment of symptomatic CDD; however, the findings of these studies are inconclusive. Using recently published evidence, this meta-analysis was conducted to further verify the benefits and harms of using CDA for treatment of symptomatic CDD. Relevant trials were identified by searching the PubMed, EMBASE, and Cochrane Library databases. Outcomes were reported as odds ratio or standardized mean difference. Both traditional frequentist and Bayesian approaches were used to synthesize evidence within random-effects models. Trial sequential analysis (TSA) was applied to test the robustness of our findings and obtain more conservative estimates. Nineteen trials were included. The findings of this meta-analysis demonstrated better overall, neck disability index (NDI), and neurological success; lower NDI and neck and arm pain scores; higher 36-Item Short Form Health Survey (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores; more patient satisfaction; greater range of motion at the operative level; and fewer secondary surgical procedures (all P  0.05). TSA of overall success suggested that the cumulative z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit, indicating sufficient and conclusive evidence had been ascertained. For treating symptomatic CDD, CDA was superior to ACDF in terms of overall, NDI, and neurological success; NDI and neck and arm pain scores; SF-36 PCS and MCS scores; patient satisfaction; ROM at the operative level; and secondary surgical procedures rate. Additionally, there was no significant difference between CDA and ACDF in the rate of adverse events. However, as the CDA procedure is a relatively newer operative technique, long

  16. Effects of cervical arthrodesis and arthroplasty on neck response during a simulated frontal automobile collision.

    Science.gov (United States)

    White, Nicholas A; Moreno, Daniel P; Brown, Philip J; Gayzik, F Scott; Hsu, Wesley; Powers, Alexander K; Stitzel, Joel D

    2014-09-01

    Whereas arthrodesis is the most common surgical intervention for the treatment of symptomatic cervical degenerative disc disease, arthroplasty has become increasingly more popular over the past decade. Although literature exists comparing the effects of anterior cervical discectomy and fusion and cervical total disc replacement (CTDR) on neck kinematics and loading, the vast majority of these studies apply only quasi-static, noninjurious loading conditions to a segment of the cervical spine. The objective of this study was to investigate the effects of arthrodesis and arthroplasty on biomechanical neck response during a simulated frontal automobile collision with air bag deployment. This study used a full-body, 50th percentile seated male finite element (FE) model to evaluate neck response during a dynamic impact event. The cervical spine was modified to simulate either an arthrodesis or arthroplasty procedure at C5-C6. Five simulations of a belted driver, subjected to a 13.3 m/s ΔV frontal impact with air bag deployment, were run in LS-DYNA with the Global Human Body Models Consortium full-body FE model. The first simulation used the original model, with no modifications to the neck, whereas the remaining four were modified to represent either interbody arthrodesis or arthroplasty of C5-C6. Cross-sectional forces and moments at the C5 and C6 cervical levels of the neck, along with interbody and facet forces between C5 and C6, were reported. Adjacent-level, cross-sectional neck loading was maintained in all simulations without exceeding any established injury thresholds. Interbody compression was greatest for the CTDRs, and interbody tension occurred only in the fused and nonmodified spines. Some interbody separation occurred between the superior and inferior components of the CTDRs during flexion-induced tension of the cervical spine, increasing the facet loads. This study evaluated the effects of C5-C6 cervical arthrodesis and arthroplasty on neck response

  17. Rastreamento anterior para câncer de colo uterino em mulheres com alterações citológicas ou histológicas Previous screening for cervical cancer among women with cytological and histological abnormalities

    Directory of Open Access Journals (Sweden)

    C Rama

    2008-06-01

    Full Text Available OBJETIVO: Analisar a história de rastreamento citológico anterior em mulheres que apresentaram alterações citológicas e confirmação histológica para câncer cervical. MÉTODOS: Estudo transversal com 5.485 mulheres (15-65 anos que se submeteram a rastreamento para o câncer cervical entre fevereiro de 2002 a março de 2003, em São Paulo e Campinas, SP. Aplicou-se questionário comportamental e foi feita a coleta da citologia oncológica convencional ou em base líquida. Para as participantes com alterações citológicas indicou-se colposcopia e, nos casos anormais, procedeu-se à biópsia cervical. Para investigar a associação entre as variáveis qualitativas e o resultado da citologia, utilizou-se o teste de qui-quadrado de Pearson com nível de significância de 5%. RESULTADOS: Dentre os resultados citológicos, 354 (6,4% foram anormais, detectando-se 41 lesões intra-epitelial escamosa de alto grau e três carcinomas; em 92,6% revelaram-se normais. De 289 colposcopias realizadas, 145 (50,2% apresentaram alterações. Dentre as biópsias cervicais foram encontrados 14 casos de neoplasia intra-epitelial cervical grau 3 e quatro carcinomas. Referiram ter realizado exame citológico prévio: 100% das mulheres com citologia compatível com carcinoma, 97,6% das que apresentaram lesões intra-epiteliais de alto grau, 100% daquelas com confirmação histológica de carcinoma cervical, e 92,9% das mulheres com neoplasia intra-epitelial cervical grau 3. A realização de citologia anterior em período inferior a três anos foi referida, respectivamente, por 86,5% e 92,8% dessas participantes com alterações citológicas e histológicas. CONCLUSÕES: Entre as mulheres que apresentaram confirmação histológica de neoplasia intra-epitelial cervical grau 3 ou carcinoma e aquelas que não apresentaram alterações histológicas não houve diferença estatisticamente significante do número de exames citológicos realizados, bem como o tempo

  18. Minimally invasive percutaneous endoscopic discectomy and drainage for infectious spondylodiscitis

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    Tsai-Sheng Fu

    2013-08-01

    Full Text Available The primary goals for treating infectious spondylodiscitis are to make an accurate diagnosis, isolate the causative organism, and prescribe effective antibiotic therapy based on the culture data. A positive culture of the responsible organism is not required for diagnosis, although it is extremely important for successful treatment and prevention of further morbidity. Surgical intervention is usually reserved for cases that are unresponsive to antibiotic therapy and for patients who have developed progressive spinal deformity or instability, epidural abscesses, or neurological impairment. However, the incidence of perioperative morbidity is particularly increased in elderly patients or in those with poor general condition. With improved endoscopic instruments and techniques, our clinical experiences demonstrate that spinal infections can be successfully treated by minimally invasive percutaneous endoscopic debridement. Direct endoscopic observation and collection of sufficient quantities of samples for microbiological examinations from the infected region are usually possible. This article summarizes the diagnostic and therapeutic values of percutaneous endoscopic discectomy and drainage (PEDD used to treat patients with spondylodiscitis. Our clinical evidence-based survey suggests that PEDD can provide adequate retrieval of specimens and has high diagnostic efficacy, thereby enabling prompt and sensitive antibiotic therapy to the offending pathogens. We propose that PEDD is an effective alternative for treating infectious spondylodiscitis and should be considered prior to extensive anterior surgery in selected cases. This method is particularly suitable for patients with early-stage spinal infection or serious medical conditions.

  19. Papel da videoendoscopia da laringe no diagnóstico de lesão do nervo laríngeo recorrente na abordagem cervical anterior Papel de la videoendoscopía de laringe en el diagnóstico de lesión del nervio laríngeo recurrente en el abordaje cervical por vía anterior The importance of larynx videoendoscopy in diagnosis of recurrent laryngeal nerve injury after anterior approach

    Directory of Open Access Journals (Sweden)

    Alexandre Coutinho Borba

    2010-12-01

    Full Text Available INTRODUÇÃO: o reconhecimento da lesão do nervo laríngeo recorrente (NLR após tratamento cirúrgico de hérnia discal cervical via anterior é importante na evolução clínica do paciente e, em especial, nos casos de reintervenção. O real papel da videoendoscopia da laringe (VEL de rotina no pós-operatório não tem sido completamente estudado. OBJETIVO: identificar a prevalência de lesões do NLR em pacientes sintomáticos ou não através da VEL após cirurgia de hérnia cervical via anterior. MÉTODOS: no período de Junho de 2009 a Julho de 2010 selecionamos 30 pacientes submetidos a tratamento cirúrgico de hérnia discal no Hospital São Lucas da PUC-RS. Realizou-se avaliação por VEL no pré-operatório e no décimo dia após a cirurgia. Pacientes que apresentaram um resultado anormal da VEL foram considerados com lesão do NLR e foram reavaliados mensalmente até a recuperação espontânea, ou no período máximo de seis meses, quando a lesão foi considerada definitiva. RESULTADOS: encontramos evidência de lesão do NLR em 3/30 (10% dos pacientes, sendo que todos se apresentavam assintomáticos no momento do exame. Dentre as lesões, 2/30 (66,6% ocorreram após abordagem cirúrgica pelo lado direito e 1/30 (33,3% pelo lado esquerdo. Não encontramos nenhuma lesão definitiva, sendo o período máximo de recuperação de 120 dias. CONCLUSÃO: a avaliação por VEL no período pós-operatório pode ser útil para diagnosticar lesões do NLR, principalmente em pacientes assintomáticos. A falta de suspeita clínica não exclui a possibilidade de lesão do LNR.INTRODUCCIÓN: el reconocimiento de la lesión del nervio laríngeo recurrente (NLR después del tratamiento quirúrgico de hernia de disco cervical por la vía anterior es importante en la evolución clínica del paciente y, principalmente, en los casos de reintervención. El real papel de la videoendoscopía de laringe (VEL de rutina en el postoperatorio no ha sido

  20. Fast spin-echo MR assessment of patients with poor outcome following spinal cervical surgery

    Energy Technology Data Exchange (ETDEWEB)

    Wu, W. [Dept. of Diagnostic Radiology, Univ. Hospital, Linkoeping (Sweden)]|[The China-Japan Friendship Hospital, Beijing (China); Thuomas, K.AA. [Dept. of Diagnostic Radiology, Univ. Hospital, Linkoeping (Sweden); Hedlund, R. [Spinal Surgery, Univ. Hospital, Linkoeping (Sweden); Leszniewski, W. [Spinal Surgery, Univ. Hospital, Linkoeping (Sweden); Vavruch, L. [Spinal Surgery, Univ. Hospital, Linkoeping (Sweden)

    1996-03-01

    The aim of the investigation was to evaluate poor outcome following spinal cervical surgery. A total of 146 consecutive patients operated with anterior discectomy and fusion (ADF) with the Cloward technique were investigated. Clinical notes, plain radiography, CT, and fast spin-echo (FSE) images were retrospectively evaluated. Some 30% of the patients had unsatisfactory clinical results within 12 months after surgery; 13% had initial improvement followed by deterioration of the preoperative symptoms, while 14.4% were not improved or worsened. Disc herniation and bony stenosis above, below, or at the fused level were the most common findings. In 45% of patients, surgery failed to decompress the spinal canal. In only 4 patients was no cause of remaining myelopathy and/or radiculopathy found. FSE demonstrated a large variety of pathological findings in the patients with poor clinical outcome after ADF. Postoperatively, patients with good clinical outcome had a lower incidence of pathological changes. FSE is considered the primary imaging modality for the cervical spine. However, CT is a useful complement in the axial projection to visualize bone changes. (orig.).

  1. Fast spin-echo MR assessment of patients with poor outcome following spinal cervical surgery

    International Nuclear Information System (INIS)

    Wu, W.; Thuomas, K.AA.; Hedlund, R.; Leszniewski, W.; Vavruch, L.

    1996-01-01

    The aim of the investigation was to evaluate poor outcome following spinal cervical surgery. A total of 146 consecutive patients operated with anterior discectomy and fusion (ADF) with the Cloward technique were investigated. Clinical notes, plain radiography, CT, and fast spin-echo (FSE) images were retrospectively evaluated. Some 30% of the patients had unsatisfactory clinical results within 12 months after surgery; 13% had initial improvement followed by deterioration of the preoperative symptoms, while 14.4% were not improved or worsened. Disc herniation and bony stenosis above, below, or at the fused level were the most common findings. In 45% of patients, surgery failed to decompress the spinal canal. In only 4 patients was no cause of remaining myelopathy and/or radiculopathy found. FSE demonstrated a large variety of pathological findings in the patients with poor clinical outcome after ADF. Postoperatively, patients with good clinical outcome had a lower incidence of pathological changes. FSE is considered the primary imaging modality for the cervical spine. However, CT is a useful complement in the axial projection to visualize bone changes. (orig.)

  2. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations.

    Science.gov (United States)

    Coric, D; Bullard, D E; Patel, V V; Ryaby, J T; Atkinson, B L; He, D; Guyer, R D

    2018-02-01

    Pulsed electromagnetic field (PEMF) stimulation was evaluated after anterior cervical discectomy and fusion (ACDF) procedures in a randomized, controlled clinical study performed for United States Food and Drug Administration (FDA) approval. PEMF significantly increased fusion rates at six months, but 12-month fusion outcomes for subjects at elevated risk for pseudoarthrosis were not thoroughly reported. The objective of the current study was to evaluate the effect of PEMF treatment on subjects at increased risk for pseudoarthrosis after ACDF procedures. Two evaluations were performed that compared fusion rates between PEMF stimulation and a historical control (160 subjects) from the FDA investigational device exemption (IDE) study: a post hoc (PH) analysis of high-risk subjects from the FDA study (PH PEMF); and a multicentre, open-label (OL) study consisting of 274 subjects treated with PEMF (OL PEMF). Fisher's exact test and multivariate logistic regression was used to compare fusion rates between PEMF-treated subjects and historical controls. In separate comparisons of PH PEMF and OL PEMF groups to the historical control group, PEMF treatment significantly (p PEMF treatment can be recommended for patients who are at high risk for pseudoarthrosis. Cite this article : D. Coric, D. E. Bullard, V. V. Patel, J. T. Ryaby, B. L. Atkinson, D. He, R. D. Guyer. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations. Bone Joint Res 2018;7:124-130. DOI: 10.1302/2046-3758.72.BJR-2017-0221.R1. © 2018 Coric et al.

  3. Single level cervical disc herniation: A questionnaire based study on current surgical practices

    Directory of Open Access Journals (Sweden)

    Abrishamkar Saeid

    2009-01-01

    Full Text Available Background: Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons. Materials and Methods: About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed. Results: The mean age of enrolled surgeons was 51 yrs (range 45-73 with mean surgical experience of 16.9 yrs (range 12-40 yrs on single level cervical disc herniation. Out of 120 surgeons 10(8% had 15-25 years experience and always preferred fusion with or without instrumentation and six (five per cent with 17-27 yrs experience had never used fusion techniques. However, 104 (87% surgeons with 12-40 yrs experience had their own criteria based on their experiences for performing fusion with graft and instrumentation (FGI, while. 85 (75% preferred auto graft with cage. Conclusions: Most of surgeons performed FGI before the age of 40, but for others, patient criteria such as job (heavier job, physical examination (especially myelopathy and imaging findings (mild degenerative changes on X-ray and signal change in the spinal cord on MRI were considered significant for performing FGI.

  4. Significance of T2 Hyperintensity on Magnetic Resonance Imaging After Cervical Cord Injury and Return to Play in Professional Athletes.

    Science.gov (United States)

    Tempel, Zachary J; Bost, Jeffrey W; Norwig, John A; Maroon, Joseph C

    2015-07-01

    Cervical cord magnetic resonance imaging (MRI) T2 hyperintensity is used as evidence of cord trauma in the evaluation and management of athletes in contact sports. The long-term pathophysiologic and prognostic value of this finding is poorly understood, especially in return to play (RTP). To examine the significance of T2 hyperintensity in the cervical spinal cord of professional athletes. Retrospective review of MRI T2 hyperintensity findings between 2007 and 2014 in 5 professional athletes. Pertinent examination and demographics, including mechanism of injury, surgical intervention, radiographs, MRI studies, long-term outcomes, and RTP recommendations were collected. Four National Football League players and 1 professional wrestler had prior traumatic neurapraxia that at the time of initial consultation had resolved. MRIs showed congenitally small cervical canal (1) and multilevel spondylosis/stenosis/disc herniation (4) along with focal cord T2 hyperintensity (5). The signal abnormalities were at C3/C4 (3), C4 mid-vertebral body (1), and C5/C6 (1). Four athletes had single-level anterior cervical discectomy and fusion, and 1 was nonoperative. Serial MRI imaging at 3 months after surgery showed hyperintensity partially resolved (4) and unchanged (1), and at 9-months 3 of the 5 completely resolved. Based on the author's RTP criteria, 4 of 5 were released to return to their sport. Clearance for RTP preceded complete resolution of MRI T2 hyperintensity in 3 of 4 athletes. The 2 athletes that have returned to profession sport have not had any additional episodes of neurapraxia or any cervical spine-related complications. MRI T2 hyperintensity in contact sport athletes who are symptom-free with normal examination and no evidence of spinal instability may not be a contraindication to RTP. Additional observations are needed to confirm this observation.

  5. Polymethylmethacrylate-assisted ventral discectomy: Rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years

    Directory of Open Access Journals (Sweden)

    Maier-Hauff Klaus

    2011-06-01

    Full Text Available Abstract Background Polymethylmethacrylate (PMMA assisted ventral discectomy has been criticized for high rates of graft migration and pseudarthrosis when compared with various other fusion procedures for the treatment of cervical degenerative disc disease (DDD, therefore rendering it not the preferred choice of treatment today. Recently however spine surgery has been developing towards preservation rather than restriction of motion, indicating that fusion might not be necessary for clinical success. This study presents a long term comparison of clinical and radiological data from patients with pseudarthrosis and solid arthrodesis after PMMA assisted ventral discectomy was performed. Methods From 1986 to 2004 416 patients underwent ventral discectomy and PMMA interposition for DDD. The clinical and radiological outcome was assessed for 50 of 127 eligible patients after a mean of 8.1 years. Based on postoperative radiographs the patients were dichotomized in those with a pseudarthrosis (group A and those with solid arthrodesis (group B. Results Pseudarthrosis with movement of more than 2 of the operated segment was noted in 17 cases (group A. In 33 cases no movement of the vertebral segment could be detected (group B. The analysis of the clinical data assessed through the neck disability index (NDI, the visual analogue scale (VAS of neck and arm pain and Odom's criteria did not show any significant differences between the groups. Patients from group B showed a trend to higher adjacent segment degeneration (ASD than group A (p = 0.06. This correlated with the age of the patients. Conclusions PMMA assisted discectomy shows a high rate of pseudarthrosis. But the clinical long-term success does not seem to be negatively affected by this.

  6. Clinical and radiological outcomes following hybrid surgery in the treatment of multi-level cervical spondylosis: over a 2-year follow-up.

    Science.gov (United States)

    Shi, Ji-Sheng; Lin, Bin; Xue, Chao; Zhang, Hai-Shen; Chen, Zhi-Da; Zhao, Zhong-Sheng

    2015-12-16

    The optimal surgical approach for treatment of multi-level cervical disc disease is currently widely debated. Anterior cervical discectomy and fusion (ACDF) combined with cervical disc arthroplasty (CDA) has been presented as a treatment approach, but to date, there are few reports with adequate clinical and radiological data for this hybrid surgical procedure. The goal of this paper is to assess clinical and radiological outcomes in patients with cervical spondylosis in three contiguous segments after treatment with artificial disc replacement combined with fusion. We performed a retrospective review of 36 patients (mean age of 48.6 years) with contiguous three-level cervical spondylosis who were treated with ACDF coupled with CDA (hybrid surgery) between October 2008 and October 2012. Clinical evaluation was based on the Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, and postoperative JOA score improvement rate (IR). Radiographic parameters, angular range of motion (ROM) for C2-C7, and ROM for the superior and inferior adjacent segments were measured before the operation, at 1, 3, 6, and 12 months postoperation, and at the final follow-up evaluation. All cases were followed for at least 28 months (range 28-65 months). All patients exhibited significant postoperative improvement in NDI and JOA scores compared to preoperative levels (P  0.05). One patient required a second surgery for symptomatic adjacent segment degeneration. Neither pseudarthrosis nor other device migration was observed in any patients during the entire follow-up period. These results indicate that hybrid surgery seems to be a promising, acceptable, and alternative surgical approach for the treatment of multi-level cervical disc disease.

  7. Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up.

    Science.gov (United States)

    Chen, Yu; Wang, Xinwei; Lu, Xuhua; Yang, Lili; Yang, Haisong; Yuan, Wen; Chen, Deyu

    2013-07-01

    Anterior cervical discectomy and fusion (ACDF) with titanium- or polyetheretherketone (PEEK)-cage reconstruction is widely used in the treatment of cervical spondylotic myelopathy (CSM). This study was to compare outcomes of titanium and PEEK cages in the treatment of multilevel CSM. Between November 2002 and December 2004, a total of 80 patients with 3-level CSM were randomized in a 1:1 ratio to titanium group and PEEK group. The overall follow-up period of the patients ranged from 86 to 116 months (average 99.7 months). Clinical and radiological results were compared between titanium group and PEEK group. At the final follow-up, the clinical outcomes including JOA score, NDI score, and the excellent and good rates of clinical outcomes in the PEEK group were better than those in the titanium group. More loss of the Cobb angles and the intervertebral height was observed in the titanium group, resulting in the radiological parameters in the titanium group becoming inferior to the PEEK group at the final follow-up. Cage subsidence rates were 34.5 and 5.4% in the titanium and PEEK groups, respectively. Fusion was observed in all patients of two groups at the final follow-up. Two patients presented with cage dislocation without clinical symptoms in the titanium group. In surgical treatment of multilevel CSM, PEEK cage is superior to titanium cage in maintenance of intervertebral height and cervical lordosis, resulting in better clinical outcomes in the long-term follow-up.

  8. Postoperative initial single fungal discitis progressively spreading to adjacent multiple segments after lumbar discectomy.

    Science.gov (United States)

    Zou, Ming-xiang; Peng, An-bo; Dai, Zhi-hui; Wang, Xiao-bin; Li, Jing; Lv, Guo-hua; Deng, You-wen; Wang, Bing

    2015-01-01

    To report multiple cases and investigate etiology of initially single fungal spondylodiscitis that progressively spread to adjacent segments following lumbar discectomy, resulting in multiple spinal involvements. From January 2005 to May 2013, ten adult patients were admitted or referred to our institution with postoperative discitis. Fungal infections were confirmed by microbiologic and pathologic examinations. The clinical appearance, radiographic features, and treatments of this pathology were investigated. All the patients were previously healthy. The average interval between the occurrence of symptoms and primary lumbar discectomy was 61 days (range, 15-120 days). All the patients were treated with anterior surgical debridement, interbody fusion, and prolonged antifungal therapy. Three patients additionally received combined posterior instrumented fusion. Despite aggressive surgical debridement and antifungal therapy, spread of the infections to adjacent multiple discs was observed. No deaths, severe neurologic deficits, or deterioration of neurologic status were noted. The infections were completely resolved in all cases with spontaneous fusion within an average follow-up of 32.4 months. Fungal spondylodiscitis after surgery represents an intractable and troublesome complication, and surgical debridement may not impede the progression of the infection in cases where an insufficient course of antifungal treatment is administered. Such cases may require prolonged antifungal treatment with regular consultation by an infectious disease specialist. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Cervical disc hernia operations through posterior laminoforaminotomy

    OpenAIRE

    Yolas, Coskun; Ozdemir, Nuriye Guzin; Okay, Hilmi Onder; Kanat, Ayhan; Senol, Mehmet; Atci, Ibrahim Burak; Yilmaz, Hakan; Coban, Mustafa Kemal; Yuksel, Mehmet Onur; Kahraman, Umit

    2016-01-01

    Objective: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients ...

  10. Radiographic Analysis of Cervical and Spinal Alignment in Multilevel ACDF with Lordotic Interbody Device.

    Science.gov (United States)

    Katsuura, Yoshihiro; Lemons, Alex; Lorenz, Eileen; Swafford, Rachel; Osborn, James; Cason, Garrick

    2017-01-01

    Restoration and maintenance of cervical lordosis is an important clinical parameter in spine surgery. The purpose of this study was to determine the extent to which a multilevel anterior cervical discectomy and fusion (ACDF: greater than 3 levels) procedure restores cervical lordosis and the affect of increasing lordosis on sagittal vertical axis. We performed a retrospective radiographic analysis of 69 patients who underwent multilevel ACDF by 2 surgeons between 2013 and 2014. We measured the global and segmental sagittal alignment of the cervical spine using the cobb method at 4 time intervals (preop, post op 4wks, 10wks and 6 months) as well as the sagittal vertical axis (SVA) using both a C1-S1 and C7-S1 plumb line methods at 2 time intervals (preop and post op 4wks). Radiographs were measured by three reviewers. Interrater reliability was good to excellent for all measurements. Cervical lordosis significantly increased from preop 10.26° to 4 weeks postop 19.44° and was maintained up to 6 months 19.34 (p<0.0005). Segmental cervical lordosis was also significantly increased from preop 8.22° to post op at 4 weeks (20.26°) and was maintained at post op 10weeks 20.30° and post op 6 months 19.56° (p<0.0005). C7-S1 SVA and C1-S1 SVA also significantly increased from 12.04mm preop to 27.49mm post op 4 wks (p<0.0005) and -1.93mm preop to 8.67mm post op (p<0.0005) respectively. A change in C2-C7 lordosis positively correlated with a change in C7-SVA and C1-SVA (r=0.37, P<0.005, and r=0.312, p<0.05 respectively). Multilevel ACDF significantly increases and maintains both segmental and global cervical lordosis up to 6 months after surgery. Increasing C2-C7 global lordosis is correlated with increasing positive sagittal vertical axis. Level of evidence: IV.

  11. Prevention: Exercise

    Medline Plus

    Full Text Available ... Supplements Surgical Options Anterior Cervical Fusion Artifical Disc Replacement (ADR) Bone Graft Alternatives Bone Morphogenetic Proteins (BMP) Cervical Disc Replacement Cervical Laminoplasty Lumbar (Open) Microscopic Discectomy Percutaneous Vertebral ...

  12. Cervical Spondylosis

    Science.gov (United States)

    ... Request an Appointment at Mayo Clinic Causes Cervical spondylosis Cervical spondylosis Cervical spondylosis is degeneration of the bones and ... Related Symptom Checker Numbness in hands Numbness Cervical spondylosis Symptoms & causes Diagnosis & treatment Doctors & departments Advertisement Mayo ...

  13. The Mobi-C cervical disc for one-level and two-level cervical disc replacement: a review of the literature

    Directory of Open Access Journals (Sweden)

    Alvin MD

    2014-11-01

    Full Text Available Matthew D Alvin,1,2 Thomas E Mroz1,3,41Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA; 2Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; 4Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USABackground: Cervical disc arthroplasty (CDA is a novel motion-preserving procedure that is an alternative to fusion. The Mobi-C disc prosthesis, one of many Food and Drug Administration (FDA-approved devices for CDA, is the only FDA-approved prosthesis for two-level CDA. Hence, it may allow for improved outcomes compared with multilevel fusion procedures.Purpose: To critically assess the available literature on CDA with the Mobi-C prosthesis, with a focus on two-level CDA.Methods: All clinical articles involving the Mobi-C disc prosthesis for CDA through September 1, 2014 were identified on Medline. Any paper that presented Mobi-C CDA clinical results was included. Study design, sample size, length of follow-up, use of statistical analysis, quality of life outcome scores, conflict of interest, and complications were recorded.Results: Fifteen studies were included that investigated Mobi-C CDA, only one of which was a level Ib randomized control trial. All studies included showed non-inferiority of one-level Mobi-C CDA to one-level anterior cervical discectomy and fusion (ACDF. Only one study analyzed outcomes of one-level versus two-level Mobi-C CDA, and only one study analyzed two-level Mobi-C CDA versus two-level ACDF. In comparison with other cervical disc prostheses, the Mobi-C prosthesis is associated with higher rates of heterotopic ossification (HO. Studies with conflicts of interest reported lower rates of HO. Adjacent segment degeneration or disease, along with other complications, were not assessed in most studies.Conclusion: One-level Mobi-C CDA is non-inferior, but not superior, to one-level ACDF for patients

  14. Degenerative Cervical Disc Disease: Long-term Changes in Sagittal Alignment and Their Clinical Implications After Cervical Interbody Fusion Cage Subsidence: A Prospective Study With Standalone Lordotic Tantalum Cages.

    Science.gov (United States)

    Tomé-Bermejo, Félix; Morales-Valencia, Julián A; Moreno-Pérez, Javier; Marfil-Pérez, Juan; Díaz-Dominguez, Elena; Piñera, Angel R; Alvarez, Luis

    2017-06-01

    A retrospective, observational study of prospectively collected outcomes. To investigate the long-term clinical course of anterior cervical discectomy and fusion with interbody fusion cages (ACDF-IFC) with lordotic tantalum implants and to correlate the radiologic findings with the clinical outcomes, with special emphasis on the significance and the influence of implant subsidence. Cage subsidence is the most frequently reported complication after ACDF-IFC. However, most reports fail to correlate cage subsidence with lower fusion rates or with unsatisfactory clinical results. Forty-one consecutive patients with symptomatic degenerative cervical disk disease with failure of conservative treatment were included. All patients underwent 1-/2-level ACDF-IFC with lordotic tantalum implants. The mean follow-up was 4.91 years. The final follow-up fusion rate was 96.96% (32/33). The interspace height (IH) at the affected levels was significantly incremented after implant insertion, and despite a gradual loss in the height over time, the final follow-up IH was significantly higher than that measured preoperatively (Psubsidence (>3 mm) occurred in 11 disk spaces (26.82%). Preoperative and postoperative IH were significantly higher in subsidence patients; however, there was no difference in the final follow-up IH (P>0.05). Patients with ≥3 years of follow-up (n=29) did not demonstrate further significant subsidence beyond the second year. Regarding C1-C7 lordosis, the segmental Cobb angle, the cervical Visual Analogue Scale, and Neck Disability Index questionnaires, no difference between patients with or without final follow-up endplate subsidence was encountered. Until fusion occurs, tantalum cage settlement into the vertebral body is to be expected. Further subsidence could be the result of segmental adaptative changes. Graft subsidence did not affect the clinical outcome in any of our patients during long-term follow-up. The occurrence of dynamical implant subsidence had

  15. Cervical spine locking plate fixation for treatment of cervical spondylotic myelopathy in large breed dogs.

    Science.gov (United States)

    Trotter, Eric J

    2009-08-01

    To describe indirect decompression by means of cervical spine locking plate (CSLP) fixation with vertebral distraction, discectomy, and cancellous block bone grafting in large breed dogs with single caudal cervical dynamic spondylotic lesions diagnosed by myelography with linear traction to the cervical spine, and contrast-enhanced computed tomography. Prospective clinical study. Dogs (n=12) with caudal cervical spondylotic myelopathy because of a single dynamic, traction-responsive lesion. Single, traction-responsive, caudal cervical spondylotic lesions were treated by vertebral distraction, discectomy, cancellous block bone grafting, and CSLP fixation. Follow-up was obtained by sequential recheck examination by the author or referring veterinarian or by telephone inquiries. Ten dogs had neurologic improvement after surgery. Indirect decompression by maintained distraction with cancellous block grafting and CSLP fixation was readily accomplished with less risk of blood loss or iatrogenic spinal cord injury than that associated with direct (ventral) decompression. There were no complications of graft intrusion, extrusion or subsidence, implant loosening, foraminal impingement, or end-plate failure. Two dogs that had satisfactory short-term recoveries developed clinical signs associated with adjacent segment disease and were euthanatized. At long-term follow-up, 8 dogs had satisfactory function, either a normal gait or one with slight to moderate proprioceptive deficits. CSLP fixation with cancellous block interbody grafting is an effective and perhaps safer method of treating single-level, traction-responsive cervical spondylosis in large breed dogs. CSLP fixation with interbody bone grafting is a viable alternative to other techniques for treatment of single-level, traction-responsive cervical spondylosis.

  16. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy

    Directory of Open Access Journals (Sweden)

    Menekse Oksar

    2016-01-01

    Full Text Available Percutaneous endoscopic laser discectomy (PELD is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required. Here we report the sedation management of three cases that underwent PELD, with a focus on deep and safe sedation that was monitored using bispectral index score and observer’s assessment of alertness/sedation score.

  17. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

    Science.gov (United States)

    Assietti, Roberto; Corbino, Leonardo; Olindo, Giuseppe; Foti, Pietro V.; Russo, Vittorio; Albanese, Vincenzo

    2009-01-01

    We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion–nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3–15°) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors’ best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure. PMID:19415346

  18. Cervical spine disc herniation at C2-C3 level: Study of a Clinical Observation and Literature Review

    Directory of Open Access Journals (Sweden)

    Oka Dominique N'Dri

    2015-12-01

    Full Text Available Cervical C2-C3 herniated disc is rare. It is characterized by its clinical polymorphism. Several surgical approaches have been described for the discectomy of a herniated disc. This work aims at discussing through personal observations and literature review clinical semiology and surgical treatment.

  19. Comparison of nerve conduction and injury degree in patients with lumbar disc herniation after microendoscopic discectomy and fenestration discectomy

    Directory of Open Access Journals (Sweden)

    Jun Li

    2017-09-01

    Full Text Available Objective: To study the difference of nerve conduction and injury degree in patients with lumbar disc herniation after microendoscopic discectomy and fenestration discectomy. Methods: Patients with single-segment lumbar disc herniation who were treated in Dazhou Central Hospital between May 2014 and February 2017 were selected as the research subjects, the history data were reviewed and the operation methods were referred to divide them into FD group and MED group who received fenestration discectomy and microendoscopic discectomy respectively. The conduction velocity of common peroneal nerve and tibial nerve were detected before operation and 4 weeks after operation; serum levels of nerve and muscle injury-related molecules as well as inflammation and stress-related molecules were detected before operation and 3 days after operation. Results: MNCV levels of common peroneal nerve and tibial nerve 4 weeks after operation as well as serum CRP, TNF-α, MDA and AOPP contents 3 d after operation of both groups of patients were significantly higher than those before operation, and the MNCV levels of common peroneal nerve and tibial nerve of MED group 4 weeks after operation were significantly higher than those of FD group while serum CRP, TNF-α, MDA and AOPP contents of MED group 3 d after operation were not significantly different from those of FD group; serum NSE, S100B, Tau, pNF-H, CPK, Myo and LDH contents of FD patients 3 d after operation were significantly higher than those before operation while serum NSE, S100B, Tau, pNF-H, CPK, Myo and LDH contents of MED group were not significantly different from those before operation. Conclusion: Microendoscopic discectomy for lumbar disc herniation can relieve the nerve and muscle injury, and is equivalent to fenestration discectomy in activating the systemic stress and inflammatory response.

  20. A novel anterior revision surgery for the treatment of cervical ossification of posterior longitudinal ligament: case report and review of the literature.

    Science.gov (United States)

    Miao, Jinhao; Sun, Jingchuan; Shi, Jiangang; Chen, Yu; Chen, Deyu

    2018-02-21

    A 62-year-old blind man with severe ossification of posterior longitudinal ligament was presented. The patient received posterior laminectomy and fixation. After surgery, the patient was not satisfied with the recovery of upper limbs although the JOA score increased from 9 to 12 points. Because the tactile sensation of his hands is especially important to his daily life, the patient asked for further treatment after 6 months. The paper is to report the novel revision surgery we invented and the outcome of the patient after the novel surgery. We performed the revision surgery using anteriorly approach from C3-7 with a novel technique, which named anterior controllable antedisplacement and fusion (ACAF). The patient was followed up for 6 months. The clinical data including JOA score and radiological images were collected and analyzed. After the revision surgery, the patient had improvement release of numbness of both hands and the JOA score was increased to 14 points. Satisfactory decompression was assessed by MRI post-operation. Bone fusion was confirmed by CT 3 months post-operation. No specific complications related to this surgery was observed. The application of such operative procedure in revision surgery for OPLL has not been reported and might be an alternative choice for patients with unsatisfied outcome from previous posterior surgery. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. Upper cervical spine injuries: a management of a series of 70 cases ...

    African Journals Online (AJOL)

    Posterior approach was performed in 29 cases including hooks and rods in 18 patients, wiring in 9 cases, and 2 transarticular screw fixations. In 9 cases anterior approach was performed: 5 odontoid screwing and 4 cases of C2-C3 discectomy with bone graft. Nearly all patients were improved in post-operative. Elsewhere ...

  2. Comparison Of Percutaneous Laser Discectomy With Other Modalities For The Treatment Of Herniated Lumbar Discs And Cadaveric Studies Of Percutaneous Laser Discectomy

    Science.gov (United States)

    Johansen, W. E.; Smith, Chadwick F.; Vangsness, Thomas; McEleney, Emmett T.; Yamaguchi, Ken; Bales, Peter

    1987-03-01

    Current modalities for treating a herniated lumbar disc include standard open discectomy, microsurgical discectomy, chemonucleoysis and percutaneous discectomy. The Food and Drug Administration has not yet approved percutaneous laser discectomy for clinical investigation. The investigators believe that percutaneous laser discectomy combines the efficacy of both chemonucleoysis and percutaneous discectomy with the safety of both open standard discectomy and microsurgical discectomy. The investigators removed two lumbar discs from a cadaveric spine and weighed each of them. The two lumbar discs weighed in the range of 13.654 grams and 15.713 grams, respectively. The investigators initiated several series of 10 firing cycles from a surgical carbon dioxide laser system. In each firing cycle the surgical carbon dioxide laser system delivered a beam of light energy having an output power of 18.0 watts at pulse duration of 0.045 second at the rate of 15 pulses per second for a period of 6 seconds and vaporized approximately 325 milligrams of disc material. Based on the findings of other investigators reported in the literature relating to percutaneous discectomy the investigators postulated that 10 to 20 firing cycles are required to vaporize 30 to 40% (2.4 to 6.4 grams) of the disc material. The investigators initiated two series of 10 firing cycles in order to perform laser discectomy in a third lumbar disc of the cadaveric spine in situ. The investigators harvested and then bisected the laser-treated third lumbar disc for gross review. Their gross findings indicated a high probability of success For percutaneous laser discectomy.

  3. Immediate post-discectomy percutaneous facet nerve continuous and nerve root pulsed radiofrequency and intraluminal injection of steroid with hyaluronidase improved outcome of surgery for lumbar disk herniation

    Directory of Open Access Journals (Sweden)

    Ahmed E. Mohamed Ali

    2017-01-01

    Conclusion: Open discectomy provided significant improvement of LBP and disability secondary to LDH. Discectomy with adjuvant therapy including PRF, CTRFN and triamcinolone and hyaluronidase intraluminar injection significantly improved outcome compared to discectomy alone.

  4. Results of arthrospine assisted percutaneous technique for lumbar discectomy

    Directory of Open Access Journals (Sweden)

    Mohinder Kaushal

    2016-01-01

    Full Text Available Background: Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive “Arthrospine assisted percutaneous technique for lumbar discectomy” is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments. Materials and Methods: 150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years. The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3, L2-L3 (n = 2, L3-L4 (n = 8, L4-L5 (n = 90, and L5-S1 (n = 47. Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments. Results: Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90% patients had excellent to good, 12 (8% had fair, and 2 patients (1.3% had poor results. The complications observed were discitis in 3 patients (2%, dural tear in 4 patients (2.6%, and nerve root injury in 2 patients (1.3%. About 90% patients

  5. A Rare Nasal Bone Fracture: Anterior Nasal Spine Fracture

    Directory of Open Access Journals (Sweden)

    Egemen Kucuk

    2014-04-01

    Full Text Available Anterior nasal spine fractures are a quite rare type of nasal bone fractures. Associated cervical spine injuries are more dangerous than the nasal bone fracture. A case of the anterior nasal spine fracture, in a 18-year-old male was presented. Fracture of the anterior nasal spine, should be considered in the differential diagnosis of the midface injuries and also accompanying cervical spine injury should not be ignored.

  6. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation : A prospective randomised controlled trial [ISRCTN51857546

    NARCIS (Netherlands)

    M.P. Arts (Mark); W.C. Peul (Wilco); R. Brand (René); B.W. Koes (Bart); R.T.W.M. Thomeer (Raph)

    2006-01-01

    textabstractBackground: Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows

  7. The addition of cervical unilateral posterior-anterior mobilisation in the treatment of patients with shoulder impingement syndrome: a randomised clinical trial.

    Science.gov (United States)

    Cook, Chad; Learman, Ken; Houghton, Steve; Showalter, Christopher; O'Halloran, Bryan

    2014-02-01

    Shoulder impingement syndrome (SIS) is a complex, multi-factorial problem that is treated with a variety of different conservative options. One conservative option that has shown effectiveness is manual therapy to the thoracic spine. Another option, manual therapy to the cervical spine, has been studied only once with good results, evaluating short-term outcomes, in a small sample size. The purpose of this study was to investigate the benefit of neck manual therapy for patients with SIS. The study was a randomised, single blinded, clinical trial where both groups received pragmatic, evidence-based treatment to the shoulder and one group received neck manual therapy. Subjects with neck pain were excluded from the study. Comparative pain, disability, rate of recovery and patient acceptable symptom state (PASS) measures were analyzed on the 68 subjects seen over an average of 56.1 days (standard deviation (SD)=55.4). Eighty-six percent of the sample reported an acceptable change on the PASS at discharge. There were no between-groups differences in those who did or did not receive neck manual therapy; however, both groups demonstrated significant within-groups improvements. On average both groups improved 59.7% (SD=25.1) for pain and 53.5% (SD=40.2) for the Quick Disabilities of the Shoulder and Hand Questionnaire (QuickDASH) from baseline. This study found no value when neck manual therapy was added to the treatment of SIS. Reasons may include the lack of therapeutic dosage provided for the manual therapy approach or the lack of benefit to treating the neck in subjects with SIS who do not have concomitant neck problems. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Randomized, prospective, and controlled clinical trial of pulsed electromagnetic field stimulation for cervical fusion.

    Science.gov (United States)

    Foley, Kevin T; Mroz, Thomas E; Arnold, Paul M; Chandler, Howard C; Dixon, Robert A; Girasole, Gerard J; Renkens, Kenneth L; Riew, K Daniel; Sasso, Rick C; Smith, Richard C; Tung, Howard; Wecht, Daniel A; Whiting, Donald M

    2008-01-01

    Multilevel fusions, the use of allograft bone, and smoking have been associated with an increased risk of nonunion after anterior cervical discectomy and fusion (ACDF) procedures. Pulsed electromagnetic field (PEMF) stimulation has been shown to increase arthrodesis rates after lumbar spine fusion surgery, but there are minimal data concerning the effect of PEMF stimulation on cervical spine fusion. To determine the efficacy and safety of PEMF stimulation as an adjunct to arthrodesis after ACDF in patients with potential risk factors for nonunion. A randomized, controlled, prospective multicenter clinical trial. Three hundred and twenty-three patients with radiographic evidence (computed tomography-myelogram [CT-myelo] or magnetic resonance imaging [MRI]) of a compressed cervical nerve root and symptomatic radiculopathy appropriate to the compressed root that had failed to respond to nonoperative management were enrolled in the study. The patients were either smokers (more than one pack per day) and/or were undergoing multilevel fusions. All patients underwent ACDF using the Smith-Robinson technique. Allograft bone and an anterior cervical plate were used in all cases. Measurements were obtained preoperatively and at each postoperative interval and included neurologic assessment, visual analog scale (VAS) scores for shoulder/arm pain at rest and with activity, SF-12 scores, the neck disability index (NDI), and radiographs (anteroposterior, lateral, and flexion-extension views). Two orthopedic surgeons not otherwise affiliated with the study and blinded to treatment group evaluated the radiographs, as did a blinded radiologist. Adverse events were reported by all patients throughout the study to determine device safety. Patients were randomly assigned to one of two groups: those receiving PEMF stimulation after surgery (PEMF group, 163 patients) and those not receiving PEMF stimulation (control group, 160 patients). Postoperative care was otherwise identical. Follow

  9. [Minimally invasive approach for cervical spondylotic radiculopathy].

    Science.gov (United States)

    Ding, Liang; Sun, Taicun; Huang, Yonghui

    2010-01-01

    To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). The recent literature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. There were two techniques of minimally invasive approach for CSR at present: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneous puncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopic discectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local ligamentum flavum thickening and spondylotic foraminal stenosis. The minimally invasive procedure has the advantages of simple handling, minimally invasive and low incidence of complications. But the scope of indications is relatively narrow at present.

  10. Management of cervical polyradiculopathy through multisegmental laminoforaminotomies

    Directory of Open Access Journals (Sweden)

    Hosam Eldin Abdel Azim Mostafa Habib

    2014-12-01

    Conclusion: Cervical laminoforaminotomy is an effective technique in addressing multisegmental cervical radicular compression. Moreover, this technique eliminates the need of fusion and possible internal fixation, which are essential if the alternative anterior procedure was performed; thus, reducing the overall cost and morbidity.

  11. Clinical Outcomes of Percutaneous Transforaminal Endoscopic Discectomy Versus Fenestration Discectomy in Patients with Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Zheng-mei DING

    2017-03-01

    Full Text Available Background: Fenestration discectomy (FD is a common treatment method for lumber disc herniation (LDH, with good effects obtained. Nevertheless, it also causes many complications, such as lumbar instability, lumbago and back pain. Percutaneous endoscopic lumbar discectomy (PTED is a new minimally invasive treatment available for LDH with conservative therapy failure. At present, this technique has been carried out in China. The purpose of this study was to conduct a randomized prospective trial to compare the surgical outcomes of PTED and FD, explore the clinical application value of PTED, and discuss the operative manipulated skills of PTED.Methods: Totally 100 patients with LDH were enrolled from March 2014 to December 2015 and randomly divided into PTED group and FD group, 50 cases in each group. FD group received FD including epidural anesthesia, unilateral fenestration decompression, removal of nucleus pulposus, and nerve root decompression and release, while FTED group received PTED including local anesthesia, endoscopic removal of herniated nucleus pulposus and nerve root decompression and release. Both groups were followed up postoperatively. The duration of operation, incision length, postoperative bed-rest and hospital stay were compared between two groups, and the visual analogue scale (VAS, Oswestry disability index (ODI, and therapeutic effects at the final follow-up time were recorded and compared between 2 groups.Results: All patients completed the operation successfully. The surgical duration was similar between two groups (P>0.05. PTED group showed a less incision length and shorter postoperative bed-rest time and hospital stay than FD group (P<0.01. The VAS and ODI scores showed a significant decrease in both groups postoperatively when compared with operation before (P<0.05, but with no significant difference between two groups (P>0.05. Moreover, the excellent and good rate was higher in PTED group thanin FD group, with no

  12. Influência do suporte e fixação anterior na resistência mecânica do fixador interno vertebral Influencia del soporte y de la fijación anterior sobre la resistencia mecánica del fijador interno vertebralartrodesis cervical anterior por hernia del disco cervica The influence of anterior reconstruction and fixation on the mechanical performance of an internal fixator

    OpenAIRE

    Gisele Cristina Ale dos Santos; Antonio Carlos Shimano; Helton LA Defino

    2009-01-01

    OBJETIVO: avaliar a influência da reconstrução e fixação anterior no desempenho mecânico do fixador interno da coluna vertebral. MÉTODOS: foram formados três grupos experimentais de acordo com a reconstrução e fixação anterior: grupo I -sem suporte anterior; grupo II - com suporte anterior; grupo III - com suporte e fixação anterior. Os corpos de prova foram submetidos a ensaios mecânicos de flexo-compressão, flexão lateral e torção, realizados em máquina de universal de ensaios, tendo sido r...

  13. Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2013-01-01

    Full Text Available Varicella-zoster virus and herpes simplex virus types 1 and 2 are neurotropic viruses that can be reactivated after a surgical or stressful intervention. Although such cases are uncommon, consequences can be debilitating, and variable treatment responses merit consideration. We describe a 41-year-old male with a history of varicella-mediated skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution following a C5-6 anterior cervical discectomy and fusion and epidural steroid injections. The operative course was uncomplicated and he was discharged home on postoperative day 1. Approximately ten days after surgery, the patient presented to the emergency department complaining of severe pain in his right upper extremity and a vesicular rash from his elbow to his second digit. He was started on Acyclovir and discharged home. On outpatient follow-up, his rash had resolved though his pain continued. The patient was started on a neuromodulating agent for chronic pain. This case adds to the limited literature regarding this rare complication, brings attention to the symptoms for proper diagnosis and treatment, and emphasizes the importance of prompt antiviral therapy. We suggest adding a neuromodulating agent to prevent long-term sequelae and resolve acute symptoms.

  14. Endoscopic anatomy and features of lumbar discectomy by Destandau technique

    Directory of Open Access Journals (Sweden)

    Keyvan Mostofi

    2017-03-01

    Full Text Available Minimally invasive spine surgery prevents alteration of paraspinal muscles and avoids traditional open surgery, so in the majority of cases, recovery is much quicker and patients have less back pain after surgery. The authors describe an endoscopic approach to lumbar disc herniation by the Destandau's method originated in Bordeaux. Destandau designed ENDOSPINE for discectomy will be inserted, and the procedure will continue using endoscopy. The Endoscopic approach to lumbar disc herniation by Destandau's method offers a convenient access to lumbar disc herniation with less complications and negligible morbidity. It gives maximum exposure to the disc space with maximal angles and minimal cutaneous incision. Contrary to other minimally invasive approaches, the visual field in discectomy by Destandau technique is broad and depending on the workability of ENDOSPINE an adequate access to lumbar disc herniation is possible.

  15. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation.

    Science.gov (United States)

    Rasouli, Mohammad R; Rahimi-Movaghar, Vafa; Shokraneh, Farhad; Moradi-Lakeh, Maziar; Chou, Roger

    2014-09-04

    Microdiscectomy or open discectomy (MD/OD) are the standard procedures for symptomatic lumbar disc herniation and they involve removal of the portion of the intervertebral disc compressing the nerve root or spinal cord (or both) with or without the aid of a headlight loupe or microscope magnification. Potential advantages of newer minimally invasive discectomy (MID) procedures over standard MD/OD include less blood loss, less postoperative pain, shorter hospitalisation and earlier return to work. To compare the benefits and harms of MID versus MD/OD for management of lumbar intervertebral discopathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), MEDLINE (1946 to November 2013) and EMBASE (1974 to November 2013) and applied no language restrictions. We also contacted experts in the field for additional studies and reviewed reference lists of relevant studies. We selected randomised controlled trials (RCTs) and quasi-randomised controlled trials (QRCTs) that compared MD/OD with a MID (percutaneous endoscopic interlaminar or transforaminal lumbar discectomy, transmuscular tubular microdiscectomy and automated percutaneous lumbar discectomy) for treatment of adults with lumbar radiculopathy secondary to discopathy. We evaluated the following primary outcomes: pain related to sciatica or low back pain (LBP) as measured by a visual analogue scale, sciatic specific outcomes such as neurological deficit of lower extremity or bowel/urinary incontinence and functional outcomes (including daily activity or return to work). We also evaluated the following secondary outcomes: complications of surgery, duration of hospital stay, postoperative opioid use, quality of life and overall participant satisfaction. Two authors checked data abstractions and articles for inclusion. We resolved discrepancies by consensus. We used standard methodological procedures expected by The Cochrane Collaboration. We used pre-developed forms to extract data

  16. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546

    Directory of Open Access Journals (Sweden)

    Brand Ronald

    2006-05-01

    Full Text Available Abstract Background Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows early ambulation, short hospital stay and quick resumption of daily activities. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in patients with lumbar disc herniation. Methods/Design Patients (age 18–70 years presenting with sciatica due to lumbar disc herniation lasting more than 6–8 weeks are included. Patients with disc herniation larger than 1/3 of the spinal canal diameter, or disc herniation less than 1/3 of the spinal canal diameter with concomitant lateral recess stenosis or sequestration, are eliglible for participation. Randomisation into microendoscopic discectomy or conventional unilateral transflaval discectomy will take place in the operating room after induction of anesthesia. The length of skin incision is equal in both groups. The primary outcome measure is the functional assessment of the patient, measured by the Roland Disability Questionnaire for Sciatica, at 8 weeks and 1 year after surgery. We will also evaluate several other outcome parameters, including perceived recovery, leg and back pain, incidence of re-operations, complications, serum creatine kinase, quality of life, medical consumption, absenteeism and costs. The study is a randomised prospective multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 2 years. Discussion Currently, open discectomy is the golden standard in the surgical treatment of lumbar disc

  17. The post-discectomy syndrome. Aetiology, diagnosis, treatment, prevention.

    Science.gov (United States)

    Ivanic, G M; Pink, T P; Homann, N C; Scheitza, W; Goyal, S

    2001-10-01

    The post-discectomy syndrome (PDS) is a common diagnosis in patients with problems following a disc operation. The different causes of PDS make the establishment of the correct diagnosis and its corresponding efficient treatment difficult. A general overview published in the bibliographical data covering the entity of PDS is rare. The following paper aims to specify PDS according to its aetiology, diagnosis, treatment and prevention. The diagnosis should be made efficiently, so that the patient can receive prompt adequate therapy.

  18. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

    Directory of Open Access Journals (Sweden)

    Kanthila Mahesha

    2017-01-01

    Full Text Available Background: Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications. Materials and Methods: One hundred patients with lumbar disc prolapse who were treated with percutaneous endoscopic discectomy from May 2012 to January 2014 were included in this retrospective study. Clinical followup was done at 1 month, 3 months, 6 months, 1 year, and at yearly interval thereafter. The outcome was assessed using modified Macnab′s criteria, visual analog scale, and Oswestry Disability Index. Results: The mean followup period was 2 years (range 18 months - 3 years. Transforaminal approach was used in 84 patients, interlaminar approach in seven patients, and combined approach in nine patients. An excellent outcome was noted in ninety patients, good outcome in six patients, fair result in two patients, and poor result in two patients. Minor complications were seen in three patients, and two patients had recurrent disc prolapse. Mean hospital stay was 1.6 days. Conclusions: Percutaneous endoscopic lumbar discectomy is a safe and effective procedure in lumbar disc prolapse. It has the advantage that it can be performed on a day care basis under local anesthesia with shorter length of hospitalization and early return to work thus improving the quality of life earlier. The low complication rate makes it the future of disc surgery. Transforaminal approach alone is sufficient in majority of cases, although 16% of cases required either percutaneous interlaminar approach or combined approach. The procedure definitely has a learning curve, but it is acceptable with adequate preparations.

  19. Aggressive discectomy for single level lumbar disk herniation

    Directory of Open Access Journals (Sweden)

    Md. Kamrul Ahsan

    2017-09-01

    Full Text Available Aggressive open lumbar discectomy is the most commonly performed surgical procedure for patients with persistent low back and leg pain. In this retrospective study,  1,380 patients were evaluated for long-term results of aggressive discectomy for the single level lumbar disk herniation. Demographic data, surgical data, complications and reherniation rate were collected and clinical outcomes were assessed using visual analogue score (VAS, Oswestry disability index (ODI and modified Mcnab criteria. The mean follow-up period was 28.8 months. According to the modified Mcnab criteria, the long-term results were excellent in 640 cases, good in 445 cases, fair in 255 cases, and poor in 40 cases. The mean VAS scores for back and radicular pains and ODI at the end of 2 years were 1.1 ± 1.0, 1.5 ± 0.5 and 6.6 ± 3.1% respectively. The complications were foot drop (n=7, dural tear (n=14, superficial wound infection (n=17, discitis (n=37 and reherniation (n=64. The dural tear and superficial wound infections resolved after treatment but 28 discitis patients were treated by conservatively and the remaining 9 underwent surgery. Among reherniation patients, 58 underwent revision discectomy and 4 underwent transforaminal lumbar interbody fusion and stabilization. Aggressive discectomy is an effective treatment of lumbar disk herniation and maintains a lower incidence of reherniation but leads to a collapse of disc height and in long run gives rise to intervertebral instability and accelerates spondylosis.

  20. Influência do suporte e fixação anterior na resistência mecânica do fixador interno vertebral Influencia del soporte y de la fijación anterior sobre la resistencia mecánica del fijador interno vertebralartrodesis cervical anterior por hernia del disco cervica The influence of anterior reconstruction and fixation on the mechanical performance of an internal fixator

    Directory of Open Access Journals (Sweden)

    Gisele Cristina Ale dos Santos

    2009-03-01

    Full Text Available OBJETIVO: avaliar a influência da reconstrução e fixação anterior no desempenho mecânico do fixador interno da coluna vertebral. MÉTODOS: foram formados três grupos experimentais de acordo com a reconstrução e fixação anterior: grupo I -sem suporte anterior; grupo II - com suporte anterior; grupo III - com suporte e fixação anterior. Os corpos de prova foram submetidos a ensaios mecânicos de flexo-compressão, flexão lateral e torção, realizados em máquina de universal de ensaios, tendo sido realizados dez ensaios para cada modalidade (flexo-compressão, flexão lateral e torção em cada grupo experimental, perfazendo um total de 90 ensaios mecânicos. As propriedades mecânicas estudadas foram: o momento-fletor, o torque e a rigidez obtidos a partir da curva carga x deflexão de cada ensaio mecânico. RESULTADOS: observou-se que a colocação do suporte e da fixação anterior aumentou a resistência mecânica nos ensaios de flexo-compressão. Nos ensaios de flexão lateral observou-se aumento da resistência mecânica somente com a fixação anterior. CONCLUSÃO: nos ensaios de torção o suporte anterior e a fixação anterior não aumentaram a resistência mecânica do sistema de fixação vertebral.OBJETIVO: evaluar la influencia de la reconstrucción y fijación anterior en el desempeño mecánico del fijador interno de la columna vertebral. MÉTODOS: fueron formados tres grupos experimentales de acuerdo com la reconstrucción y fijación anterior: grupo I- sin soporte anterior, grupo II- con soporte anterior y grupo III- con soporte y fijación anterior. Los cuerpos de prueba fueron sometidos a ensayos mecánicos de flexocompresión, flexión lateral y torción, realizados en la máquina universal de ensayos, habiéndose realizados 10 ensayos para cada modalidad (flexocompresión, flexión lateral y torción en cada grupo experimental,con untotal de 90 ensayos mecánicos. Las propiedades mecánicas estudiadas fueron el

  1. Magnetic resonance imaging evaluation after implantation of a titanium cervical disc prosthesis: a comparison of 1.5 and 3 Tesla magnet strength.

    Science.gov (United States)

    Sundseth, Jarle; Jacobsen, Eva A; Kolstad, Frode; Nygaard, Oystein P; Zwart, John A; Hol, Per K

    2013-10-01

    Cervical disc prostheses induce significant amount of artifact in magnetic resonance imaging which may complicate radiologic follow-up after surgery. The purpose of this study was to investigate as to what extent the artifact, induced by the frequently used Discover(®) cervical disc prosthesis, impedes interpretation of the MR images at operated and adjacent levels in 1.5 and 3 Tesla MR. Ten subsequent patients were investigated in both 1.5 and 3 Tesla MR with standard image sequences one year following anterior cervical discectomy with arthroplasty. Two neuroradiologists evaluated the images by consensus. Emphasis was made on signal changes in medulla at all levels and visualization of root canals at operated and adjacent levels. A "blur artifact ratio" was calculated and defined as the height of the artifact on T1 sagittal images related to the operated level. The artifacts induced in 1.5 and 3 Tesla MR were of entirely different character and evaluation of the spinal cord at operated level was impossible in both magnets. Artifacts also made the root canals difficult to assess at operated level and more pronounced in the 3 Tesla MR. At the adjacent levels however, the spinal cord and root canals were completely visualized in all patients. The "blur artifact" induced at operated level was also more pronounced in the 3 Tesla MR. The artifact induced by the Discover(®) titanium disc prosthesis in both 1.5 and 3 Tesla MR, makes interpretation of the spinal cord impossible and visualization of the root canals difficult at operated level. Adjusting the MR sequences to produce the least amount of artifact is important.

  2. Cervical Cancer

    Science.gov (United States)

    ... the place where a baby grows during pregnancy. Cervical cancer is caused by a virus called HPV. The ... for a long time, or have HIV infection. Cervical cancer may not cause any symptoms at first. Later, ...

  3. Cervical Dysplasia

    Science.gov (United States)

    ... pass through. Cervical dysplasia is detected in a pap test (pap smear), and diagnosed in a biopsy. Abnormal ... American Academy of Family Physicians (AAFP) recommends routine pap tests to diagnose cervical cancer early. You can check ...

  4. Cervical cancer

    Science.gov (United States)

    ... bleeding between periods, after intercourse, or after menopause Vaginal discharge that does not stop, and may be pale, ... Instructions Hysterectomy - abdominal - discharge Hysterectomy - laparoscopic - ... Images Cervical cancer Cervical neoplasia ...

  5. Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2007-03-06

    Did you know that cervical cancer rates differ by race/ethnicity and region? Or that cervical cancer can usually be prevented if precancerous cervical lesions are found by a Pap test and treated? Find out how getting regular Pap tests can save a woman's life.  Created: 3/6/2007 by National Breast and Cervical Cancer Early Detection Program.   Date Released: 4/25/2007.

  6. [Disphagia secondary to cervical osteophytes].

    Science.gov (United States)

    Torres Muros, B; Serrano, J A; Meschian Coretti, S

    2006-01-01

    Disphagia is a common cause of medical query in the ENT field, in which could be involved a variety of medical reason. One of those is the extrinsic compression of the digestive tract due to a tumoral process, or as the case we report, secundary to a large osteophyte at the anterior side of the cervical spine, after a surgical intervention in this area.

  7. Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials.

    Science.gov (United States)

    Jawahar, Ajay; Cavanaugh, David A; Kerr, Eubulus J; Birdsong, Elisa M; Nunley, Pierce D

    2010-12-01

    Advancements in the philosophy of "motion preservation" have led to the use of total disc arthroplasty (TDA) as an alternative to fusion for degenerative disc disease (DDD) in the cervical spine. A commonly proposed theory is that TDA could reduce the incidence of adjacent segment disease. All the published clinical studies for TDA discuss the "equal efficacy" results of different investigational device exemption (IDE) trials between TDA and anterior cervical discectomy and fusion (ACDF) but have not addressed the issue of adjacent segment disease. To present the comparison of outcome data with respect to clinical success rates, symptom-free period, and incidence of adjacent segment disease in 93 patients with one- and two-level cervical DDD treated with TDA or ACDF in three different Food and Drug Administration (FDA) investigational trials. Prospective, randomized, FDA IDE trials. Ninety-three patients with established symptomatic one-or two-level cervical disc disease who failed to respond to conservative treatment were randomized to receive TDA (59) or ACDF (34) as part of clinical trials involving three different artificial discs at our institution. Subjects were blind to the assigned group until after the surgery. Visual analog pain score (VAS), Neck Disability Index, and cervical spine radiographs were collected at 6 weeks and at 3, 6, 12, 24, 36, and 48 months after surgery. Success of the index surgery was assessed based on outcome measures at the seven data points. Success was defined as reduction by more than 30 points in both VAS and Neck Disability Index, absence of neurological deficits, and no further intervention at the index level. Adjacent segment disease was established by radiology, neurophysiology, and subsequent interventions administered to the patients. At median follow-up of 37 months (range, 24-49 months), 64 (25 ACDF and 39 TDA) patients satisfied the criteria for clinical success. Neck Disability Index was a better predictor of outcome

  8. Usurering af osteosyntesemateriale gennem øsofagus efter anterior cervikalkirurgi

    DEFF Research Database (Denmark)

    Wiis, Julie Therese; Nittby, Henrietta Carolina; Lauritsen, Anne Oberg

    2014-01-01

    The rare, potentially life-threatening complication to anterior cervical surgery, oesophageal perforation, occurs after surgical trauma or due to erosion by migrating hardware. Symptoms are hoarseness, dysphagia, neck/throat pain, subcutaneous emphysema and fever. Imaging and endoscopic diagnosis...

  9. Transforaminal endoscopic discectomy with foraminoplasty for the treatment of spondylolisthesis.

    Science.gov (United States)

    Jasper, Gabriele P; Francisco, Gina M; Telfeian, Albert E

    2014-01-01

    Lumbar degenerative spondylolisthesis is a common entity and occurs mainly in elderly patients. The trend in surgery has been to offer decompression with instrumented fusion based on patient-based outcome data and the inherent instability of the condition. Transforaminal endoscopic discectomy and foraminotomy is an ultra-minimally invasive outpatient surgical option available to patients that does not require general anesthesia and does not involve the same amount of destabilizing facet joint removal as a traditional laminectomy and medial facetectomy. The purpose of this study was to assess the benefit of tranforaminal endoscopic discectomy and foraminotomy in patients with lumbar 4-5 (L4-L5) and lumbar 5-sacral 1 (L5-S1) spondylolisthesis and lumbar radiculopathy. After Institutional Review Board Approval, charts from 21 consecutive patients with L4-L5 or L5-S1 spondylolisthesis and complaints of lower back and radicular pain who underwent endoscopic procedures between 2007 and 2012 were reviewed. The average pain relief one year postoperatively was reported to be 71.9%, good results as defined by MacNab. The average pre-operative VAS score was 8.48, indicated in our questionnaire as severe and constant pain. The average one year postoperative VAS score was 2.30, indicated in our questionnaire as mild and intermittent pain. This is a retrospective study and only offers one year follow-up data for patients with spondylolisthesis undergoing endoscopic spine surgery for treatment of lumbar radiculopathy. Endoscopic discectomy is a safe and effective alternative to open back surgery. The one year follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the treatment of lumbar radiculopathy in the setting of spondylolisthesis that has a low complication rate, avoids general anesthesia, and is outpatient might be worth studying in a prospective, longer term way. IRB approval: Meridian Health: IRB Study # 201206071J.

  10. Clinical outcomes and efficacy of transforaminal lumbar endoscopic discectomy

    Directory of Open Access Journals (Sweden)

    Cezmi Çagri Türk

    2015-01-01

    Full Text Available Background: Transforaminal lumbar endoscopic discectomy (TLED is a minimally invasive procedure for removing lumbar disc herniations. This technique was initially reserved for herniations in the foraminal or extraforaminal region. This study concentrated on our experience regarding the outcomes and efficacy of TLED. Materials and Methods: A total of 105 patients were included in the study. The patients were retrospectively evaluated for demographic features, lesion levels, numbers of affected levels, visual analog scores (VASs, Oswestry disability questionnaire scale scores and MacNab pain relief scores. Results: A total of 48 female and 57 male patients aged between 25 and 64 years (mean: 41.8 years underwent TLED procedures. The majority (83% of the cases were operated on at the levels of L4-5 and L5-S1. Five patients had herniations at two levels. There were significant decreases between the preoperative VAS scores collected postoperatively at 6 months (2.3 and those collected after 1-year (2.5. Two patients were referred for microdiscectomy after TLED due to unsatisfactory pain relief on the 1 st postoperative day. The overall success rate with respect to pain relief was 90.4% (95/105. Seven patients with previous histories of open discectomy at the same level reported fair pain relief after TLED. Conclusions: Transforaminal lumbar endoscopic discectomy is a safe and effective alternative to microdiscectomy that is associated with minor tissue trauma. Herniations that involved single levels and foraminal/extraforaminal localizations were associated with better responses to TLED.

  11. OUTCOMES OF TRANSFORAMINAL ENDOSCOPIC DISCECTOMY FOR LUMBOSACRAL DISC HERNIATION

    Directory of Open Access Journals (Sweden)

    I. V. Volkov

    2017-01-01

    Full Text Available Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED in comparison with microdiscectomy (MD and to specify factors determining complications and failures.Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9% which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic

  12. Multivariate prognostic modeling of persistent pain following lumbar discectomy.

    LENUS (Irish Health Repository)

    Hegarty, Dominic

    2013-03-04

    Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined.

  13. A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen.

    Science.gov (United States)

    Shim, Jung Hyun; Park, Choon Keun; Lee, Ju Hyun; Choi, Jin Wook; Lee, Dong Chan; Kim, Dong Hyun; Kim, Jae Keon; Hwang, Jang Hoe

    2009-08-01

    The object of this study is to demonstrate that angled sagittal magnetic resonance imaging (MRI) enables the precise diagnosis of herniated disc and stenosis in the cervical foramen, which is not available with conventional MRI. Due to both the anatomic features of the cervical foramen and the limitations of conventional MR techniques, it has been difficult to identify disease in the lateral aspects of the spinal canal and foramen using only conventional MRI. Angled sagittal MRI oriented perpendicular to the true course of the foramina facilitates the identification of the lateral disease. A review of 43 patients, who underwent anterior cervical discectomy and interbody fusion, is presented with a herniated disc and/or stenosis in the cervical foramen. They all had undergone conventional MRI and angled sagittal MRI. Fifty levels were surgically explored for evidence of foraminal herniated disc and stenosis. The results of each test were correlated with what was found at each explored surgical level. The sensitivity, specificity, and accuracy of both examinations for making the diagnosis of foraminal herniated disc and stenosis were compared. During the diagnosis of foraminal herniated disc, the sensitivity, specificity, and accuracy of angled sagittal MRI were 96.7, 95.0, and 96.0%, respectively, compared with 56.7, 85.0, and 68.0% for conventional MRI. In making the diagnosis of foraminal stenosis, the sensitivity, specificity, and accuracy of angled sagittal MRI were 96.3, 95.7, and 96.0%, respectively, compared with 40.7, 91.3, and 66.0% for conventional MRI. In the above groups, the difference between the tests for making the diagnosis of both foraminal herniated disc and stenosis was found to be statistically significant in sensitivity and accuracy. Angled sagittal MRI was a more accurate test compared to conventional MRI for making the diagnosis of herniated disc and stenosis in the cervical foramen. It can be utilized for the precise diagnosis of foraminal

  14. Radiologic Assessment of Subsidence in Stand-Alone Cervical Polyetheretherketone (PEEK) Cage.

    Science.gov (United States)

    Ha, Sung-Kon; Park, Jung-Yul; Kim, Se-Hoon; Lim, Dong-Jun; Kim, Sang-Dae; Lee, Sang-Kook

    2008-12-01

    Aim of study was to find a proper method for assessing subsidence using a radiologic measurement following anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK), Solistrade mark cage. Forty-two patients who underwent ACDF with Solistrade mark cage were selected. With a minimum follow-up of 6 months, the retrospective investigation was conducted for 37 levels in 32 patients. Mean follow-up period was 18.9 months. Total intervertebral height (TIH) of two fused vertebral bodies was measured on digital radiographs with built-in software. Degree of subsidence (DeltaTIH) was reflected by the difference between the immediate postoperative and follow-up TIH. Change of postoperative disc space height (CT-MRDeltaTIH) was reflected by the difference between TIH of the preoperative mid-sagittal 2D CT and that of the preoperative mid-sagittal T1-weighted MRI. Compared to preoperative findings, postoperative disc height was increased in all cases and subsidence was observed only in 3 cases. For comparison of subsidence and non-subsidence group, TIH and CT-MRDeltaTIH of each group were analyzed. There was no statistically significant difference in TIH and CT-MRDeltaTIH between each group at 4 and 8 weeks, but a difference was observed at the last follow-up TIH (p=0.0497). ACDF with Solistrade mark cage was associated with relatively good radiologic long-term results. Fusion was achieved in 94.5% and subsidence occurred in 8.1% by the radiologic assessment. Statistical analysis reveals that the subsidence seen later than 8 weeks after surgery and the development of subsidence does not correlate statistically with the change of the postoperative disc space height.

  15. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

    LENUS (Irish Health Repository)

    Burke, Siun M

    2010-04-01

    Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

  16. Spondilitis Tuberkulosa Cervical

    Directory of Open Access Journals (Sweden)

    Roni Eka Saputra

    2015-05-01

    Full Text Available Abstrak Spondilitis tuberkulosa servikalis adalah penyakit yang cukup jarang dijumpai, hanya berkisar 2-3% dariseluruh kasus spondilitis tuberkulosa. Gambaran klinis sangat bervariasi, mulai dari gejala ringan dan tidak spesifikhingga komplikasi neurologis yang berat. Seorang wanita berusia 29 tahun datang dengan keluhan lemah keempatanggota gerak yang semakin memberat dalam 10 hari terakhir yang didahului oleh nyeri leher yang menjalar ke bahudan lengan sejak 6 bulan sebelumnya. Nyeri awalnya dirasakan sebagai keterbatasan gerakan leher saat menolehkesamping kiri dan kanan serta menundukkan kepala. Nyeri dirasakan semakin berat dengan pergerakan danberkurang jika istirahat. Pasien mengalami penurunan berat badan sejak 2 bulan terakhir. Tidak dijumpai riwayat batukatau nyeri dada. Pemeriksaan neurologis menunjukkan kelemahan  pada keempat ekstremitas. Hasil laboratoriumditemukan peningkatan Laju Endap Darah (LED. Rontgen foto toraks dalam batas normal. Roentgen foto cervicalmenunjukkan destruksi setinggi C5. MRI cervical menunjukkan destruksi pada korpus C5-6 dengan penyempitan padadiscus intervertebrae C5-6 disertai dengan  massa/abses paravertebral dengan penekanan ke posterior. MRI Thorakaltampak destruksi corpus verebre T4,5 dengan diskus intervertebralis yang menyempit. Sugestif suatu spondilitistuberkulosa. Pasien dilakukan tindakan pembedahan anterior corpectomi melalui microscopic surgery dengan graftdari iliac sinistra, serta insersi anterior plate 1 level. Hasil pemeriksaan patologi anatomi menunjukkan spodilitis TBCkaseosa. Pada spondilitis vertebre T4,5 dilakukan laminectomi, debridement costotrasversektomi, dan stabilisasidengan pedicle screw T2, T3, dan T5. Pasien diterapi dengan obat antituberkulosis. Keadaan pasien saat ini, pasiensudah bisa beraktifitas normal dengan motorik dan sensorik baik. Spondilitis tuberkulosa merupakan bentuktuberkulosa tulang yang paling sering dijumpai. Spondilitis tuberkulosa cervical berkisar 2

  17. Athletic performance outcomes following lumbar discectomy in professional basketball players.

    Science.gov (United States)

    Anakwenze, Okechukwu A; Namdari, Surena; Auerbach, Joshua D; Baldwin, Keith; Weidner, Zachary D; Lonner, Baron S; Huffman, G R; Sennett, Brian J

    2010-04-01

    Retrospective case-control study. To quantify the athletic performance profiles after lumbar discectomy (LD) in a cohort of National Basketball Association (NBA) players in comparison with a control group of matched NBA players who did not undergo LD during the same study period. LD provides symptomatic relief and improved functional outcomes in the majority of patients as assessed by validated measures such as Oswestry Disability Index, Visual Analog Scale, and Short Form-36 (SF-36). Among professional athletes, however, the goal of lumbar HNP treated by discectomy is not only to improve functional status but also, ultimately, to return the player to preinjury athletic performance levels. No study to date has compared the athletic performance profiles before and after discectomy in professional athletes. An analysis of NBA games summaries, weekly injury reports, player profiles, and press releases was performed to identify 24 NBA players who underwent LD for symptomatic lumbar HNP between 1991 and 2007. A 1:2 case: control study was performed using players without history of lumbar HNP who were matched for age, position, experience, and body mass index as control subjects (n = 48). Paired t tests were conducted on the following parameters: games played, minutes per game, points per 40 minutes, rebounds per 40 minutes, assists per 40 minutes, steals per 40 minutes, blocks per 40 minutes, and shooting percentage. For each athletic performance outcome, between-group comparisons evaluating preindex to postindex season performance were done (index season = season of surgery). In the LD group, 18 of 24 players (75%) returned to play again in the NBA, compared with 42 of 48 players (88%, P = 0.31) in the control group. One year after surgery, between-group comparisons revealed statistically significant increase in blocked shots per 40 minutes in the LD (0.18) versus control group (-0.33; P = 0.008) and a smaller decrease in rebounds per 40 minutes in the LD (-0

  18. Microendoscopic lumbar discectomy: Technique and results of 188 cases

    Directory of Open Access Journals (Sweden)

    Arvind G Kulkarni

    2014-01-01

    Full Text Available Background: Discectomy performed open or with an operating microscope remains the standard surgical management. Tubular retractor system is being increasingly used. Potential benefits include less muscle and local damage, better cosmesis, decreased pain and operative time and faster recovery after surgery. We have evaluated the outcome of micro endoscopic discectomy (MED utilizing tubular retractors in terms of safety and efficacy of the technique. Materials and Methods: 188 consecutive patients who underwent surgery for herniated disc using the tubular retractors between April 2007 and April 2012 are reported. All patients had a preoperative MRI (Magnetic Resonance Imaging and were operated by a single surgeon with the METRx system (Medtronic, Sofamor-Danek, Memphis, TN using 18 and 16 mm ports. All patients were mobilized as soon as pain subsided and discharged within 24-48 hours post surgery. The results were evaluated by using VAS (Visual Analog Scale 0-5 for back and leg pain and ODI (Oswestry Disability Index. Patients were followed up at intervals of 1 week, 6 weeks, 3 months, 6 months, 12 months and 2 years. Results: The mean age of patients was 46 years (range 16-78 years and the sex ratio was 1.5 males to 1 female. The mean followup was 22 months (range 8-69 months. The mean VAS scale for leg pain improved from 4.14 to 0.76 ( P < 0.05 and the mean VAS scale for back pain improved from 4.1 to 0.9 ( P < 0.05. The mean ODI changed from 59.5 to 22.6 ( P < 0.05. The mean operative time per level was about 50 minutes (range 20-90 minutes. Dural punctures occurred in 11 (5% cases. Average blood loss was 30 ml (range 10-500 ml. A wrong level was identified and later corrected in a case of revision discectomy. Four patients with residual disc-herniation had revision MED and three patients with recurrent disc herniation later underwent fusion. One patient had wound infection which needed a debridement. Conclusion: MED for herniated discs

  19. The evaluation of the bone graft survival status in titanium cervical ...

    African Journals Online (AJOL)

    ONOS

    2010-08-09

    Aug 9, 2010 ... To find a better way to evaluate the bone graft survival status in cervical cages, forty-one patients suffering from one-level cervical spondylosis were enrolled in this study. All underwent anterior cervical decompression and fusion with titanium cage and plate. When followed up, another 21 patients were.

  20. The evaluation of the bone graft survival status in titanium cervical ...

    African Journals Online (AJOL)

    To find a better way to evaluate the bone graft survival status in cervical cages, forty-one patients suffering from one-level cervical spondylosis were enrolled in this study. All underwent anterior cervical decompression and fusion with titanium cage and plate. When followed up, another 21 patients were confirmed as ...