What's New in Spine Surgery.

Abstract

An increasing number of prospective studies have established the efficacy of many cervical spine procedures. At the same time, complications and morbidity have been critically analyzed. Several of these studies regarding anterior fusion and laminoplasty will be reviewed. ### Outcomes Long-term follow-up with use of validated instruments and strict radiographic criteria are effective for evaluating surgical results. The Cervical Spine Research Society prospectively followed 181 patients for two years to assess the influence of plates on outcomes. In patients with single-level fusions, the use of a plate was associated with a significantly higher rate of successful fusion (94% compared with 73%). Rigid and translational plates were associated with better results than plates that only allowed the toggle of screw heads. Other studies of intervertebral fusion devices have demonstrated conflicting results. Carbon fiber-reinforced spacers used as stand-alone devices had results similar to allografts, whereas tantalum mesh implants had poor results that necessitated the discontinuation of a randomized study. Pulsed electromagnetic field stimulation has been shown to induce fusion in the lumbar spine and the healing of extremity nonunions. In a prospective, randomized study, pulsed electromagnetic field stimulation was associated with higher rates of successful cervical fusion (84% compared with 69%), although no significant differences in functional outcomes were noted. Interestingly, successful fusion, either with or without pulsed electromagnetic field stimulation, was significantly correlated with good clinical outcomes. Controversies still remain with regard to the approach (i.e., anterior or posterior) for treatment of cervical spondylotic myelopathy. In a randomized study comparing corpectomy and autograft fusion with laminoplasty, no differences were noted with regard to the rate of neurologic recovery or the range of motion of the neck. However, both groups had significant improvement in neurologic function. Axial pain was greater in the laminoplasty group. Complications in the anterior treatment group included dysphagia and pseudarthrosis, …