Level Anterior Cervical Discectomy Research Articles

Zero-profile implant versus integrated cage-plate implant in treatment of single level cervical disc disease.

The aim of this retrospective study is to evaluate and compare the clinical and radiological results of the use of Zero-P implant and the integrated cage-plate implant in surgical treatment of single level cervical disc disease. It includes 54 consecutive patients who underwent single level anterior cervical discectomy and fusion. The patients were divided into 2 groups. Group (A) including 28 patients operated with zero- profile implant and group (B) including 26 patients operated with integrated cage-plate implant. Mean operative time, blood loss, incidence of dysphagia and any other complications related to the procedure were recorded and compared. Patients were assessed radiologically by measuring cervical lordosis using the Cobb angle and the segmental angle. Patients were assessed clinically by the Japanese orthopedic association score and the neck disability index. These values were also compared. The mean age of the patients in group (A) was 49.5±11 years, and in group (B) it was 49.8±11.6 years. Mean blood loss and operative time in group (A) were 77.3±9.4 ml and 72.1±7.9 minutes, while in group B, they were 80.7±9.5 ml and 74.8±8.4 minutes with no statistically significant difference between both groups. There were also no statistically significant difference between both groups as regards incidence of dysphagia, clinical scores nor radiological parameters. In conclusion, both zero-profile implant and integrated cage-plate implant have comparable satisfactory clinical and radiological results in treatment of single level cervical disc diseases with little complications.

Response to: A Randomized Control Trial Comparing Local Autografts and Allografts in Single Level Anterior Cervical Discectomy and Fusion Using a Stand-Alone Cage.

See the letter "Letter to the Editor: A Randomized Control Trial Comparing Local Autografts and Allografts in Single Level Anterior Cervical Discectomy and Fusion Using a Stand-Alone Cage" on page 311.

Letter to the Editor: A Randomized Control Trial Comparing Local Autografts and Allografts in Single Level Anterior Cervical Discectomy and Fusion Using a Stand-Alone Cage.

See the reply "Response to: A Randomized Control Trial Comparing Local Autografts and Allografts in Single Level Anterior Cervical Discectomy and Fusion Using a Stand-Alone Cage" on page 313.

Stand-Alone Cage Versus Anterior Plating for 1-Level and 2-Level Anterior Cervical Discectomy and Fusion: A Randomized Controlled Trial.

Prospective, randomized controlled trial. The aim was to compare perioperative and radiographic outcomes between stand-alone and anterior plated 1 and 2-level anterior cervical discectomy and fusion (ACDF). ACDF with interbody spacer and separate plate/screw construct (PLATE) may be associated with a higher incidence of postoperative dysphagia, increased operative time, and other complications. Therefore, some have opted to utilize an interbody cage with integrated screws and no plate (CAGE) with good results. Patients with 1-level to 2-level degenerative disease were prospectively enrolled and randomized into 1 of 2 treatment arms consisting of either PLATE or CAGE reconstruction. Patients were followed for a minimum of 1 year postoperatively. Primary endpoints included improvement on patient-reported outcome metrics, construct integrity, cervical alignment, successful arthrodesis, and subsequent revision surgeries. Forty-six patients were included: 12 with 1-level PLATE, 12 with 1-level CAGE, 12 with 2-level PLATE, and 10 with 2-level CAGE. For 1-level ACDF, PLATE patients reported worse swallow function on Swallowing Quality of Life Questionnaire at 6 weeks (P=0.050) and 6 months (P=0.042). Pseudarthrosis requiring revision was observed in one PLATE patient. For 2-level ACDF CAGE patients reported worse disability on neck disability index (P=0.037) at 6 weeks, as well as worse neck disability index (P=0.017) and visual analog scale neck (P=0.010) at 6 months. However, PLATE patients reported worse swallow function on Swallowing Quality of Life Questionnaire at 6 weeks (P=0.038). There were no differences in the rates of fusion, loss of disc height correction, subsidence, or in sagittal parameters between cohorts for both 1-level and 2-level ACDF. There was greater incidence of transient postoperative dysphagia in both single and 2-level PLATE cohorts. However, early postoperative outcomes were worse for 2-level CAGE in certain patient-reported metrics. This suggests that although anterior instrumentation may be associated with a higher likelihood of dysphagia, it may also lead to higher short-term stability and improved patient-reported outcomes for 2-level fusion.

Simulated Bundled Payments for 4 Common Surgical Approaches to Treat Degenerative Cervical Myelopathy: A Consideration to Break the Clinical Equipoise.

Retrospective cohort study. The aim was to compare 90-day and 2-year reimbursements for ≥2-level anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), posterior laminectomy and fusion (LF) and laminoplasty (LP) done for degenerative cervical myelopathy (DCM). In DCM pathologies where there exists a clinical equipoise in approach selection, a randomized controlled trial found that an anterior approach did not significantly improve patient-reported outcomes over posterior approaches. In the era of value and bundled payments initiatives, cost profile of various approaches will form an important consideration for decision making. IBM MarketScan Research Database (2005-2018) was used to study beneficiaries (30-75 y) who underwent surgery (mACDF, ACCF, LF, LP) for DCM. Index hospital stay (operating room, surgeon, hospital services) and postdischarge inpatient, outpatient and prescription medication payments have been used to simulate 90-day and 2-year bundled payment amounts, along with their distribution for each procedure. A total of 10,834 patients with median age of 54 years were included. The median 90-day payment was $46,094 (interquartile range: $34,243-$65,841) for all procedures, with LF being the highest ($64,542) and LP the lowest ($37,867). Index hospital was 62.4% (operating room: 46.6) and surgeon payments were 17.5% of the average 90-day bundle. There was significant difference in the index, 90-day and 2-year reimbursements and their distribution among procedures. In a national cohort of patients undergoing surgery for DCM, LP had the lowest complication rate, and simulated bundled reimbursements at 90 days and 2 years postoperatively. The lowest quartile 90-day payment for LF was more expensive than median amounts for mACDF, ACCF, and LP. If surgeons encounter scenarios of clinical equipoise in practice, LP is likely to result in maximum value as it is on an average 70% less expensive than LF over 90 days.

Multilevel Anterior Cervical Decompression and Fusion: Cervical Range of Motion and Clinical Outcomes

Background: Multiple level anterior cervical discectomy and fusion (ACDF) is indicated for those who suffer from multilevel stenosis or compression of the spinal canal. It was reported that this intervention would unfortunately lead to a loss of normal cervical range of motion (CROM). Although, fewer studies have demonstrated the exact impact of the procedure on CROM. In our study, short and midterm postoperative CROM was described. Methods: Ninety patients who underwent ACDF were followed up postoperatively for at least 3 months. Active CROM was measured in all patients preoperatively and in postoperative follow-ups by cervical spine X-rays in lateral dynamic view using Cobb’s angle method. Results: Unfortunately, postoperative CROM was significantly diminished. At the short-term (3 months) follow-up there was a great limitation in CROM. While an obvious increase in CROM at the midterm (6 months) follow-up was observed in flexion especially. The reduction in global ROM (calculated as preoperative global ROM – 6 months postoperative ROM) was 4.1 and the reduction rate (calculated as reduction ROM divided by preoperative ROM) was 9.5%. The recovery ROM (calculated as 6 months postoperative ROM – 1 month postoperative ROM) was 8.2. The recovery rate (calculated as recovery ROM divided by 1 month postoperative ROM) was 26.5%. Conclusion: Active CROM following multiple level ACDF was obviously diminished. The most affected motion after surgery was flexion. It was noticed that at the short-term follow-up CROM would be more limited while after further follow up CROM was obviously improved even in neck flexion motion.

Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database.

The impact of the type of pain presentation on outcomes of spine surgery remains elusive. The aim of this study was to assess the impact of predominant symptom location (predominant arm pain vs predominant neck pain vs equal neck and arm pain) on postoperative improvement in patient-reported outcomes. The Quality Outcomes Database cervical spine module was queried for patients undergoing 1- or 2-level anterior cervical discectomy and fusion (ACDF) for degenerative spine disease. A total of 9277 patients were included in the final analysis. Of these patients, 18.4% presented with predominant arm pain, 32.3% presented with predominant neck pain, and 49.3% presented with equal neck and arm pain. Patients with predominant neck pain were found to have higher (worse) 12-month Neck Disability Index (NDI) scores (coefficient 0.24, 95% CI 0.15-0.33; p < 0.0001). The three groups did not differ significantly in odds of return to work and achieving minimal clinically important difference in NDI score at the 12-month follow-up. Analysis from a national spine registry showed significantly lower odds of patient satisfaction and worse NDI score at 1 year after surgery for patients with predominant neck pain when compared with patients with predominant arm pain and those with equal neck and arm pain after 1- or 2-level ACDF. With regard to return to work, all three groups (arm pain, neck pain, and equal arm and neck pain) were found to be similar after multivariable analysis. The authors' results suggest that predominant pain location, especially predominant neck pain, might be a significant determinant of improvement in functional outcomes and patient satisfaction after ACDF for degenerative spine disease. In addition to confirmation of the common experience that patients with predominant neck pain have worse outcomes, the authors' findings provide potential targets for improvement in patient management for these specific populations.

Opioid Use Disorder in Patients Undergoing Primary 1- to 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Readmissions, Complications, and Costs of Care.

Retrospective study. To determine whether opioid use disorder (OUD) patients undergoing 1- to 2-level anterior cervical discectomy and fusion (1-2ACDF) have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) complications; and 4) costs. OUD patients undergoing primary 1-2ACDF were identified within the Medicare database and matched to a control cohort in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 80,683 patients who underwent 1-2 ACDF with (n = 13,448) and without (n = 67,235) OUD. Outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, and costs. Multivariate logistic regression analyses were used to calculate odds-ratios (OR) for medical complications and readmissions. Welch's t-test was used to test for significance for LOS and cost between the cohorts. An alpha value less than 0.002 was considered statistically significant. OUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (3.41 vs. 2.23-days, P < .0001), in addition to higher frequency and odds of requiring readmissions (21.62 vs. 11.57%; OR: 1.38, P < .0001). Study group patients were found to have higher frequency and odds of developing medical complications (0.88 vs. 0.19%, OR: 2.80, P < .0001) and incurred higher episode of care costs ($20,399.62 vs. $16,812.14, P < .0001). The study can help to push orthopaedic surgeons in better managing OUD patients pre-operatively in terms of safe discontinuation and education of opioid drugs and their effects on complications, leading to more satisfactory outcomes.

Front-Back Cervical Deformity Correction by Anterior Cervical Discectomy and Fusion With Posterior Instrumentation: 2-Dimensional Operative Video.

Front-back procedures for cervical deformity permit the correction of cervical kyphosis in the setting of unfused facets. Here, we highlight the operative treatment of a 65-yr-old female entailing a 4-level anterior cervical discectomy and fusion (ACDF) at C3-C4, C4-C5, C5-C6, and C6-C7 with hyperlordotic interbody implants, supplemented by a posterior C2-T2 instrumented fusion. The patient initially presented with symptoms of treatment-refractory neck pain while neurologically intact on examination. Her imaging demonstrated significant cervical kyphosis measuring 46° as the Cobb angle between C2 and C7 without neural compression. The patient consented to the procedure and publication of their image. After 2 d of traction, the operation proceeded with the patient initially in a supine position with dissection medial to the sternocleidomastoid muscle down to the vertebral bodies. Discectomies were performed at each level followed by installation of the interbody implants. After closure of this access wound, the patient was turned to a prone position for the posterior element of the operation. The posterior bony elements were exposed and a C2-T2 instrumented fusion performed. Postoperative imaging demonstrated improvement of her sagittal cervical curvature and the patient described improvement in her neck pain.

254. Pain catastrophizing impacts outcome scores but not recovery kinetics after 1-2 level anterior cervical surgery

BACKGROUND CONTEXT For a subset of patients who catastrophize pain, communication of symptoms/disability is a challenge for themselves and for practitioners to interpret. PURPOSE To determine if patients that catastrophize pain had worse clinical outcomes after anterior cervical surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE All patients who underwent 1- or 2-level anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR) for cervical radiculopathy and/or myelopathy and had 1-year follow-up were included in our study. OUTCOME MEASURES Patient-reported Outcome Measures (PROMs) - health related quality of life scores (HRQOLs), including Neck Disability Index (NDI), Short-Form 12 Physical Component Score (SF-12 PCS), Short-Form 12 Mental Component Score (SF-12 MCS), PROMIS Physical Function score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores were collected prospectively pre- and postoperatively (2 weeks, 6 weeks, 12 weeks, 6 months, 1 year). METHODS Patients with preoperative VAS-neck or VAS-arm score of 9-10/10 were classified as pain catastrophizing (PC cohort) and the rest as non-pain catastrophizing (non-PC cohort). HRQOLs were compared between cohorts at all time points. We compared recovery kinetics between the PC versus non-PC cohorts. This was done by normalizing all HRQOLs at each interval time point. The area under the curve (AUC) was then calculated for a plot of the normalized score versus follow-up time point as has been done in previous studies (IHS, Integrated Health State). A Mann-Whitney test or student's t-test was used to compare mean values from the two cohorts based upon whether data was normally distributed. RESULTS Forty-eight patients with a mean age of 50.0±11.8 years and comprised of 22 females were included. All patients had a minimum of 1-year follow-up. There were 13 patients in the PC cohort. There were no significant differences in age, gender and preoperative radiographic parameters. Preop VAS-arm, VAS-neck, SF-12 PCS, SF-12 MCS, NDI and PROMIS were all worse for the PC cohort (p CONCLUSIONS Our findings demonstrate that patients that catastrophize pain may have worse overall outcome scores after anterior cervical surgery (ACDF or CDR). After normalizing their outcome scores, we demonstrated that PC patients have similar rates of improvement after ACDF or CDR. Pain catastrophizing patients might communicate pain in a more extreme manner, but clinicians should counsel these patients that outcomes are positive after ACDF or CDR. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P130. Comparative safety and efficacy of four surgical techniques in three level Anterior Cervical Discectomy and Fusion (ACDF)

<h3>BACKGROUND CONTEXT</h3> No consensus exists on the ideal surgical technique for multilevel ACDF, the gold standard treatment for cervical disc disease. Anterior plate (AP) fixation has been traditionally utilized for additional stability but associated complications have led to the increased use of stand-alone (SA) PEEK-anchored cages in recent years. There is a paucity of literature on use of these techniques in 3-level ACDF patients. In order to gain insight into the optimal surgical technique for 3-level ACDF, we conducted a retrospective comparative analysis of the safety and efficacy of the AP, SA and two other common surgical techniques. <h3>PURPOSE</h3> To compare the safety and efficacy of four surgical techniques in patients receiving three-level Anterior Cervical Discectomy and Fusion (ACDF). <h3>STUDY DESIGN/SETTING</h3> A retrospective chart review of patients who underwent primary 3-level ACDF by the two senior authors at two hospitals in Westchester County, NY. <h3>PATIENT SAMPLE</h3> A total of 50 patients who received primary 3-level ACDF by the senior authors between August 2015 and February 2020. <h3>OUTCOME MEASURES</h3> The outcomes investigated in this study include the following: Clinical Success (measured using Odom's criteria score), Safety (complication incidence), Operative (OP) Time, Blood Loss (BL) and Hospital Length of Stay (LOS). <h3>METHODS</h3> Surgical and clinical data for 50 patients who received primary 3-level ACDF by the senior authors between August 2015 and February 2020 was retrospectively analyzed. All patients received a combination of autograft and allograft. Four patient groups were compiled based on surgical technique performed; Anterior Plating with no cage at 3 levels (AP, 24%), Stand-Alone PEEK-anchored cages at 3 levels (SA, 30%), Stand-Alone PEEK-anchored cage at the first level and Anterior Plating with PEEK-anchored cages at the 2 subsequent levels (SAAP, 30%), and Anterior Plating with PEEK-anchored cages at three levels (APC, 16%). Patients were assessed at 5 time points: 1-4 weeks, 5-10 weeks, 3-5.5 months, 6-8 months and 9-12 months. At each time point, patients were evaluated for clinical success (using Odom's Criteria scoring) and safety (complication incidence). Other outcomes investigated include Operative (OP) Time, Blood Loss (BL) and Hospital Length of Stay (LOS). Data analysis was conducted in SPSS 20.0 (SPSS, Inc. Chicago, IL) and included one-way ANOVA, two-tailed t-test, and linear regression analyses. <h3>RESULTS</h3> Patients in the AP group had longer mean OP times (220 min) when compared to patients in the SA (170 min, p=0.04), SAAP (175 min, p=0.009), and APC (167 min, p=0.01) groups. The difference in mean OP time between the AP group and each of the other patient groups were statistically significant (p=0.008). A linear regression analysis showed no significant differences in the mean Odom's criteria score between the four groups (1) over time and (2) at each time point. There were four complications recorded, one per group. The complications were as follows (group in parenthesis): pulmonary embolism (AP), hematoma (SA), adjacent level disease (SAAP) and broken hardware (APC). There were no statistically significant differences between any of the patient groups regarding BL (p = 0.378) and LOS (p = 0.174). The following patient factors were controlled for in all analyses: advanced age (age greater than 65), gender, high BMI (BMI greater than 35), diabetes, osteoporosis, cardiac history (hypertension and/or myocardial infarction), sleep apnea and smoking status. None of these factors were found to have a statistically significant effect on the study outcomes. <h3>CONCLUSIONS</h3> Consistent with the literature, the OP times were longer for 3-level ACDF patients who underwent the AP technique compared to patients who underwent the SA technique. We demonstrated that patients in the AP group also had longer OP times than patients in the SAAP and APC groups. In addition, all four surgical techniques appeared to have analogous safety profiles and clinical success rates. Past studies in the literature examining the AP and SA techniques in 2-level ACDF patients have reported comparable clinical outcomes. Future studies should employ a larger sample size and investigate radiological outcomes such as fusion rate and loss of lordosis. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P51. Differences in charges for elective single level anterior cervical discectomy and fusion across hospital size: A nationwide readmissions database analysis

<h3>BACKGROUND CONTEXT</h3> Rising health care expenditures in the United States place an imperative on providers, payers, and policymakers to more closely evaluate hospital charges. While previous spine surgery studies have compared charges across procedures and in the presence of comorbidities, the association between charges and hospital size in Anterior Cervical Discectomy and Fusion (ACDF) has yet to be understood. <h3>PURPOSE</h3> To assess the differences in charges for elective single-level ACDF procedures across hospitals of different size. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective analysis utilizing elective, single-level ACDF data from January 2016 to September 2016 in the HCUP Nationwide Readmissions Database (NRD). <h3>PATIENT SAMPLE</h3> A total of 13,776 cases of elective, single-level ACDF were identified. Patients who underwent single-level ACDF were identified using the ICD-10 procedural codes for single-level anterior cervical fusion. Patients who underwent cervical disc arthroplasty were excluded from this study. Additional exclusion criteria were death during hospitalization, nonelective surgery, use of emergency services, and age < 18. <h3>OUTCOME MEASURES</h3> Total charges were compared across hospital sizes (small, medium, and large). <h3>METHODS</h3> Elective single-level ACDF cases were stratified into three groups by hospital bedsize (small, medium, and large) as classified by the NRD. As per the NRD, about one-third of the hospitals within a specific teaching status, location, and region grouping are assigned to each bedsize category. Mean total charges were compared across hospital size utilizing one-way analysis of variance (ANOVA) and subsequently the post-hoc Tukey's range test. <h3>RESULTS</h3> There was significant variation in mean total charges across small ($59,010.97 ± $55,211.71), medium ($63,775.99 ± $50,823.21) and large ($63,546.59 ± $54,831.45) hospitals (p=0.002). Post-hoc testing revealed significant differences in charge between small and medium hospitals (p=0.004) and between small and large hospitals (p=0.002). <h3>CONCLUSIONS</h3> Hospital size is a determining factor for cost of elective single-level ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P115. Analysis of 90-day readmissions across hospital size: Risk factors for readmission in single level anterior cervical discectomy and fusion

P115. Analysis of 90-day readmissions across hospital size: Risk factors for readmission in single level anterior cervical discectomy and fusion

Cervical spine alignment and clinical outcomes after multilevel anterior cervical decompression and fusion with or without plate: A minimal 5-year follow-up of a CONSORT-compliant article.

It was reported imperative on cervical sagittal alignment reconstruction after anterior multilevel procedures with self-locked stand-alone cage (SSC) or anterior cage-with-plate (ACP) system multilevel while there was little knowledge about the relationship on cervical alignment and clinical outcomes.To identify the importance of cervical sagittal alignment after 3-level anterior cervical discectomy and fusion on cervical spondylotic myelopathy with SSC and ACP system.Seventy-seven patients with SSC system (SSC group) and 52 cases with ACP system (ACP group) from February 2007 to September 2013 were enrolled with well-matched demographics. Cervical alignment included C2–7 lordosis (CL), operated-segment cervical lordosis (OPCL), upper and lower adjacent-segment cervical lordosis, range of motion of upper and lower adjacent segment at preoperation, immediate postoperation, and the final follow-up. Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score, visual analogous scale (VAS) of arm and neck and adjacent segment degeneration (ASD). Patients were then divided into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P < .05) but upper adjacent-segment cervical lordosis/lower adjacent-segment cervical lordosis and range of motion of upper adjacent segment/range of motion of lower adjacent segment were of no significance. NDI, JOA, and VAS got improvement in both groups at immediate postoperation and the final follow-up while ASD was in no difference between SSC and ACP group. A total of 80 patients (39 vs 41) acquired CL improvement with a larger population in ACP group. There were no differences on the rate of ASD, NDI, JOA, VAS, and their change between IM and NIM subgroup. The changes of CL were not correlated to NDI, JOA, VAS, and their change.SSC and ACP group both provide improved OPCL and efficacy on 3-level cervical spondylotic myelopathy with little impact on adjacent segment. The change of CL is not correlated to clinical outcomes.

Is Complete Correction of Cervical Sagittal Malalignment Necessary During 4-Level Anterior Cervical Discectomy and Fusion Surgery in Patients With Kyphosis?

Retrospective analysis. We investigated whether complete correction of cervical sagittal malalignment is necessary during 4-level anterior cervical discectomy and fusion (ACDF) in patients with kyphosis. This retrospective study included 84 patients who underwent 4-level ACDF surgery at a university hospital between January 2010 and December 2015. Based on the degree of cervical lordosis correction, patients were categorized into the following groups: mild (0-10°), moderate (10-20°), and complete correction (>20°). The clinical outcomes, radiological parameters, and functional outcomes were analyzed. We observed no significant intergroup differences in the baseline characteristics. The cervical sagittal vertical axis (CSVA) correction loss at the final follow-up was lesser in the mild- and moderate- than in the complete-correction group. The spinocranial angle (SCA) and T1 slope (T1 S) were significantly higher in the moderate- and complete-correction groups than in the mild-correction group, 3 days postoperatively. The cervical proximal junctional kyphosis (CPJK), adjacent segment degeneration (ASD), and ASD following CPJK rates were higher in the complete-correction group. We observed no significant intergroup differences in postoperative complications; however, 5 patients showed internal fixation failure in the complete-correction group; 4 of these patients required reoperation. No significant intergroup difference was observed in the Japanese Orthopedic Association and neck disability index scores at any time point. A mild-to-moderate correction of cervical lordosis is superior to complete correction in patients with kyphosis who undergo 4-level ACDF because this approach is associated with lesser axial stress and CSVA correction loss.

Does Cervical Alignment Matter? The Effect of 2-level Anterior Cervical Discectomy and Fusion on Sagittal Alignment and Patient-reported Outcomes.

Retrospective review of prospectively collected data. This study aimed to determine the change in cervical sagittal balance following 2-level anterior cervical discectomy and fusion (ACDF) and whether the degree of change was associated with improvement in patient-reported outcomes (PROs). Sagittal balance in cervical spine surgery has been recognized as an important surgical goal. However, its influence on clinical outcomes following anterior decompressive procedures remains debatable. Patients who underwent primary 2-level ACDF for cervical spondylotic radiculopathy and/or myelopathy were identified from an institutional spine registry. Radiographic measurements were done preoperatively, postoperatively, and at minimum 24 months follow-up. Measurements comprised segmental lordosis (SL), C2-C7 cervical lordosis (CL), C2-C7 sagittal vertical axis, C7 slope (C7S), T1 slope (T1S) and C7 slope minus cervical lordosis (C7S-CL). Disk heights were measured preoperatively and postoperatively. PROs including the Neck Disability Index, Short Form-36, and Visual Analog Scale for neck pain and arm pain were collected preoperatively and at 24 months postoperatively. In total, 90 patients were included. Mean follow-up was 58.6±22.9 months. Significant improvement in all PROs was achieved at 24 months (P<0.05). SL was -1.2±8.2 degrees preoperatively, increased to 5.2±5.9 degrees postoperatively (P<0.001), and decreased to 1.2±6.2 degrees at follow-up (P=0.005). CL was 8.5±12.5 degrees preoperatively, increased to 10.8±12.4 degrees postoperatively (P=0.018), and maintained at 10.9±11.2 degrees at follow-up (P=0.030). Sagittal vertical axis, C7S, T1S, and C7S-CL did not change significantly. Significant increases in disk heights were achieved postoperatively (P<0.001). Fusion rate was 98.9% at follow-up. PROs were not related to radiologic measurements. Maintaining or increasing CL or SL was not related to a greater degree of improvement in PROs. Two-level ACDF restored segmental and global CL, but changes in cervical sagittal alignment did not correlate with the magnitude of improvement in PROs. Adequate decompression with solid fusion remains fundamental to achieving good clinical outcomes in patients with degenerative cervical disease.

Complications of Peek Cage Following Single Level Anterior Cervical Discectomy and Fusion

Abstract Background: Prospective study of complications related to PEEK cage in fusion following single level anterior cervical discectomy. Aim of Study: To assess the complications related to PEEK cage following single level anterior cervical discectomy and fusion. Patients and Methods: A total of 127 case have been operated, 12 of them developed complications after using PEEK cage after anterior cervical discectomy and fusion. Follow-up at Cairo University Hospital between 2011 to 2013. Outcome assessment was done using visual analogue score (VAS), forearm pain, neck pain as well as neurological assess-ment and radiological follow-up with cervical X-rays. Results: 12 patients from a total of 127 patients following single level anterior cervical discectomy and fusion using PEEK cage had cage related complications. Follow-up ranged from 12 to 27 months, with a mean follow-up of 15 month. There were five cases of cage migration, three cases with subsidence, two cases with adjacent level degeneration, one case with kyphotic deformity and one case pseudoarthrosis. Conclusion: Use of PEEK cage in cervical fusion following single level Anterior Cervical Discectomy is widely used and provide satisfactory results. Complications related to PEEK cage use is relatively low and avoidable through careful attention to technically steps in graft site and choosing an appropriate sized cage.

Clinical Correlation of Change in Sagittal Parameters after Anterior Cervical Microdiscectomy

Objective: Cervical radiculopathy is the syndrome of pain and / or sensorimotor deficit caused by compression of the cervical nerve root. Symptoms of cervical radiculopathy in the upper limb are described as pain, numbness, or weakness. Conservative treatment is recommended initially for degenerative cervical radiculopathy. Surgical treatment is recommended in cases where progressive loss of muscle strength does not respond to conservative therapy. Many radiographic parameters are used to define the sagittal alignment of the cervical spine. This variation contrasts with the assessment of caudal spine segments where there are more established guides for measuring deformity angles. The aim of this study is to evaluate the effect of anterior cervical discectomy and fusion, which are widely used in spinal surgery practice, on cervical sagittal alignment.Methods: We retrospectively evaluated 33 patients who were operated with anterior cervical discectomy and fusion technique with the diagnosis of single level degenerative cervical disc hernia after an average of 3 months of follow-up period. For radiological evaluation, we analyzed the C2-C7 lordosis angles, the anterior and posterior disc heights at the operating level on lateral scoliosis radiographs, preoperatively and at 3rd month postoperatively. Japanese Orthopedic Association scores and visual analog scale scores were examined to evaluate clinical results.Results: A statistically significant difference was found between the preoperative radiological sagittal parameters and the postoperative 3rd month (p = 0.001). When the clinical correlation of the findings was examined, a statistically significant difference was found in the Japanese Orthopedic Association scores and visual analog scale scores of the patients measured preoperatively versus 3 months postoperatively (p &amp;lt; 0.001).Conclusion: Radiological and clinical parameters improve significantly in patients after single level anterior cervical discectomy surgery.

Comparison Between Three- and Four-Level Anterior Cervical Discectomy and Fusion: Patient-Reported and Radiographic Outcomes

We compared the long-term clinical and radiographic outcomes after 3- and 4-level anterior cervical discectomy and fusion (ACDF) in a retrospective cohort study. Patients who had undergone primary 3- or 4-level ACDF were retrospectively identified. The demographic data and patient-reported outcome measures (PROMs) were collected through a review of the medical records. PROM surveys were administered preoperatively for baseline measurements and at 1 year postoperatively. The surveys included the Neck Disability Index, 12-item short-form physical component summary, 12-item short-form mental component summary, and visual analog scale (VAS) scores for neck and arm pain. The cervical sagittal alignment parameters included C2-C7 lordosis, segmental lordosis, the sagittal vertical axis (SVA), and the T1 slope. Multivariate regression models were used to compare the changes in the PROMs and radiographic measurements over time between 3- and 4-level ACDF. Correlation coefficients were calculated to compare the delta scores for the PROMs and radiographic measurements. The VAS scores for neck and arm pain had significantly improved from baseline in both cohorts. Only the 3-level group showed significant improvements perioperatively in the Neck Disability Index and 12-item short-form physical component summary. No significant differences were found in the improvement in clinical outcomes between the 2 groups. The pooled results demonstrated a significant negative correlation between the perioperative changes in segmental lordosis and VAS scores for arm pain. A significant negative correlation was also found between the perioperative changes in the SVA and 12-item short-form mental component summary and VAS scores for neck pain. C2-C7 lordosis significantly increased postoperatively only in the 3-level ACDF group. Patients undergoing both 3- and 4-level ACDF experienced significant clinical improvement without significant differences between the 2 groups. The radiographic measures of segmental lordosis and SVA also correlated with the changes in clinical outcomes.

The Surgical Autonomy Program: A Pilot Study of Social Learning Theory Applied to Competency-Based Neurosurgical Education.

Over the last decade, strict duty hour policies, pressure for increased work related value units from faculty, and the apprenticeship model of education have coalesced to make opportunities for intraoperative teaching more challenging. Evidence is emerging that graduating residents are not exhibiting competence by failing to recognize major complications, and perform routine operations independently. In this pilot study, we combine Vygotsky's social learning theory with a modified version of the competency-based scale called TAGS to study 1 single operation, anterior cervical discectomy and fusion, with 3 individual residents taught by a single faculty member. In order for the 3 residents to achieve "Solo and Observe" in all 4 zones of proximal development, the number of cases required was 10 cases for postgraduate year (PGY)-3a, 19 cases for PGY 3b, and 22 cases for the PGY 2. In this pilot study, the time required to complete an independent 2-level anterior cervical discectomy and fusion by the residents correlated with the number of cases to reach competence. We demonstrate the Surgical Autonomy Program's ability to track neurosurgical resident's educational progress and the feasibility of using the Surgical Autonomy Program (SAP) to teach residents in the operating room and provide immediate formative feedback. Ultimately, the SAP represents a paradigm shift towards a modern, scalable competency-focused subspecialty teaching, evaluation and assessment tool that provides increases in resident's autonomy and metacognitive skills, as well as immediate formative feedback.