After Anterior Cervical Discectomy And Fusion Research Articles

Development and Validation of a Predictive Model to Evaluate the Risk of Dysphagia Following Anterior Cervical Discectomy and Fusion.

A retrospective study. To investigate the potential risk factors of dysphagia after anterior cervical discectomy and fusion (ACDF) and to establish and validate a prediction model. The clinical data of 252 patients who underwent anterior cervical discectomy and fusion in our hospital from January 2018 to October 2020 were retrospectively analyzed and divided into the dysphagia group and the non-dysphagia group according to whether dysphagia occurred after surgery. Age, gender, body mass index, smoking and drinking history, hypertension history, diabetes history, disease duration, placement of Hemovac negative pressure drain, number of segments involved in surgery, whether C4-5/C5-6 segment surgery, incision length, incision position, level of preoperative EAT-10 score, whether preoperative tracheal exercise, and changes in cervical curvature before and after surgery were recorded in both groups. Risk factors for postoperative dysphagia were identified and nomogram prediction models were developed. A total of 252 patients were included in the study, 115 of whom presented with dysphagia within 1 week after anterior cervical fusion. The results of multivariate logistic regression analysis indicated that male gender (OR = .045, 95% CI .223-.889) and whether preoperative tracheal exercise (OR = .260, 95% CI .107-.633) were independent risk factors associated with reduced incidence of postoperative dysphagia. The incidence of dysphagia symptoms after anterior cervical decompression and fusion gradually decreased with the extension of follow-up time, and preoperative tracheal exercise and shortening the operation time may help to reduce the occurrence of postoperative dysphagia.

Pseudoarthrosis after anterior cervical discectomy and fusion: rate of occult infections and outcome of anterior revision surgery

BackgroundPseudoarthrosis after anterior cervical discectomy and fusion (ACDF) is relatively common and can result in revision surgery. The aim of the study was to analyze the outcome of patients who underwent anterior revision surgery for pseudoarthrosis after ACDF.MethodsFrom 99 patients with cervical revision surgery, ten patients (median age: 48, range 37–74; female: 5, male: 5) who underwent anterior revision surgery for pseudoarthrosis after ACDF with a minimal follow up of one year were included in the study. Microbiological investigations were performed in all patients. Computed tomography (CT) scans were used to evaluate the radiological success of revision surgery one year postoperatively. Clinical outcome was quantified with the Neck Disability Index (NDI), the Visual Analog Scale (VAS) for neck and arm pain, and the North American Spine Society Patient Satisfaction Scale (NASS) 12 months (12–60) after index ACDF surgery. The achievement of the minimum clinically important difference (MCID) one year postoperatively was documented.ResultsOccult infection was present in 40% of patients. Fusion was achieved in 80%. The median NDI was the same one year postoperatively as preoperatively (median 23.5 (range 5–41) versus 23.5 (7–40)), respectively. The MCID for the NDI was achieved 30%. VAS-neck pain was reduced by a median of 1.5 points one year postoperatively from 8 (3–8) to 6.5 (1–8); the MCID for VAS-neck pain was achieved in only 10%. Median VAS-arm pain increased slightly to 3.5 (0–8) one year postoperatively compared with the preoperative value of 1 (0–6); the MCID for VAS-arm pain was achieved in 14%. The NASS patient satisfaction scale could identify 20% of responders, all other patients failed to reach the expected benefit from anterior ACDF revision surgery. 60% of patients would undergo the revision surgery again in retrospect.ConclusionOccult infections occur in 40% of patients who undergo anterior revision surgery for ACDF pseudoarthrosis. Albeit in a small cohort of patients, this study shows that anterior revision surgery may not result in relevant clinical improvements for patients, despite achieving fusion in 80% of cases.Level of evidenceRetrospective study, level III.

Analysis of risk factors for non-fusion of bone graft in anterior cervical discectomy and fusion: A clinical retrospective study

BackgroundBone graft fusion is a major concern among surgeons after Anterior Cervical Discectomy and Fusion (ACDF) surgery as non-fusion may lead to further physical and drug therapies. MethodsThe related risk elements of non-fusion of bone graft in ACDF surgery were retrospectively assessed. Patients receiving ACDF operation in our hospital from January 2015 to December 2019 were retrospectively analyzed. According to the criteria, 107 study subjects were recruited with a total of 164 surgical segments. The general information of patients, bone graft materials, imaging parameters, and clinical efficacy was recorded. T-test, chi-square test and binary logistic regression evaluation were employed to explore the risk factors of bone graft nonunion. ResultsLow housefield unit (HU) value, diabetes, allogeneic bone, and hydroxyapatite (HA) artificial bone could be risk factors for bone graft fusion in ACDF surgery. Further multivariate analysis was performed and confirmed those related factors of bone graft non-fusion including low HU value (non-fusion rate: 32.53% [27/83], OR = 5.024, p = 0.025), diabetes (non-fusion rate: 53.33% [8/15], OR = 4.776, p = 0.031), allogeneic bone (18.57% [13/70], OR = 3.964, p = 0.046), and artificial bone (68.29% [28/41], OR = 50.550, p < 0.01). ConclusionBy looking at bone graft fusion, selecting autologous iliac bone is an ideal selection to avoid non-fusion of bone graft in ACDF. Diabetes was more important predictor of bone graft nonunion than low HU value. Larger sample size and longer follow-up are required to further confirm these findings in the future.

Fate of pseudarthrosis detected 2 years after anterior cervical discectomy and fusion: results of a minimum 5-year follow-up

BACKGROUND CONTEXTPrior study has shown that 70% of cervical pseudarthrosis after anterior cervical discectomy and fusion (ACDF) detected at 1 year will go on to fusion by 2 year. Pseudarthrosis detected 2 years after ACDF may have different bone healing potential compared to nonunion detected 1 year after surgery. Therefore, it might have a different clinical significance. PURPOSETo examine the radiographic and clinical prognosis of pseudarthrosis detected 2 years after ACDF with a minimum follow-up of 5 years. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENTS SAMPLEA total of 249 patients who completed a 5-year follow-up after ACDF. OUTCOMES MEASURESClinical outcomes such as neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) and radiographic assessment such as X-ray, computed tomography (CT) scan. METHODSA total of 249 patients who completed a 5-year follow-up after ACDF were retrospectively reviewed. Patients who were diagnosed with pseudarthrosis at 2 years postoperatively were included. Fusion, neck pain VAS, arm pain VAS, and NDI were assessed. The results were compared between the union group (patients who achieved union), and the nonunion group (patients with pseudarthrosis) at 5 years postoperatively. RESULTSAmong the patients who had pseudarthrosis at 2 years postoperatively, the fusion rate at 5 years was 32.6% (14/43). While the union group showed continued improvements in neck pain VAS, arm pain VAS, and NDI until 5 years, the nonunion group showed significant worsening of arm pain VAS and NDI at 5 years, with the values of neck pain VAS, arm pain VAS, and NDI being significantly worse than those of the union group at 5 years. CONCLUSIONThe incidence of pseudarthrosis detected at 2 years postoperatively after ACDF was 67.4%, and it remained unfused at 5 years postoperatively. Nonunion identified 2 years after ACDF may be considered a poor prognostic factor because it has less potential to achieve fusion with further follow-up and a higher chance of worsening clinical symptoms. Therefore, the presence of fusion at the 2-year follow-up can be considered an indicator of the success of the surgery.

Outcomes of cervical spinal stenosis surgery in patients aged ≥ 65 years based on insurance status: a single-center cohort study from a tertiary center in Germany

ObjectiveThe prevalence of degenerative disorders of the spine, such as cervical spinal stenosis with cervical spine myelopathy (CSM) in the geriatric population, has rapidly increased worldwide. To date, there has been no systematic analysis comparing outcomes in older patients suffering from progressive CSM and undergoing surgery depending on their health insurance status. We sought to compare the clinical outcomes and complications after anterior cervical discectomy and fusion (ACDF) or posterior decompression with fusion in patients aged ≥ 65 years with multilevel cervical spinal canal stenosis and concomitant CSM with special focus on their insurance status.MethodsClinical and imaging data were retrieved from patients’ electronic medical records at a single institution between September 2005 and December 2021. Patients were allocated into two groups with respect to their health insurance status: statutory health insurance (SHI) vs. private insurance (PI).ResultsA total of 236 patients were included in the SHI group and 100 patients in the privately insured group (PI) group. The overall mean age was 71.7 ± 5.2 years. Regarding comorbidities, as defined with the age-adjusted CCI, SHI patients presented with higher rates of comorbidities as defined by a CCI of 6.7 ± 2.3 and higher prevalence of previous malignancies (9.3%) when compared to the PI group (CCI 5.4 ± 2.5, p = 0.051; 7.0%, p = 0.048). Both groups underwent ACDF (SHI: 58.5% vs. PI: 61.4%; p = 0.618), and the surgical duration was similar between both groups. Concerning the intraoperative blood transfusion rates, no significant differences were observed. The hospital stay (12.5 ± 1.1 days vs. 8.6 ± 6.3 days; p = 0.042) and intenisve care unit stay (1.5 ± 0.2 days vs. 0.4 ± 0.1 days; p = 0.049) were significantly longer in the PI group than in the SHI group. Similar in-hospital and 90-day mortality rates were noted across the groups. The presence of comorbidities, as defined with the age-adjusted CCI, poor neurological status at baseline, and SHI status, was significant predictor for the presence of adverse events, while the type of surgical technique, operated levels, duration of surgery, or blood loss was not.ConclusionsHerein, we found that surgeons make decisions independent of health insurance status and aim to provide the most optimal therapeutic option for each individual; hence, outcomes were similar between the groups. However, longer hospitalization stays were present in privately insured patients, while SHI patients presented on admission with poorer baseline status.

Effect of workers' compensation status on pain, disability, quality of life, and return to work after anterior cervical discectomy and fusion: a 1-year propensity score-matched analysis.

Patients with workers' compensation (WC) claims are reported to demonstrate poorer surgical outcomes after lumbar spine surgery. However, outcomes after anterior cervical discectomy and fusion (ACDF) in WC patients remain debatable. The authors aimed to compare outcomes between a propensity score-matched population of WC and non-WC patients who underwent ACDF. Patients who underwent 1- to 4-level ACDF were retrospectively reviewed from the prospectively maintained Quality Outcomes Database (QOD). After propensity score matching, 1-year patient satisfaction, physical disability (Neck Disability Index [NDI]), pain (visual analog scale [VAS]), EQ-5D, and return to work were compared between WC and non-WC cohorts. A total of 9957 patients were included (9610 non-WC and 347 WC patients). Patients in the WC cohort were significantly younger (50 ± 9.1 vs 56 ± 11.4 years, p < 0.001), less educated, and were more frequently male, non-Caucasian, and active smokers (29.1% vs 18.1%, p < 0.001), with greater baseline VAS and NDI scores and poorer quality of life (p < 0.001). One-year postoperative improvements in VAS, NDI, EQ-5D, and return-to-work rates and satisfaction were all significantly worse for WC compared with non-WC patients. After adjusting for baseline differences via propensity score matching, WC versus non-WC patients continued to demonstrate worse 3- and 12-month VAS neck pain and NDI (p = 0.010), satisfaction (χ2 = 4.03, p = 0.045), and delayed return to work (9.3 vs 5.7 weeks, p < 0.001). WC status was associated with greater 1-year residual disability and axial pain along with delayed return to work, without any difference in quality of life despite having fewer comorbidities and being a younger population. Further studies are needed to determine the societal impact that WC claims have on healthcare delivery in the setting of ACDF.

Comparative study of outcomes between allograft intervertebral disc transplantation and anterior cervical discectomy and fusion: a retrospective cohort study at least 5 years of follow-up

PurposeAdjacent segment degeneration (ASDeg) after anterior cervical discectomy and fusion (ACDF) seriously affects the long-term efficacy of the operation. Therefore, our team has done a lot of research on allograft intervertebral disc transplantation (AIDT) to prove its feasibility and safety. This study will compare the efficacy between AIDT and ACDF in the treatment of cervical spondylosis.MethodsAll patients who received ACDF or AIDT in our hospital from 2000 to 2016 and followed up for at least 5 years were recruited and divided into ACDF and AIDT groups. The clinical outcomes including functional scores and radiological data of both groups were collected and compared preoperatively and postoperatively at 1 week, 3 months, 6 months, 12 months, 24 months, 60 months and last follow-up. Functional scores included Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), Visual Analog Scale of Neck (N-VAS) and Arms (A-VAS) pain, the Short Form Health Survey-36 (SF-36) and imaging dates including digital radiographs in the lateral, hyperextension and flexion positions to assess the stability, sagittal balance and mobility of the cervical spine and magnetic resonance imaging (MRI) scans to assess the degeneration of adjacent segment.ResultsThere were 68 patients with 25 in AIDT group and 43 in ACDF group. Satisfactory clinical results were obtained in both groups, but the long-term NDI score and N-VAS score in the AIDT group were better. The AIDT obtained the same stability and sagittal balance of the cervical spine as fusion surgery. The range of motion of adjacent segments can be restored to the preoperative level after transplantation, but this increases significantly after ACDF. There were significant differences in the superior adjacent segment range of motion (SROM) between two groups at 12 months (P = 0.039), 24 months (P = 0.035), 60 months (P = 0.039) and the last follow-up (P = 0.011). The inferior adjacent segment range of motion (IROM) and SROM had a similar trend in the two groups. The ratio value of the greyscale (RVG) of adjacent segments showed a downward trend. At the last follow-up, the RVG decreased more significantly in the ACDF group. At the last follow-up, there was a significant difference in the incidence of ASDeg between the two groups (P = 0.000). And the incidence of adjacent segment disease (ASDis) is 22.86% in the ACDF group.ConclusionThe allograft intervertebral disc transplantation may be as an alternative technique to traditional anterior cervical discectomy and fusion for the management of cervical degenerative diseases. For the more, the results showed it would improve cervical kinematics and reduce the incidence of adjacent segment degeneration.

Risk Factors of Subsidence after Anterior Cervical Discectomy and Fusion with Double Cylindrical Cages for Cervical Degenerative Diseases: Minimum Two-year Follow-up Results.

Cylindrical cages were known to cause subsidence after anterior cervical discectomy and fusion (ACDF); hence, they were gradually replaced by box-shaped cages. However, this phenomenon has been inconclusive due to limited information and short-term results. Therefore, this study aimed to clarify risk factors for subsidence after ACDF using titanium double cylindrical cages with mid-term follow-up periods. This retrospective study included 49 patients (76 segments) diagnosed with cervical radiculopathy or myelopathy caused by disc herniation, spondylosis, and ossification of the posterior longitudinal ligament. These patients underwent ACDF using these cages from January 2016 to March 2020 in a single institution. Patient demographics and neurological outcomes were also examined. Subsidence was defined as a ≥3-mm segmental disc height decrease at the final follow-up lateral X-ray compared to that on the next day postoperatively. Subsidence occurred in 26 of 76 segments (34.7%) within the follow-up periods of approximately three years. Multivariate analysis using a logistic regression model demonstrated that multilevel surgery was significantly associated with subsidence. The majority of patients achieved good clinical outcomes based on the Odom criteria. This study demonstrated that multilevel surgery was the only risk factor of subsidence post-ACDF with double cylindrical cages. Despite the relatively high subsidence rates, the clinical outcome was almost good at least during the mid-term period.

Cost-utility Analysis of Anterior Cervical Discectomy and Fusion for Cervical Spondylosis Patients Comparing Polyetheretherketone Versus Tricortical Iliac Crest Bone Graft.

Prospective cohort study. To perform a cost-utility analysis and to investigate the clinical outcomes and patient's quality of life after anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis compared between fusion with polyetheretherketone (PEEK) and fusion with tricortical iliac bone graft (IBG) in Thailand. ACDF is one of the standard treatments for cervical spondylosis. The fusion material options include PEEK and tricortical IBG. No previous studies have compared the cost-utility between these 2 fusion material options. Patients with cervical spondylosis who were scheduled for ACDF at Siriraj Hospital (Bangkok, Thailand) during 2019-2020 were prospectively enrolled. Patients were allocated to the PEEK or IBG fusion material group according to the patient's choice of fusion material. EuroQol-5 dimensions 5 levels and relevant costs were collected during the operative and postoperative periods. A cost-utility analysis was performed using a societal perspective. All costs were converted to 2020 United States dollars (USD), and a 3% discount rate was used. The outcome was expressed as the incremental cost-effectiveness ratio. Thirty-six patients (18 ACDF-PEEK and 18 ACDF-IBG) were enrolled. Except for Nurick grading, there was no significant difference in patient baseline characteristics between groups. The average utility at 1 year after ACDF-PEEK and ACDF-IBG were 0.939 ± 0.061 and 0.798 ± 0.081, respectively ( P < 0.001). The total lifetime cost of ACDF-PEEK and ACDF-IBG was 83,572 USD and 73,329 USD, respectively. The incremental cost-effectiveness ratio of ACDF-PEEK when compared with that of ACDF-IBG showed a gain of 4468.52 USD/quality-adjusted life-years, which is considered cost-effective at the Thailand willingness-to-pay threshold of 5115 USD/quality-adjusted life-year gained. ACDF-PEEK was found to be more cost-effective than ACDF-IBG for treating cervical spondylosis in Thailand. Level II.

The Recurrence of Symptoms After Anterior Cervical Discectomy and Fusion.

Objectives This study aimedto evaluate the recurrence symptoms rate after anterior cervical discectomy and fusion (ACDF) for one year and seek thecommoncervicalvertebral disk affected inatertiary center in Saudi Arabiaover the past fiveyears. Methods This is asingle-center, cross-sectional study conducted on patients followed inour centerfrom January 2016 to December 2022.All patients whowereolder than 18 andunderwentACDF were included. Results Out of 77 patients, 43 (55.8%) have experiencedarecurrence of symptoms aftertheACDF operation.The highest rate of recurrent symptoms was neck pain22(28.6%), left upper limb numbness20(26%),and right upper limb numbness16(20.8%).It was found that shoulder pain recurredafter one level ofACDF insixpatients out of10 (60%), and only one (10%) patient experienced shoulder pain after two-level ACDF. Conclusion ACDF hasahighrate ofrecurrenceof symptoms, and the most common type of ACDF was two levels. Most symptoms were neck pain and upper limb radicularpain. However,there is a lack of studies. We recommend conducting more studies on the secondary managementofrecurrentsymptoms post-ACDF.

Comparison of revision surgery for pseudarthrosis with or without adjacent segment disease after anterior cervical discectomy and fusion

BackgroundPatients with a pseudarthrosis after anterior cervical discectomy and fusion (ACDF) may have concurrent adjacent segment disease (ASD). Although prior studies have shown posterior cervical decompression and fusion (PCDF) is effective in repairing pseudarthrosis, improvement in patient reported outcomes (PROs) has been marginal. The aim of this study is to evaluate the effectiveness of PCDF in achieving symptom relief in patients with pseudarthrosis after ACDF and whether that is altered by the additional treatment of ASD. MethodsThirty-two patients with pseudarthrosis were compared with 31 patients with pseudarthrosis and concurrent ASD after ACDF who underwent revision PCDF with a minimum 1-year follow-up. Primary outcomes measures included the neck disability index (NDI), and numerical rating scale (NRS) scores for neck and arm pain. Secondary measures included estimated blood loss (EBL), operating room (OR) time, and length of stay. ResultsDemographics between cohorts were similar, however there was a significantly higher mean body mass index (BMI) in the group with concurrent ASD (32.23 vs. 27.76, p=.007). Patients with concurrent ASD had more levels fused during PCDF (3.7 vs. 1.9, p<.001), greater EBL (165 cc vs. 106 cc, p=.054), and longer OR time (256 minutes vs. 202 minutes, p<.000). Preoperative PROs for NDI (56.7 vs. 56.5, p=.954), NRS arm pain (5.9 vs. 5.7, p=.758), and NRS neck pain (6.6 vs. 6.8, p=.726) were similar in both cohorts. At 12 months patients with concurrent ASD experienced a slightly greater, but not statistically significant, improvement in PROs (Δ NDI 4.40 vs. -1.44, Δ NRS neck pain 1.17 vs. 0.42, Δ NRS arm pain 1.28 vs. 0.10, p=.107). ConclusionsPCDF is a standard procedure for treatment of pseudarthrosis following ACDF, however improvements in PROs are marginal. Slightly greater improvements were seen in patients whose indication for surgery also included concurrent ASD, rather than a diagnosis of pseudarthrosis alone.

Safety and Efficacy of Local Steroid Application on Dysphagia Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-analysis.

A systematic review and meta-analysis. To evaluate the safety and efficacy of local steroid application (LSA) on dysphagia after anterior cervical discectomy and fusion (ACDF). Dysphagia is one of the most common adverse events in the early postoperative period of ACDF. LSA is reported as an effective method to reduce the swelling of soft tissues, thereby decreasing the incidence of dysphagia. However, the safety and efficacy of LSA on dysphagia after ACDF need to be systematically reviewed and analyzed. A comprehensive literature search was carried out in the database PubMed, Web of Science, EMBASE, Clinical key, Cochrane library, and Wiley Online Library to screen papers that report LSA in ACDF surgery. The Cochrane Collaboration tool and a methodological index for nonrandomized studies were used for the assessment of study quality. Data were analyzed with the Review Manager 5.3 software. A total of 10 studies were included. The results revealed no significant differences between the steroid group and the control group in ACDF regarding postoperative drainage, estimated blood loss, and neck disability index score ( P > 0.05). LSA significantly alleviates visual analog scale score for neck pain (or odynophagia) ( P < 0.05), reduces the length of hospital stay (weighted mean difference, -1.00 (-1.05 to -0.95); P < 0.001), and mitigates dysphagia rate and prevertebral soft-tissue swelling in the early postoperative period ( P < 0.05). There seemed to be no significant increase in the complication rate and steroid-related adverse events in the steroid group compared with the control group ( P < 0.05). LSA shows advantages in reducing the length of hospital stay, decreasing dysphagia rate, and mitigating prevertebral soft-tissue swelling in the early postoperative period of ACDF. Further large-scale studies are urgently required for the development of a standard protocol for LSA and further analysis of potential delay complications.

A novel nanohydroxyapatite/polyamide-66 cage for reducing the subsidence rate after single-level anterior cervical discectomy and fusion: a comparative study of 7-year follow-up

BackgroundA novel nanohydroxyapatite/polyamide-66 cage (n-HA/PA66 cage) with a horseshoe shape was designed to lower the subsidence rate of the traditional hollow cylindrical n-HA/PA66 cage. However, no studies have compared the incidence of subsidence in the two cages. The purpose of this study was to compare the long-term clinical and radiological outcomes of the novel n-HA/PA66 cage with the hollow cylindrical n-HA/PA66 cage after anterior cervical discectomy and fusion (ACDF) to treat single-level cervical degenerative disk disease (CDDD).MethodsFifty-two patients with novel n-HA/PA66 cages (Group A) and fifty-five patients with hollow cylindrical n-HA/PA66 cages (Group B) were included. The radiological parameters included intervertebral height (IH), C2-7 angle (C2-7a), segmental alignment (SA), subsidence rate, and fusion rate. The clinical outcomes were visual analog scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and patient satisfaction rates.ResultsThe pre- and postoperative SA, C2-7a, and fusion rates of the patients in Groups A and B were similar. The preoperative and 6-month postoperative IHs in both groups were comparable. However, the final follow-up IH in Group B was significantly smaller than that in Group A (35.9 mm vs. 36.7 mm). The difference in the subsidence rates at the final follow-up between Group A (5.8%, 3/52) and Group B (18.2%, 10/55) was significant. The VAS score, JOA score, and patient satisfaction rate were not significantly different.ConclusionsThe novel n-HA/PA66 cage had similar favorable SA, C2-7a, fusion rate, and clinical outcomes compared to the hollow cylindrical n-HA/PA66 cage for treating single-level ACDF. Moreover, the novel n-HA/PA66 cage achieved a lower subsidence rate and higher IH than the hollow cylindrical n-HA/PA66 cage at the final follow-up.

ACDF versus corpectomy in octogenarians with cervical epidural abscess: early complications and outcomes with 2 years of follow-up

PurposeCervical spinal epidural abscess (CSEA) is a rare condition, manifesting as rapid neurological deterioration and leading to early neurological deficits. Its management remains challenging, especially in patients older than 80 years. Therefore, we aimed to compare the clinical course and determine morbidity and mortality rates after anterior cervical discectomy and fusion (ACDF) versus corpectomy in octogenarians with ventrally located CSEA at two levels.MethodsIn this single-center retrospective review, we obtained the following from electronic medical records between September 2005 and December 2021: patient demographics, surgical characteristics, complications, hospital clinical course, and 90-day mortality rate. Comorbidities were assessed using the age-adjusted Charlson comorbidity index (CCI).ResultsOver 16 years, 15 patients underwent ACDF, and 16 patients underwent corpectomy with plate fixation. Between the two groups, patients who underwent corpectomy had a significantly poorer baseline reserve (9.0 ± 2.6 vs. 10.8 ± 2.7; p = 0.004) and had a longer hospitalization period (16.4 ± 13.1 vs. 10.0 ± 5.3 days; p = 0.004) since corpectomy lasted significantly longer (229.6 ± 74.9 min vs. 123.9 ± 47.5 min; p < 0.001). Higher in-hospital and 90-day mortality and readmission rates were observed in the corpectomy group, but the difference was not statistically significant. Both surgeries significantly improved blood infection parameters and neurological status at discharge. Revision surgery due to pseudoarthrosis was required in two patients after corpectomy.ConclusionsWe showed that both ACDF and corpectomy for ventrally located CSEA can be considered as safe treatment strategies for patients aged 80 years and above. However, the surgical approach should be carefully weighed and discussed with the patients and their relatives.

Incidence and severity of dysphagia after anterior cervical discectomy and fusion with zero-profile spacer: prospective study with 3-years follow-up.

Dysphagia after anterior cervical discectomy and fusion (ACDF) is a regular complication. The aim of this study was to identify risk factors for incidence and severity of dysphagia after ACDF with zero-profile spacer. Incidence and severity of dysphagia was evaluated preoperatively and for time of three years after ACDF (regular outpatient check-ups) ‒ prospective study with 3-years follow-up. Severity of dysphagia was assessed subjectively using Bazaz‒Yoo dysphagia score. Influence of selected factors on the incidence and severity of postoperative dysphagia was evaluated. Following statistical methods were used: Fisher's exact test, unpaired Student's t-test, one-way ANOVA and Spearman's correlation coefficient. Level of significance was defined as p ˂ 0.05. Correlations between paired parameters were evaluated according to Spearman's correlation. Our study included 133 patients who underwent one-, two- or three-level ACDF with zero-profile spacer in years 2013‒2018. Myelopathy and GERD had significant impact on incidence and severity of pre-existing dysphagia. Risk factors for incidence of dysphagia after ACDF were number of treated segments, myelopathy, pre-existing dysphagia and surgery of C4/5 segment. Age of patients, duration of surgery and pre-existing dysphagia correlated positively very weakly to weakly with severity of dysphagia after ACDF. Number of treated segments, myelopathy, GERD and surgery of the C4/5 segment were risk factors for greater severity of postoperative dysphagia. Risk factors for incidence and severity of pre-existing dysphagia were myelopathy and GERD. Risk factors for dysphagia incidence after ACDF were number of treated segments, pre-existing dysphagia, myelopathy and surgery of C4/5 segment (Tab. 6, Fig. 1, Ref. 30).

Realistic long-term dysphagia rates after anterior cervical discectomy with fusion: is there a correlation with postoperative sagittal alignment and lordosis at a minimum 2-year follow-up?

Postoperative dysphagia after anterior cervical discectomy and fusion (ACDF) has many contributing factors, and long-term data are sparse. The authors evaluated dysphagia after ACDF based on levels fused and cervical sagittal parameters. Patients who underwent ACDF between 2009 and 2018 at the University of California, San Francisco (UCSF), were retrospectively studied. Dysphagia was evaluated preoperatively, immediately postoperatively, and at last follow-up using the UCSF dysphagia score. Dysphagia was categorized as normal (level 7), mild (levels 5 and 6), moderate (levels 3 and 4), and severe (levels 1 and 2). The UCSF mild dysphagia score was further classified as "minimal dysphagia," while moderate and severe dysphagia were classified as "significant dysphagia." "Any dysphagia" included any dysphagia, regardless of grade. Cervical sagittal parameters were measured preoperatively, immediately postoperatively, and at last follow-up. A total of 131 patients met inclusion criteria. The mean follow-up was 43.89 (24-142) months. Seventy-eight patients (59.5%) reported dysphagia immediately postoperatively, and 44 patients (33.6%) reported some dysphagia at last follow-up (p < 0.001). The rates of moderate dysphagia were 13.0% immediately postoperatively and 1.5% at the last follow-up (p < 0.001). Twenty-two patients (16.8%) had significant dysphagia immediately postoperatively, and 2 patients (1.5%) had significant dysphagia at last follow-up (p < 0.001). Patients with immediate postoperative dysphagia had less C2-7 preoperative lordosis (-9.35°) compared with patients without (-14.15°, p = 0.029), but there was no association between C2-7 lordosis and dysphagia at last follow-up (p = 0.232). The prevalence rates of immediate postoperative dysphagia and long-term dysphagia were 87.5% and 58.3% in ≥ 3-level ACDF; 64.0% and 40.0% in 2-level ACDF; and 43.9% and 17.5% in 1-level ACDF, respectively (p < 0.001). The realistic incidence of any dysphagia after ACDF was 59.5% immediately postoperatively and 33.6% at the minimum 2-year follow-up, higher than previously published rates. However, most dysphagia was not severe. The number of fused levels was the most important risk factor for long-term dysphagia, but not for immediate postoperative dysphagia. Loss of preoperative C2-7 lordosis was associated with immediate postoperative dysphagia, but not long-term dysphagia. ACDF segmental lordosis and cervical sagittal vertical axis were not associated with long-term dysphagia in ACDF.

Endplate-specific fusion rate 1year after surgery for two-level anterior cervical discectomy and fusion(ACDF).

This is a retrospective study. Implant nonfusion is an important prognostic factor for patients after anterior cervical discectomy and fusion (ACDF). This study aimed to investigate endplate-specific pseudarthrosis after ACDF, to determine if the rate of fusion is inferior in the lower endplate, and to identify any differences in clinical and radiological results. Research comparing each endplate on which the endplate affects nonfusion is limited. We analyzed 71 patients with 142 total spinal levels who underwent double-level ACDF (C4-5-6 and C5-6-7) with an allograft and plate at our hospital between January 2012 and December 2018. Fusion grades were assessed using computed tomography and the Bridwell fusion grade system at 1year postoperatively. Radiological parameters were obtained from lateral cervical radiographs collected preoperatively and at 1month and 1year after surgery. There was no difference in fusion between the C4-5-6 and C5-6-7 ACDF procedures, but the fusion rate and Bridwell fusion grade at the caudal surgery level were lower than those at the cranial surgery level (93 vs. 79%, p < 0.001). The lower endplate of the caudal fusion level showed the most common pseudarthrosis (18 of 71 [25%]). There was no difference in radiological parameters and clinical outcomes between the fusion and pseudarthrosis groups. In double-level ACDF procedures, the nonfusion rate was higher at the caudal fusion levels, especially at the lower endplates of the caudal fusion levels.

Reoperation and Perioperative Complications After Surgical Treatment of Cervical Radiculopathy: A Comparison Between Three Procedures.

A retrospective database study. The purpose of our study was to compare the perioperative complications and reoperation rates after anterior cervical discectomy and fusion (ACDF), cervical disk arthroplasty (CDA), and posterior cervical foraminotomy (PCF) in patients treated for cervical radiculopathy. Cervical radiculopathy results from compression or irritation of nerve roots in the cervical spine. While most cervical radiculopathy is treated nonoperatively, ACDF, CDA, and PCF are the techniques most commonly used if operative intervention is indicated. There is limited research evaluating the perioperative complications of these surgical techniques. A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of cervical radiculopathy that underwent ACDF, CDA, or PCF at one or two levels from 2007 to 2016. Perioperative complications and reoperations following each of the procedures were assessed. During the study period, 25,051 patients underwent ACDF, 522 underwent CDA, and 3986 underwent PCF. After propensity score matching, each of the three groups consisted of 507 patients. Surgical site infection rates were highest after PCF (2.17%) compared with ACDF (0.20%) and CDA (0.59%) at 30 days and three months ( P =0.003, P <0.001), respectively. New-onset cervicalgia was highest following ACDF (34.32%) and lowest after PCF (22.88%) at three and six months ( P <0.001 and P =0.003), respectively. Revision surgeries were highest among those who underwent CDA (6.90%) versus ACDF (3.16%) and PCF (3.55%) at six months ( P =0.007). Limb paralysis was significantly higher after PCF compared with CDA and ACDF at six months ( P <0.017). The rate of surgical site infection was higher in PCF compared with ACDF and CDA. New-onset cervicalgia was higher after ACDF compared with PCF and CDA at short-term follow-up. Revision surgeries were highest among those undergoing CDA and lowest in those undergoing ACDF. 3.

Intraoperative Monitoring of the Recurrent Laryngeal Nerve with Electromyography Endotracheal Tube in Anterior Cervical Discectomy and Fusion

ObjectiveRecurrent laryngeal nerve (RLN) injury is common complication after anterior cervical discectomy and fusion (ACDF). In the present study, we evaluated RLN function during ACDF surgery using intraoperative RLN monitoring with an electromyography-endotracheal tube (EMG-ET).MethodsIn the present study, we retrospectively compared the postoperative RLN injury outcomes between patients who had undergone ACDF with and without an EMG-ET at Vajira Hospital from March 2017 to March 2022.ResultsThe analysis included 85 patients, 58 (68.2%) of whom had undergone surgery without an EMG-ET and 27 (31.8%) with an EMG-ET. Of the no EMG-ET group, 8 (13.8%) and 1 (1.7%) patient had developed immediate postoperative dysphagia and hoarseness, respectively, with complete recovery within 12 months. In the EMG-ET group, 2 (7.4%) and 1 (3.7%) patient had developed dysphagia and hoarseness, respectively, with complete recovery within 3 months for all 3 patients. Persistent postoperative RLN palsy had occurred in 5 patients (8.6%) without the EMG-ET but in none of the patients with the EMG-ET. The sensitivity and specificity for the use of intraoperative EMG-ET to detect a potential RLN injury were 67.0% and 96.0%, respectively. The use of an EMG-ET reduced the retractor time (P = 0.003), and a retractor time of <70 minutes was associated with a decreased incidence of postoperative RLN injury (odds ratio, 0.122; 95% confidence interval, 0.015–0.981; P = 0.048).ConclusionsThe use of an EMG-ET for RLN monitoring during ACDF surgery was helpful in detecting postoperative RLN injury with fair sensitivity and high specificity and resulted in a shorter retractor time, thereby significantly reducing the risk of postoperative RLN injury.

Is Patient Geography a Risk Factor for Chronic Opioid Use After ACDF?

The social and medical implications intrinsic to patient zip codes with high opioid fatality may reveal residence in these locations to be a risk factor predicting chronic opioid use after anterior cervical discectomy and fusion (ACDF). The purpose of this study is to determine if residence in Pennsylvania zip codes with high incidence of opioid overdose deaths is a risk factor for chronic postoperative opioid use after ACDF. Preoperative opioid usage did not vary meaningfully between high- and low-risk zip code groups. Patients in high-risk opioid overdose zip codes were significantly more likely to exhibit chronic postoperative opioid use. The Kaplan-Meier curve demonstrated that opioid discontinuation was less probable at any postoperative time for patients residing in high opioid fatality zip codes. Logistic regression found opioid tolerance, smoking, and depression to predict extended opioid use.