Anterior Cervical Decompression Fusion Research Articles

A novel porous interbody fusion cage modified by microarc oxidation and hydrothermal treatment technology accelerate osseointegration and spinal fusion in sheep.

The clinical outcome of spinal fusion surgery is closely related to the success of bone fusion. Nowadays, the interbody cage which is used to replace the disc for spinal fusion is expected to have biological activity to improve osseointegration, especially for the aging and osteoporotic patients. Here, through micro-arc oxidation and hydrothermal treatment (MAO + HT), a bioactive CaP coating with micro/nano multilevel morphology was developed on 3D printed Ti6Al4V alloy then verified in vitro and in sheep anterior cervical decompression fusion model systematically. In vitro studies have confirmed the positive effects of characteristic micro/nano morphology and hydrophilicity of the coating formed after surface treatment on the adhesion, proliferation, and osteogenic differentiation of osteoblast precursor cells. Furthermore, the MAO + HT treated interbody cage showed a closer integration with the surrounding bone tissue, improved kinetic stability of the implanted segment, and significantly reduced incidence of fusion failure during the early postoperative period, which indicated that such a surface modification strategy is applicable to the biomechanical and biological microenvironment of the intervertebral space.

Diagnosis and treatment of 11 patients with cevical spondylotic amyotrophy

To explore clinical features, treatment methods and clinical effects of cervical spondylosis with proximal muscular atrophy. Eleven patients with proximal-type cervical spondylotic amyotrophy were retrospectively studied from September 2016 to November 2020, including 7 males and 4 females, aged 38 to 68 years old. Clinical symptoms, MRI and neuroelectrophysiological manifestations were analyzed, and patients were treated with conservative treatment or anterior cervical decompression fusion surgery, respectively. The efficacy was evaluated by manual muscle test (MMT) before and after treatment, and patients' satisfaction was followed up at the same time. All patients were followed up for 6 to 19 months. All 11 patients were unilateral, mainly manifested by atrophy of deltoid muscle, supraspinatus muscle and infraspinatus muscle, and may be accompanied by ipsilateral neck and shoulder pain at early stage. MRI showed lesions at C4,5, C5,6 segments were more common. Electrophysiological examination showed the affected muscle was denervated, and amplitude of compound muscle action potential (CMAP) of innervated nerve on the affected side was lower than that on the healthy side. All patients were obtained bone fusion. One patient who were underwent anterior cervical corpectomy and fusion (ACCF) occurred developed contralateral C5 nerve root paralysis after operation, which recovered completely after 10 weeks of symptomatic treatment. At 12 months after operation, the efficacy was evaluated according to MMT, 3 patients were treated conservatively, 2 patients excellent and 1 good;in 8 patients treated by operation, 3 patients were excellent, 4 good, and 1 moderate. The incidence of cervical spondylosis with proximal muscular atrophy is low, which is manifested as unilateral proximal muscle atrophy and may be accompanied by ipsilateral neck and shoulder pain in the early stage. Combined with MRI and neuroelectrophysiological examination, misdiagnosis could be reduced. In the early stage of disease, especially in the case of nucleus pulposus protrusion leading to nerve compression, conservative treatment could be taken. When the conservative treatment is ineffective or the pain cannot be tolerated, anterior decompression surgery is recommended, and the overall effect is satisfactory.

Comparison of Anterior Cervical Decompression and Fusion and Posterior Laminoplasty for Four-Segment Cervical Spondylotic Myelopathy: Clinical and Radiographic Outcomes.

Although anterior or posterior surgery for cervical spondylotic myelopathy (CSM) has been extensively studied, the choice of anterior or posterior approach in four-segment CSM remains poorly studied and controversial. We compared the clinical and radiographic outcomes of four-segment CSM by posterior laminoplasty (LAMP) and anterior cervical decompression fusion (ACDF) to further explore the merits and demerits of ACDF and LAMP for four-segment CSM in this study. Patients with four-segment CSM who underwent ACDF or LAMP between January 2016 and June 2019 were retrospectively analyzed. We compared the preoperative and postoperative cervical Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI), neck pain visual analog scale (VAS) score, sagittal vertical axis, cervical lordosis (CL), and range of motion. There were 47 and 79 patients in the ACDF and LAMP groups, respectively. Patients in the ACDF group had a significantly longer surgical time and lower estimated blood loss and length of stay than those in the LAMP group. There was no significant difference in the JOA, NDI, or neck pain VAS scores between the two groups preoperatively, but the NDI and neck pain VAS scores in the ACDF group were significantly lower than those in the LAMP group at the final follow-up. The preoperative C2-C7 Cobb angle of the ACDF group was significantly lower than that of the LAMP group but there was no significant difference between the two groups postoperatively. The improvement of C2-C7 Cobb angle (∆C2-C7 Cobb angle) in the ACDF group was significantly higher than that in the LAMP group. This indicated that ACDF can improve CL better than LAMP. The linear regression analysis revealed the ∆C2-C7 Cobb angle was negatively correlated with the final follow-up neck pain VAS scores and NDI. This indicated that patients with better improvement of CL may have a better prognosis. Although both ACDF and LAMP surgeries are effective for four-segment CSM, ACDF can better improve CL and neck pain. For patients with poor CL, we suggest ACDF when both approaches are feasible.

Effect of Anterior Cervical Decompression Fusion and Partial Resection of Uncinate Vertebra Joint on Cervical Sagittal Sequence in Patients with Non-Single-Segment Radiculopathy and its Correlation with Curative Effect: A Retrospective Analysis.

Analyze the effect of preservation or resection of the partial uncinate joint on the sagittal sequence of the cervical vertebrae in patients with non-single-segment radiculopathy and the correlation between the sagittal sequence of the cervical vertebrae and the long-term effect after surgery, we explored whether it is necessary to perform partial resection of the uncinate joint in patients with cervical spondylotic radiculopathy undergoing anterior cervical decompression and fusion (ACDF). The study retrospectively analyzed 96 patients with cervical spondylotic radiculopathy with more than two segments from August 2016 to January 2021, who underwent ACDF (ACDF group, 45 patients) or ACDF combined with partial uncinate joint resection (ACDF + UT group, 51 patients). Partial resection of the uncinate joint indicated removal of part of the uncinate joint and osteophyte based on the compression of the nerve root during surgery, whereas the uncinate joints in the ACDF group were retained completely. The imaging data and functional scores of the two groups were recorded before surgery, 1 month after surgery, and at the last follow-up. A paired t-test or rank sum test was applied to analyze the data. In addition, the correlation between the imaging parameters and functional scores was validated using the Pearson's test. All 96 patients successfully completed the surgery and were followed up for at least 12months, with an average follow-up time of 14months. At the last follow-up, the pain visual analog scale (VAS), neck disability index (NDI), and neck pain and disability scale (NPAD) scores of the two groups were significantly lower than those before surgery, and the Japanese Orthopaedic Association (JOA) score was significantly higher than that before surgery. At the last follow-up, compared with the ACDF+UT group, the NDI and NPAD scores in the ACDF group decreased more significantly (p < 0.05), and C2-7SVA, △C2-7SVA (the difference between C2-7 SVA at last follow-up and before operation), and T1S values decreased significantly (p < 0.05). The C2-7 Cobb angle was positively correlated with the JOA score and T1S (p < 0.05) and negatively correlated with the VAS, NDI, and NPAD scores and CGH-C7SVA (p < 0.05). C2-7SVA was positively correlated with CGH-C7SVA and T1S (p < 0.05). Patients with non-single-segmental cervical spondylotic radiculopathy and ACDF with or without uncinate joint resection can have effective improvement in the clinical effect and sagittal balance; however, partial uncinate joint resection has a certain negative impact on the long-term reconstruction of sagittal balance and long-term effects in patients after surgery.

Role of Anterior Cervical Decompression Fusion (ACDF) and Plating in Patients with Lower Cervical Caries Spine

Objective: We assessed the neurologic status of patients with cervical spine caries after anterior cervical decompression fusion and plating in terms of muscle power measured by MRC (medical research council) grade and functional status measured by Nurick grade.&#x0D; Materials and Methods: A descriptive case series study was conducted and 36 subjects with lower cervical spine (C3 – C7) were included with cervical spine caries who needed anterior cervical decompression and plating operated by the department of Neurosurgery, KEMU/Mayo Hospital. The cervical spine TB was confirmed using an MRI plain and contrasted cervical spine. Post-surgical neurological examinations were performed on the 1st, 7th, 21st, and 42nd days and the 3rd and 6th months after surgery. The neurological state was measured in terms of muscle power measured by MRC grades and functional outcome was assessed from Nurick grades.&#x0D; Results: The mean age of the patients was 37.0 ± 14.4 years. The majority of patients had C5 caries spine (28%) and the least had C7 caries spine (14%). Most of the patients had pre-operative MRC grade 3 (41.7%). The majority had Nurick’s grade 5 (55.6%). 17% of patients had post-operative hoarseness of voice. 31% of the patients had post-operative dysphasia which improved by 3 weeks. 3% developed a new neurological deficit in the form of deterioration of muscle power measured by MRC grade during 6 months’ follow-up time.&#x0D; Conclusion: All follow-up improvements were statistically significant in terms of pre-operative status.

What have we learned from C5 palsy – A short communication

A study group on C5 palsy retrospectively reviewed 1001 cervical operations at their institutions in order to understand the incidence, prognosticators, pathogenesis, and outcome of C5 palsy after cervical operations. Three studies are summarized. C5 palsy was higher after posterior versus anterior operations. C4-C5 foraminotomy and age were the strongest predictors of C5 palsy after posterior surgeries and anterior cervical decompression-fusion, respectively. Among patients undergoing C4-C5 posterior laminoforaminotomy with instrumented fusion, cord shift on postoperative imaging was thought to be implicated in the pathogenesis of C5 palsy. Among affected patients, 81.4% recovered. Median time to resolution of C5 palsy was between 6 months to 1 year.

Comparison of Outcomes between Anterior and Posterior Cervical Procedures: Results of Surgery Involving Four or More Vertebral Levels from the AOSpine North America Cervical Spondylotic Myelopathy Study

Introduction Debate continues about the relative merits of anterior versus posterior surgery for multilevel cervical stenosis causing myelopathy. Conclusions from previous studies were limited because one- or two-level anterior surgeries have been compared with multilevel posterior cases. The objective of this study was to compare outcomes and complications of anterior versus posterior-based cervical procedures (≥ 4 levels) for patients with multilevel disease. Material and Methods Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, were analyzed. A subset of patients with myelopathy involving four or five vertebrae was analyzed in this study. The outcome measures included NDI, modified-Japanese Orthopaedic Association scores, SF36v2, and Nurick grades. Adverse events were also collected in a standardized manner and externally monitored. Rates of perioperative complications (within 30 days of surgery) and delayed complications (31 days–2 years following surgery) were tabulated and stratified based on clinical factors. Results Of the 264 patients in the main study, 113 patients (42.8%) had four or more levels of surgery. There were 49 patients who underwent anterior cervical surgery (ACS, combination of anterior cervical decompression fusion ± corpectomy) and 64 patients who underwent posterior-based cervical surgeries (PCS, 45 laminectomy + fusion, 19 laminoplasty). There were statistically significant differences in age, cardiovascular comorbidities, and source of stenosis between these two groups. There was a statistically significant difference in baseline Nurick grades between groups (2.8 ACS vs. 3.3 PCS, p = 0.0075). There was no difference in any outcome measures at baseline. Outcome scores improved in both the ACS and PCS groups from baseline over a period of 2 years. There were no statistically significant differences between the anterior and posterior surgical procedures in terms of outcomes at 2 years ( p &gt; 0.05). This was true for NDI, mJOA, SF36v2, and Nurick scores for both unadjusted and adjusted analyses. There was no significant difference in complication rates between ACS and PCS groups. Each group had 14 reported complications (total 28). Both the groups reported two postoperative C5 radiculopathies. There was one reoperation in the ACS group. Worsening of neck pain was reported in one patient who had an anterior corpectomy/fusion procedure and there was one case of infection in the PCS group. Two patients in the ACS group had worsening of myelopathy. Conclusion In patients with four or five involved vertebral levels of pathology that require surgical intervention for cervical myelopathy, both anterior and posterior surgical procedures demonstrate improved outcomes. With this dataset, we found no evidence of difference between anterior versus posterior surgical procedures in outcomes or associated complication rates. Surgical decision-making related to approach and technique to address issues in these patients can be made by surgeons based on their judgment and experience with these procedures. The limitations of this study include (1) a nonrandomized study design and (2) the grouping together of different subtypes of anterior or posterior procedures.

Commentary: Patient heterogeneity complicates efforts to compare effectiveness for anterior versus posterior surgery for cervical spondylotic myelopathy

COMMENTARY ON: Seng C, Tow BPB, Siddiqui MA, et al. Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. Spine J 2013;13:723–31 ( in this issue ).

Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty

Background contextMultilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach. PurposeTo elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study. Study designA prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty. Patient sampleIn total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3–C6 and C3–C7). Outcome measuresSelf-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales. MethodsComparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables. ResultsPosterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group. ConclusionsOur study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.

Surgically Treated Cervical Myelopathy: A Functional Outcome Comparison Study between Multiple Level Anterior Cervical Decompression Fusion and Instrumentation and Posterior Laminoplasty

Multi- level cervical myelopathy can be treated with anterior cervical discetomy and fusion (ACDF) or anterior cervical corpectomy and fusion(ACCF) via the anterior approach and laminoplasty for the posterior approach. Till date there is no proven superior approach.