Anterior Cervical Discectomy Surgery Research Articles

Drilling Condition Identification Based on Sound Pressure Signal in Anterior Cervical Discectomy Surgery

BackgroundIn anterior cervical discectomy and fusion (ACDF) surgery, drilling operation causes a high risk of tissue injury. This study aimed to present a novel feedback system based on sound pressure signals to identify drilling condition during ACDF.Material/MethodsACDF surgery was performed on the C4/5 segments of 6 porcine cervical specimens. The annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and posterior longitudinal ligament (PLL) were drilled until penetration using a 2-mm high-speed burr. Sound pressure signals were collected using a microphone and dynamic signal analyzer. The recorded signals of different tissues were proceeded with lifting wavelet transform for extracting harmonic components. The frequencies of harmonic components are 1, 2, 3, 4, and 5 times higher than the motor frequency. The magnitude of harmonic components was calculated to identify different drilling conditions, along a broad spectrum of frequencies (1–5 kHz). For statistical analysis, one-way ANOVA (analysis of variance) and post hoc test (Dunnett’s T3) were performed.ResultsVery good demarcation was found among the signal magnitudes of different drilling conditions. Different drilling conditions do not present the same rate of variation of frequency. Differences in magnitude among all drilling conditions were statistically significant at certain frequency points (p<0.05). In 3 cases, one tissue could not be identified with respect to another (annulus fibrosus and endplate cartilage at 2 kHz, PLL and penetration at 3 kHz, annulus fibrosus and sub-endplate cortical bone at 5 kHz, p>0.05).ConclusionsSound pressure signals may provide an auxiliary feedback system for enhancing drilling operation in ACDF surgery, especially in minimally invasive surgery.

Dysphagia Prevention in Anterior Cervical Discectomy Surgery: Results from a Prospective Clinical Study

Dysphagia is a common complication after anterior cervical discectomy surgery (ACDS). Recent studies have shown that reducing the endotracheal tube cuff pressure, local irrigation with methylprednisolone, and minimizing the pharynx/esophagus retraction can decrease the incidence of postoperative dysphagia after ACDS. This is the first study assessing the efficacy of all these 3 measures simultaneously. This prospective study included 35 patients (group 1) who underwent ACDS with the adoption of all the 3 preventive measures. Group 1 was compared with a homogenous group of 35 patients who underwent regular ACDS (group 2). Postoperative dysphagia and odynophagia were evaluated after 2, 7, and 14 days and 3, 6, and 12 months. Age, gender, body mass index (BMI), operating time, blood loss, and preoperative Japanese Orthopaedic Association score were collected. Postoperative dysphagia was observed in 3 cases (8.6%) in group 1 and 15 cases (42.9%) in group 2 (P<0.05). Three patients in group 1 had transient dysphagia with complete resolution at the last follow-up whereas 6 patients in group 2 (17.1%) had permanent dysphagia (P<0.05). Nine patients (25.7%) in group 2 presented with transient dysphagia with complete resolution at the last follow-up. The mean visual analog scale for odynophagia was significantly lower in group 1 compared with group 2 (P < 0.05). Postoperative dysphagia occurs frequently after ACDS. We show that the adoption of preventive measures during surgery can reduce the rate of dysphagia. Future evaluations in a large clinical trial are mandatory.

Effect of Using High-Speed Drill in Anterior Cervical Discectomy and Fusion.

The objective of this study was to investigate the effect of using 2 different surgical techniques (curette or high-speed drill) in anterior cervical discectomy surgery on the healing of cases. Fifty-four operated cervical disc hernia cases were retrospectively examined in 2 groups. Discectomy and osteophytectomy were carried out in Group A by using a high-speed drill, while a curette was used for group B. Preoperative and postoperative computerized tomography and direct radiography were performed. Cervical disc height, cervical and segmental lordotic angles were calculated. The visual analogue scale and Odom's criteria were used in the assessment of pain and clinical healing. The fusion ratio of both groups was compared. The Mann-Whitney U test was used to compare data from the groups. Satisfactory results were obtained in the groups where high-speed drill and curette were used. Independently from the surgical technique, pain scores were significantly reduced in both groups after surgery. No radiologically significant differences were identified between the two groups within the postoperative period. Either high-speed drill or curette can be chosen for the osteophytectomy and discectomy stages of anterior cervical discectomy operations.