Anterior Decompression Research Articles

Efficacy of NHP66 Bioactive Cage on Patients with Cervical Spine Injury in Short-Track Speed Skating.

Background Short-track speed skating (STSS) is an extreme sport in pursuit of extreme speed and explosive force. In such a sport, once athletes fall down, they are susceptible to serious cervical spine injury (CSI) under the inertia of high-velocity movement. Nanohydroxyapatite/polyamide 66 (NHP66) bioactive cage is a high-tech product of nanotechnology in the medical field in recent years. With a structure similar to that of human cortical bone, NHP66 bioactive cage has extremely high toughness and strength, which tailors to the needs of STSS. Objective This study mainly analyzed the therapeutic effect of NHP66 on patients with CSI in STSS, aiming to provide new opportunities for the treatment of this patient population. Methods A total of 51 patients with CSI treated in our hospital were enrolled, including 19 cases of short-track speed skaters (observation group) and 32 cases of car accidents, falls from heights, or collision injuries (control group). The relevant surgical indicators (operation time, intraoperative blood loss, etc.), the incidence of adverse reactions, the Cobb angle of cervical lordosis before and after surgery, and the fusion segment height of the cage were observed and compared between the two groups. Postoperative pain was evaluated by the visual analog scale (VAS), improvement of spinal cord injury was assessed by the American Spinal Cord Injury Association (ASIA) Impairment Scale, and bone fusion, bone subsidence, and other motor functions were assessed by the Japanese Orthopaedic Association (JOA) score rating system. Results The operation time, intraoperative blood loss, and incidence of adverse reactions in the observation group were significantly lower than those in the control group. The Cobb angle of cervical lordosis and the fusion segment height of cage increased significantly higher in both groups after surgery. In addition, the VAS scores of the observation group 2 h and 3 d after operation were significantly lower than those of the control group. In terms of improvement of spinal cord injury, ASIA and JOA scores in the observation group were significantly higher than those before treatment and in the control group. There was no significant difference in bone fusion activity between the two groups. Conclusions In this study, it is found through experiments that NHP66 has higher safety and application value than autogenous iliac bone, confirming that NHP66 can achieve significant results as a cage for anterior cervical decompression and iliac bone graft fusion and internal fixation in short-track speed skaters after CSI.

Single-stage C6-7 ACDF with T1-2 Oblique Keyhole Transcorporeal Disectomy to Treat Cervico-thoracic Tandem Disc Herniation: A Case Report

Symptomatic cervico-thoracic tandem disc herniation occurs very rarely. On the other hand, cervical disc herniations are common and may be treated via a variety of surgical procedures. Symptomatic upper thoracic disc herniations are extremely rare, and use of a surgical approach in their treatment is controversial due to the narrow operative space within which surgical procedures must be performed. We report an extremely rare case of symptomatic tandem C6-7 and T1-2 disc herniation successfully treated via single-stage, single-incision, C6-7 anterior cervical decompression and fusion, and T1-2 oblique keyhole transcorporeal discectomy. This is the first symptomatic cervico-thoracic tandem disc herniation with its treatment.

Anterior cervical pseudomeningocele causing syncope after spinal surgery: A case report.

Introduction and importancePseudomeningocele formation from incidental durotomy is a known risk in spine surgery. We present a case of incidental durotomy leading to anterior neck pseudomeningocele, compressing the carotid body (CB) resulting in syncopal episodes. To our knowledge, this is the first case report implicating syncopal episodes to CB compression via a pseudomeningocele.Case presentationA mid sixty-year-old patient with history of obesity, hypertension, and diabetes presented with gait impairment and hand weakness. Ossification of posterior longitudinal ligament (OPLL) was diagnosed with computed tomography imaging (CT) and magnetic resonance imaging (MRI). Elective surgery was completed with an anterior and posterior approach for decompression and fusion. Hospital course (San Jose, CA, USA) was complicated by respiratory depression and incomplete tetraplegia. On post-operative day (POD) six, CT revealed anterolateral soft tissue neck swelling; subsequent CT and MRI showed fluid collection expansion, with associated syncopal episodes on POD thirty-nine. Despite interventional radiology drainage, the fluid collection and symptoms returned five days later. The patient ultimately underwent durotomy revision and repair with muscle patch.Clinical discussionThis case highlights the challenges in managing anterior cervical dural tears resulting in pseudomeningocele. Risk factors include anterior cervical corpectomy and decompression, as well as an underlying diagnosis of OPLL. Untreated dural tears may develop into pseudomeningoceles which can contribute to life-threatening outcomes.ConclusionThis case report presents the serious consequences of incidental durotomy, the unique post-surgical complication of syncope due to compression of the CB from a pseudomeningocele, and the challenges of managing a persistent pseudomeningocele.

Combined Anterior and Posterior Decompression With Fusion for Cervical Ossification of the Posterior Longitudinal Ligament.

Objective:Cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) is not uncommon among Asian ethnic groups. Despite reports comparing the pros and cons of anterior- and posterior-only approaches, the optimal management remains debatable. This study aimed to evaluate the outcomes of patients who underwent a combined anterior and posterior approach, simultaneous circumferential decompression and fixation, for cervical OPLL.Method:The study retrospectively reviewed patients with OPLL and who underwent circumferential decompression and fixation, combined anterior corpectomy and posterior laminectomy. The clinical outcomes were evaluated by the Visual Analog Scale of neck and arm pain, the Japanese Orthopedic Association scores, Neck Disability Index, and Nurick scores at each time-point of evaluation. Radiological evaluations included plain and dynamic radiographs and computed tomography for every patient within 2 years post-operation. Subgroup analyses were further performed between the groups, with and without intra-operative cerebrospinal fluid (CSF) leakage.Results:A total of 41 patients completed the follow-up for more than 2 years (mean = 39.8 months) and were analyzed. Continuous-type OPLL was the most common (44%), followed by segmental (27%), mixed (22%), and localized types (7%) in the cohort. Myelopathy and all other functional outcomes improved significantly at 2 years post-operation (all p < 0.05). There were 13 (32%) patients who had intra-operative CSF leakage. At 2 years post-operation, there were no differences in the demographics, functional outcomes, and complication rates between the CSF-leakage and no-leakage groups. The CSF-leakage group had more patients with continuous-type OPLL than the no-leakage group (77 vs. 29%, p = 0.004 < 0.05). During the follow-up, there was no secondary or revision surgery for pseudomeningocele, pseudarthrosis, or other surgery-related complications.Conclusions:Simultaneous circumferential decompression and fixation combine the surgical benefits of sufficient decompression by the posterior approach and direct decompression of OPLL by the anterior approach. It is an effective surgical option for patients with cervical myelopathy caused by OPLL, given that myelopathy unanimously improved without neurological complications in this study. The fusion rates were high, and reoperation rates were low. Despite higher rates of CSF leakage, there were no related long-term sequelae, and minimal wound complications.

Midterm osteolysis-induced aseptic failure of the M6-C™ cervical total disc replacement secondary to polyethylene wear debris

BackgroundAccording to published meta-analyses, cervical total disc replacement (CTDR) seems to be superior to anterior cervical decompression and fusion (ACDF) in most clinical parameters. Despite short-term clinical success of CTDR, there are concerns regarding long-term durability of these prostheses.MethodsThis prospective study involved 382 patients who received standalone CTDR or a hybrid procedure (ACDF/CTDR). A retrospective comparison between different CTDR devices was conducted regarding patient-reported outcome measures (PROMs), failure scenarios, and revision surgeries. The M6-C™ Artificial Cervical Disc (Orthofix, Lewisville, Texas) cohort was compared to the other CTDR devices clinically. Etiological reasons for revision, and the surgical technique of the revision was investigated.ResultsFifty-three patients received M6-C CTDR. Eighteen patients (34%) were revised at an average of 67 months postoperatively for wear-induced osteolysis. There were three additional cases of pending revision. The PROMs of the two groups were similar, indicating that the failure mode (wear-induced osteolysis) is often asymptomatic. The demographics of the two groups were also similar, with more women undergoing revision surgery than men. There were three one-level CTDR, four two-level hybrids, seven three-level hybrids, and three four-level hybrids revised anteriorly. Sixteen patients underwent removal of the prosthesis and were treated according to the extent of osteolysis. There were four vertebrectomies, six revisions to ACDF, and six revisions to another CTDR. One patient underwent supplemental fixation using a posterior approach. The other CTDR cohort had an incidence of 3.3% at the equivalent time, and none of these were due to osteolysis or wear-related events.ConclusionsThere is a concerning midterm failure rate related to ultra-high-molecular-weight-polyethylene wear-induced osteolysis in the M6-C. Patients implanted with the M6-C prosthesis should be contacted, informed, and clinically and radiologically assessed.

Full endoscopic anterior cervical discectomy and interbody fusion in patients with cervical spondylotic myelopathy

Background: For the surgical treatment of cervical spondylotic myelopathy (CSM), anterior decompression with fusion or posterior decompression using microscopy has been used widely as the standard procedure, depending on the location of pathology and the surgeon's preference. Endoscopic anterior cervical discectomy and interbody fusion (E-ACDF) is a minimally invasive, effective surgical option for the management of CSM. The advantages of using endoscopy for anterior cervical discectomy and interbody fusion (ACDF) are better visualization of the operative field with the possibility of changing the angle of the endoscope. This reduces the damage to the normal anatomical structure. Although long-term follow-up results are needed to evaluate fusion rate and complication, this appears to be a safe and feasible alternative to conventional ACDF for CSM. In this article, we have described the surgical technique, summarized the endoscopic process to discuss its operative strategies, and reviewed the radiographic records, pre- and postoperatively.Material and Methods: This retrospective review study included 36 cases aged 37 to 65 years, with CSM at one segment. All of them underwent full E-ACDF from January 2018 to April 2021. All patients were followed up for 12 months after the procedure by outpatient interviews. The clinical outcomes were evaluated based on the Visual Analog Scale (VAS) of the arm, and Japanese Orthopedic Association (JOA) score with clinical data at preoperative, 3, and 12 months after the operation. Hirabayashi method was used to assess the neurological recovery after 12 months of operation. Radiological outcomes were evaluated using plain radiography and magnetic resonance imaging, computed tomography scan to evaluate disc height, cervical lordosis (Cobb's angle), and solid fusion.Results: The mean operation time was 150 min (range 120–170 min) and the average length of hospital stay was 2 ± 3 days. There was one case of immediate postoperative anterior neck hematoma, which required open revision surgery. There was no case of infection or damage to the anterior visceral organ. The mean VAS scores for arm pain and mean JOA scores after endoscopic ACDF were significantly improved compared with before the operation during the follow-up period. The recovery rate, which was evaluated by the Hirabayashi method, looked good enough to indicate well recovered postoperatively. The disc height changed from 5.2 mm preoperatively to 6.2 mm after immediate postoperative and 5.9 mm after 6 months (P < 0.01). Cervical lordosis as Cobb's angle between C2 and C7 was significantly improved compared to the preoperative one during the follow-up periods also. The bone fusion rate was 100% at 6 months after the operation, and there was no segmental instability.Conclusions: The present study demonstrates that E-ACDF is a minimally invasive and effective surgical option for the surgical management of CSM. Based on the present study, E-ACDF may potentially enable the avoidance of various shortcomings related to surgical approaches. Through a sort of preliminary investigation, the authors confirmed the feasibility of E-ACDF and presented comparable outcome results, which might dispel the safety concern because of only one complication of wound hematoma. Better-designed randomized controlled studies with larger sample sizes in longer-term follow-ups are strongly warranted.

Risk Factors of Dysphagia after Anterior Decompression and Fusion Surgery for Degenerative Cervical Spine

Risk Factors of Dysphagia after Anterior Decompression and Fusion Surgery for Degenerative Cervical Spine

Outcome of ACCF in Multilevel Cervical Spondylotic Myelopathy with OPLL and Kyphotic Deformity

Purpose: To evaluate the Outcome of Anterior cervical corpectomy &amp; Fusion in multilevel Cervical Spondylotic Myelopathy with Ossification Posterior Longitudinal Ligament &amp; kyphotic deformity. Background: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the adult. Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic condition of the spine, where the PLL becomes progressively calcified, leading to spinal canal stenosis. Anterior decompression by corpectomy and removal of ossified posterior longitudinal ligament is a well-recognized technique for decompressing the cervical spine. The involved vertebral body/bodies are removed and after assuring adequate decompression, titanium mesh cage filled with autogenous bone graft is placed in the gap with reinforcement by anterior cervical locking plate and screw. Materials &amp; Method: Retrospectively we reviewed 15 cases from 2010 to 2021 of CSM with OPLL and kyphotic deformity. All the patients with positive MRI &amp; CT scan findings and underwent ACCF by mesh cage with bone graft. Neurological improvement was assessed by the Nurick Score , improvement of pain control by VAS score, fusion rate by Bridwell’s criteria &amp; Overall functional assessment by modified Odom’s score . Results: Total number of patients was 15. Average age was 60 years (range 35-85). Average follow-up period was 18 months. Post-operatively, Nurick scores improved by grade 1 in 7 patients, grade 2 in 5 patients, grade 3 in 2 patients, and grade 4 in 1 patient. In our series we have no chair bound or bedridden patients after surgery. There was no difference in myelopathy outcomes comparing patients older and younger than 75 years . There was no radiographic progression after surgery. But, more than 90% patients had kyphotic correction of 10-20ͦ respectively. Conclusion: ACCF is a safe and effective method in treating the CSM with correction of few degrees of kyphotic deformity. Keywords: ACCF, Mesh cage, Locking plate

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.

Anterior Cervical Discectomy and Fusion (ACDF) with Stabilization by cervical locking plate and screw in traumatic sub-axial incomplete cervical spine injury: Early experience

Introduction: Cervical spine injuries represent 2 to 6% of adult blunt trauma, and one third of all spinal injuries. Anterior approach of operative management of cervical spinal injury with incomplete neurological lesion has least analyzed in our settings, the present study has been designed to evaluate the outcome of ACDF and stabilization by cervical plate and screw for managing traumatic cervical spine injury with incomplete neurological deficit.Methods: This study was conducted at NITOR, Dhaka, from July 2016 to June 2018.Twenty available patients meeting the inclusion & exclusion criteria were included. All cases were properly evaluated pre-operatively and underwent ACDF & stabilization with cervical plate and screws. Follow up was done for 5 to 12 months. The final assessment was done by ASIA impairment scale, MRC grading, Bridewell fusion grade, Denis work & pain scale and modified Odom’s criteria.Results: Highest number of patients 10 (50%) were in ASIA grade B, 7(35.0%) patients were in ASIA grade D and 3(15.0%) patients were in ASIA grade C on admission. But in last follow up, highest number of patients were in ASIA grade E (45%). The ASIA grade has improved 1 grade in 55% cases. Bridewell fusion grade showed anterior fusion grade I in 55% of cases, grade II in 45% cases. 60% of cases were in W2 group of Denis work scale after last follow up. Early post-operative complications were dysphagia (20%), respiratory distress (5%) and neck pain (20%). Late post-operative complications were neck pain (10%), donor site pain (5%) and bed sore (5%). According to modified Odom’s criteria, 65% of the cases were found excellent.Conclusion: On the basis of the results in this study, it can be said that anterior cervical decompression, stabilization and fusion by bone graft of the patients who have traumatic unstable cervical spine injury with incomplete neurological lesion will provide effective benefit.

Electrothermal Denervation of Synovial and Capsular Tissue Does not Improve Postoperative Pain in Arthroscopic Debridement of Anterior Ankle Impingement—A Prospective Randomized Study

PurposeThe purpose of the study was to investigate the added value of electrothermal denervation (ETD) in arthroscopic debridement of anterior ankle impingement.MethodsBetween May 2019 and December 2020, 58 patients who received arthroscopic anterior decompression for the impingement of the anterior tibiotalar joint were randomized to Group A (n = 29) with ETD of synovial and capsular tissue of the ankle and Group B (n = 29) without ETD. Patients included 37 men and 21 women, with a mean age of 42 years. The pain, range of motion (ROM), and function were recorded using the visual analog scale foot and ankle (VAS FA), the Foot Function Index (FFI), and the American Orthopaedic Foot and Ankle Society Score (AOFAS), both preoperatively and postoperatively.ResultsTwenty-four hours after surgery, the pain level at rest using the VAS (worst 10 points) was 3.8 points on average (Group A: 3.7, Group B: 3.9). After 6 weeks, the mean VAS FA was 62.6 points, and ROM improved by an average of 9.1° (Group A: 9.8°, Group B: 8.6°; P > .05), the mean FFI was 40.4 points (Group A: 37.8, Group B: 42.8), the mean AOFAS was 73.1 points (Group A: 71.3, Group B: 75.1). All postoperative scores improved significantly compared with preoperative scores. No significant differences were observed between groups.ConclusionsThe hypothesis of pain reduction with the use of ETD was refuted. The addition of ETD as part of the arthroscopic debridement of the anterior ankle impingement did not show any significant superiority in terms of the collected scores (VAS-FA, FFI, and AOFAS) at 24 hours and 6 weeks after the surgery and resulted in a comparable length of stay in the hospital and incapacity to work.Level of EvidenceLevel I, prospective cohort study.

Research on application of new nanomaterials in repairing ligament injury of Wushu athletes

Objective: The paper explored the application value of nanohydroxyapatite/polyamide 66 composite bioactive artificial vertebral body in anterior surgery of thoracolumbar ligament injury in martial arts athletes. Methods: In the experiment, 81 patients with thoracolumbar ligament injury who were treated by anterior menstrual route from January 2016 to September 2019 and were followed up divided into titanium mesh group and artificial vertebral body group according to different intervertebral bone graft support materials. Results: All 81 cases were followed up for more than 12 months. There was no significant difference in the Cobb angle and the height of adjacent intervertebral space between the two groups at 1 week and 3 months after surgery (P > 0.05). Conclusion: Thoracolumbar ligament injury anterior decompression is thorough, the reconstruction method conforms to the principle of spine biomechanical distribution, and the spinal cord function recovery is better.

Patients With Preoperative Cervical Deformity Experience Similar Clinical Outcomes to Those Without Deformity Following 1-3 Level Anterior Cervical Decompression and Fusion.

Retrospective cohort study. The aim was to compare the outcomes of patients with incompletely corrected cervical deformity against those without deformity following short-segment anterior cervical decompression and fusion for clinically significant radiculopathy or myelopathy. Cervical deformity has increasingly been recognized as a driver of disability and has been linked to worse patient-reported outcomes measures (PROMs) after surgery. Patients 18 years or above who underwent 1-3 level anterior cervical decompression and fusion to address radiculopathy and/or myelopathy at a single institution between 2014 and 2018 with at least 1 year of PROMs were reviewed. Patients were categorized based on cervical deformity into 2 groups: sagittal vertebral axis (cSVA) ≥40 mm as the deformity group, and cSVA <40 mm as the nondeformity group. Patient demographics, surgical parameters, preoperative and postoperative radiographs, and minimum 1-year PROMs were compared. Of the 230 patients, 191 (83%) were in the nondeformity group and 39 (17%) in the deformity group. Patients with deformity were more likely to be male (69.2% vs. 40.3%, P<0.001) and have a greater body mass index (32.8 vs. 29.7, P=0.028). The deformity group had significantly greater postoperative cSVA (44.2 vs. 25.1 mm, P<0.001) but also had significantly greater ∆cSVA (-4.87 vs. 0.25 mm, P=0.007) than the nondeformity group. Both groups had significant improvements in visual analog scale arm, visual analog scale neck, Short-Form 12 Physical Component Score, and neck disability index (NDI) (P<0.001). However, the deformity group experienced significantly greater ∆NDI and ∆mental component score (MCS)-12 scores (-19.45 vs. -11.11, P=0.027 and 7.68 vs. 1.32, P=0.009). Patients with preoperative cervical sagittal deformity experienced relatively greater improvements in NDI and MCS-12 scores than those without preoperative deformity. These results suggest that complete correction of sagittal alignment is not required for patients to achieve significant clinical improvement. III.

Deep Learning-Based Cervical Spine Posterior Percutaneous Endoscopic Disc Nucleus Resection for the Treatment of Cervical Spondylotic Radiculopathy.

In the past 10 years, the technology of percutaneous spine endoscopy has been continuously developed. The indications have expanded from simple lumbar disc herniation to various degenerative diseases of the cervical, thoracic, and lumbar spine. Traditional surgery for the treatment of cervical radiculopathy includes anterior cervical decompression surgery, anterior cervical decompression plus fusion surgery, and posterior limited fenestration surgery. This article mainly studies the treatment of cervical spondylosis caused by radiculopathy caused by the nucleus resection of the posterior cervical spine percutaneous spinal endoscopy based on deep learning. In the PPECD group, the height of the intervertebral cavity was measured before the operation and during the final follow-up, and the height change of the intervertebral cavity was evaluated. The relative angle and relative displacement of the sagittal plane of the operation segment in the PPECD group were measured, and the stability was evaluated. Using the cervical spine X-ray Kelvin degeneration evaluation criteria, before and during the final follow-up operation, the degeneration of the adjacent segments of the two groups was evaluated. A retrospective analysis of 26 cases of cervical radiculopathy that met the criteria for diagnosis, inclusion, and exclusion was reviewed. Among them, 11 cases were treated with PPECD surgery; 15 cases were treated with ACDF surgery. According to the evaluation method of Odom, the excellent rate and the good rate of the two groups were compared. According to the location of the lesion, the nerve detection or dull tip device is exposed under the armpit or shoulder of the nerve root, and the protruding nucleus pulposus tissue is explored and removed, and annulus fibrosus is performed as needed. After hemostasis was detected, the surgical instruments were removed and the surgical incision was completely sutured. Before the operation and 3 months after the operation, the final follow-up made no significant difference in the overall average height of the intervertebral cavity (F = 2.586, P > 0.05). The results show that posterior foramen expansion is an effective surgical method for the treatment of cervical spondylotic radiculopathy, but surgical adaptation requires strict management. In order to achieve satisfactory results, appropriate cases must be selected.

Does Cigarette Smoking Affect Cervical Laminoplasty Clinical and Radiologic Outcomes?

Retrospective review. This study aimed to investigate if smokers have both poorer early clinical and radiologic outcomes in cervical laminoplasty when compared with nonsmokers. Cigarette smoking had been reported to increase rates of pseudoarthrosis following spinal instrumentation with fusion. A retrospective review of all patients who underwent open-door cervical laminoplasty was performed. Nurick, neck pain visual analog scale, and neck disability index scores were reviewed. Cervical lordosis, range of motion (ROM), and intervertebral disc height were measured. The rates and reasons for revision surgery were recorded and classified according to the etiology of laminoplasty revision surgery. Sixty patients were recruited, of which 20 patients (18 males, 2 females) were smokers and 40 patients (27 males, 13 females) were nonsmokers. There was no statistically significant difference between smokers and nonsmokers in preoperative and postoperative visual analog scale, neck disability index, and Nurick scores. A trend was noted toward a greater postoperative reduction in cervical lordosis (13±8 vs. 11±11 degrees). Furthermore, 41% of smokers versus 30% in nonsmokers had >10% loss of postoperative ROM, and 59% smokers versus 50% nonsmokers had >5% loss of postoperative ROM.Postoperative complications and intervertebral disc deterioration were similar in both groups. A higher reoperation rate was noted in smokers with 6 smokers (30%) as compared with 4 nonsmokers (10%), although this did not reach statistical significance. Among the smokers, 4 (20%) were because of cervical disease progression while 2 were technique related. In nonsmokers, all 4 (10%) were because of cervical disease progression. This study showed that while there was a nonstatistically significant trend noted toward higher rates of revision surgery in smokers, the laminoplasty outcomes were not significantly poorer in smokers. In heavy smokers with multilevel cervical myelopathy, laminoplasty may be the treatment of choice over anterior spinal decompression and fusion where a high risk of pseudoarthrosis is anticipated.

Subjective and Objective Change in Cervical Spine Mobility After Single-level Anterior Cervical Decompression and Fusion: Erratum.

Subjective and Objective Change in Cervical Spine Mobility After Single-level Anterior Cervical Decompression and Fusion: Erratum.

Work Ability After Anterior Cervical Decompression and Fusion Followed by a Structured Postoperative Rehabilitation: Secondary Outcomes of a Prospective Randomized Controlled Multi-Centre Trial with a 2-year Follow-up

Purpose Information on work ability after ACDF and postoperative rehabilitation is lacking. The aim of the present study is therefore to investigate the work ability benefits of a structured postoperative treatment (SPT) over a standard care approach (SA) in patients who underwent anterior cervical decompression and fusion (ACDF) for cervical radiculopathy and factors important to the 2-year outcome. Methods Secondary outcome and prediction model of a prospective randomized controlled multi-centre study with a 2-year follow-up (clinicaltrials.gov NCT01547611). The Work Ability Index (WAI) and Work Ability Score (WAS) were measured at baseline and up to 2 years after ACDF in 154 patients of working age who underwent SPT or SA after surgery. Predictive factors for the WAI at 2 years were analysed. Results Both WAI and WAS significantly improved with SPT and SA (p < 0.001), without any between-group differences. Thoughts of being able to work within the next 6 months, Neck Disability Index (NDI), and work-related neck load explained 59% of the variance in WAI at the 2-year follow-up after ACDF. Conclusions Patients improved over time without group differences, suggesting the improvement to be surgery related. Expectation to work within the next 6 months, self-reported neck functioning and work-related neck load were important to work ability and are central factors to ask early after ACDF, to identifying further interventions promoting return to work.

Polarization of infiltrating macrophages in the outer annulus fibrosus layer associated with the process of intervertebral disc degeneration and neural ingrowth in the human cervical spine

BACKGROUND CONTEXTAs no infiltrating macrophages exist in healthy discs, understanding the role of infiltrating macrophages including their polarity (M1 and M2 phenotypes) in intervertebral discs (IVDs) is important in the assessment of the pathomechanisms of disc degeneration. PURPOSETo determine the relationship between infiltrating macrophage polarization and the progression of human cervical IVD degeneration. STUDY DESIGNHistopathological study using harvested human cervical IVDs. METHODSIVDs collected during anterior cervical decompression from 60 patients were subjected to immunostaining and immunoblotting. The samples were classified as type 0–3 according to the percentage of CD16- and CD206-positive cells to CD68-positive cells in the outer annulus fibrosus layer. The number of vessels and nerve fibers and the severity of chronic inflammation with a focus on inflammatory cell infiltration, fibrosis, and capillary proliferation were also assessed. RESULTSThe number of CD16-positive cells was the highest in type 2 IVDs, and was suppressed following the infiltration of CD206-positive cells. The degree of chronic inflammation was significantly higher in type 2 and type 3 IVDs, and the number of nerve fibers was significantly higher in type 3 IVDs. The endothelial cells of small vessels were positive for nerve growth factor, brain-derived neurotrophic factor, and neurotrophin-3 expression. Staining for tropomyosin receptor kinase (Trk)-A, Trk-B, and Trk-C was positive in aberrant fibers. In immunoblot analysis, the expression levels of these neurotrophic factors and receptors were significantly higher in type 2 and 3 IVDs. CONCLUSIONSThe polarity of macrophages around newly developed microvasculature might be altered with cervical IVD degeneration. A higher number of infiltrating M1 macrophages around the vessels was associated with chronic inflammation; however, their number got suppressed following the infiltration of M2 macrophages. The expression of neurotrophins in the capillaries of small vessels might contribute to neural ingrowth into degenerated IVDs. CLINICAL SIGNIFICANCEClarifying macrophages polarity change around new microvasculature associated with progression of IVD degeneration could enhance our understanding of the underlying mechanisms of neural ingrowth into degenerated IVDs and lead to development of a novel therapeutic target for prevention of IVD.

Management of Symptomatic Cervical Spine Pseudarthrosis: A Suggested Algorithm for Surgical Planning.

The clinical outcome of anterior cervical decompression and fusion (ACDF) correlates with fusion rates. There is a debate about how patients with symptomatic pseudarthrosis should be managed. In this study, a treatment plan is developed based on the surgical results of 95 patients and the recent literature. A retrospective study to evaluate the long-term results after surgical treatment of symptomatic pseudarthrosis after ACDF. Between 1994 and 2015, 95 patients underwent surgery due to symptomatic pseudarthrosis after ACDF. The diagnosis was confirmed with dynamic radiographs and computed tomography scans. The approach used was anterior in 62 (65.1%), posterior in 13 (13.7%), and combined anterior and posterior in 20 (21.2%) patients. The operative details and the radiological and clinical results were analyzed. The primary operation was fusion using cages in 70, bone graft and plate in 16, and bone graft only in 9 patients. The revision was performed after a mean of 27 months. After a mean follow-up of 52 months, the mean Visual Analog Scale improved from 7.5 to 2.3 (P = 0.001), and the mean Neck Disability index improved from 26.4 to 8.7 (P = 0.034). Fusion was achieved in all patients after a mean of 7.8 (SD 2.9) months. Reoperation was indicated in 4 patients, all of whom were in the anterior-only group, and was due to retropharyngeal hematoma in 1 patient and cage sinking with kyphosis in 3 patients. Solid arthrodesis significantly improves the symptoms of cervical pseudarthrosis patients. The presence of adjacent segment disease, implant migration, residual stenosis, and segmental kyphosis plays an important role in decision-making. A treatment recommendation plan has been suggested. 4.

A pragmatic single centre retrospective comparative review of complication profile between PEEK cages and Zero-P cage screw constructs

Background Anterior Decompression and Fusion (ACDF) is a common surgery recommended for symptomatic cervical degenerative disc disease after failed conservative care. There is no consensus on the choice of implants, and it varies between surgeons. This study aims to analyse the early complications following ACDF performed using a standalone cage versus a Zero-P (Cage Screw – (CS)) construct for patients with cervical degenerative disc disease. Methods A total of 162 patients underwent an ACDF between August 2016 and July 2018. There were 83 patients (111 cervical disc levels) with standalone cage (SA) and 79 patients (111 cervical disc levels) with cage-screw (CS) fixation. There was no difference between the groups in terms of age, gender, and levels of surgery. The follow-up ranged from 2 months to 24 months. Complications, both clinical and radiological, were assessed between the groups. Results Both the SA and Zero-P (CS) groups were subdivided into single and multilevel surgery. Complications encountered in the SA group were temporary swallowing problems 10, hoarseness of voice 3, cage migration 1, delayed union 1, Horner’s syndrome 1, cage subsidence 2. In the CS group swallowing problems 4, hoarseness of voice 4, CSF leak 1, recurrent symptoms 1. The observed difference in the incidence of complications between the groups did not reach statistical significance. Univariate analysis between the groups did not show any difference in the improvement of cervical sagittal balance, fusion rate, subsidence, and complications encountered. Multivariate logistic regression analysis for complications showed no difference between the groups when assessed for smoking, gender, age, Charlson comorbidity index, levels of surgery, fusion status, Odom score, or the type of implant. Conclusion In this short-term study, the standalone (SA) cages showed no difference in their complication profile in comparison to a cage-screw construct for both single and multilevel ACDF. Standalone cages might be a cost-effective option without increased complication risks. Nevertheless, we propose a longer-term follow-up with a prospective randomized trial for further evaluation of this finding.