Anterior Discectomy Research Articles

A national snapshot of the impact of clinical depression on post-surgical pain and adverse outcomes after anterior cervical discectomy and fusion for cervical myelopathy and radiculopathy: 10-year results from the US Nationwide Inpatient Sample.

Depression is associated with poorer outcomes in a wide spectrum of surgeries but the specific effects of depression in patients undergoing cervical spine surgery are unknown. This study aimed to evaluate the prevalence and impact of pre-surgical clinical depression on pain and other outcomes after surgery for cervical degenerative disc disease using a national representative database. Data of patients with cervical myelopathy and radiculopathy were extracted from the 2005–2014 US Nationwide Inpatient Sample (NIS) database. Included patients underwent anterior discectomy and fusion (ACDF). Acute or chronic post-surgical pain, postoperative complications, unfavorable discharge, length of stay (LOS) and hospital costs were evaluated. Totally 215,684 patients were included. Pre-surgical depression was found in 29,889 (13.86%) patients, with a prevalence nearly doubled during 2005–2014 in the US. Depression was independently associated with acute or chronic post-surgical pain (aOR: 1.432), unfavorable discharge (aOR: 1.311), prolonged LOS (aOR: 1.152), any complication (aOR: 1.232), respiratory complications/pneumonia (aOR: 1.153), dysphagia (aOR: 1.105), bleeding (aOR: 1.085), infection/sepsis (aOR: 1.529), and higher hospital costs (beta: 1080.640) compared to non-depression. No significant risk of delirium or venous thrombotic events was observed in patients with depression as compared to non-depression. Among patients receiving primary surgery, depression was independently associated with prolonged LOS (aOR: 1.150), any complication (aOR:1.233) and postoperative pain (aOR:1.927). In revision surgery, no significant associations were found for prolonged LOS, any complication or pain. In conclusion, in the US patients undergoing ACDF, pre-surgical clinical depression predicts post-surgical acute or chronic pain, a slightly prolonged LOS and the presence of any complication. Awareness of these associations may help clinicians stratify risk preoperatively and optimize patient care.

Device profile of the sapphire XTM anterior cervical plate system: overview of its safety and efficacy

ABSTRACT Introduction:The Sapphire X Anterior Cervical Plate System is a new medical device designed to provide stability after anterior discectomy and fusion procedures. It has unique benefits over many of the more established plates on the market. It is manufactured predominantly from titanium alloy and was first launched in late 2020. Areas covered:The structure and unique features of the Sapphire X are described. The indications for its use are discussed. The delivery system designed for the plate is reviewed in detail. Research outlining the shortcomings of current plate technologies and alternative technologies in this market space are reviewed. Expert Opinion:The evidence in this article demonstrates the risk of adjacent-level ossification development (ALOD) with current cervical plate designs. The industry is saturated with cervical plate technologies, yet there are very few plates small enough to avoid encroaching upon adjacent levels of disc space, particularly in the upper subaxial cervical segments and in patients with small vertebrae. This device review demonstrates the successful application of a cervical plate device that is small enough to avoid encroachment on the adjacent-level disc spaces while providing immediate stability after discectomy and fusion in the cervical spine.

Etiology and treatment of cervical kyphosis: state of the art review-a narrative review.

To provide state of the art review regarding cervical kyphosis. Cervical spine kyphosis has been increasingly common due to the growing elderly population. Clinicians should comprehensively understand its symptoms, biomechanics, etiology, radiographic evaluation, classification, and treatment options and complications of each treatment. Comprehensive review will help clinicians improve the management for patients with cervical kyphosis. The available literature relevant to cervical kyphosis was reviewed. PubMed, Medline, OVID, EMBASE, and Cochrane were used to review the literature. This article summarizes current concepts regarding etiology, evaluation, surgical treatment, complications and outcomes of cervical kyphosis. Major etiologies of cervical kyphosis include degenerative, post-laminectomy, and ankylosing spondylitis. Clinical presentations include neck pain, myelopathy, radiculopathy, and problems with horizontal gaze, swallowing and breathing. Cervical lordosis, C2-7 sagittal vertical axis, chin-brow to vertical angle, and T1 slope should be evaluated from upright lateral 36-inch film. The most widely used classification system includes a deformity descriptor and 5 modifiers. A deformity descriptor provides a basic grouping of the deformity consisting of five types, cervical, cervicothoracic, thoracic, coronal cervical deformity, and cranio-vertebral junction deformity. The 5 modifiers include C2-7 sagittal vertical axis, chin-brow to vertical angle, T1 slope minus cervical lordosis, myelopathy based on modified Japanese Orthopaedic Association score, and SRS-Schwab classification for thoracolumbar deformity. Current treatment options include anterior discectomy and fusion, anterior osteotomy, Smith-Peterson osteotomy, pedicle subtraction osteotomy, or a combination of these based on careful preoperative evaluation.

Sustainable Surface Modification of Polyetheretherketone (PEEK) Implants by Hydroxyapatite/Silica Coating-An In Vivo Animal Study.

Polyetheretherketone (PEEK) has the potential to overcome some of the disadvantages of titanium interbody implants in anterior cervical and discectomy and fusion (ACDF). However, PEEK shows an inferior biological behavior regarding osseointegration and bioactivity. Therefore, the aim of the study was to create a bioactive surface coating on PEEK implants with a unique nanopore structure enabling the generation of a long-lasting interfacial composite layer between coating material and implant. Seventy-two PEEK implants—each thirty-six pure PEEK implants (PI) and thirty-six PEEK implants with a sprayed coating consisting of nanocrystalline hydroxyapatite (ncHA) embedded in a silica matrix and interfacial composite layer (SPI)—were inserted in the femoral condyles of adult rats using a split-side model. After 2, 4 and 8 weeks, the femur bones were harvested. Half of the femur bones were used in histological and histomorphometrical analyses. Additionally, pull-out tests were performed in the second half. Postoperative healing was uneventful for all animals, and no postoperative complications were observed. Considerable crestal and medullary bone remodeling could be found around all implants, with faster bone formation around the SPI and fewer regions with fibrous tissue barriers between implant and bone. Histomorphometrical analyses showed a higher bone to implant contact (BIC) in SPI after 4 and 8 weeks (p < 0.05). Pull-out tests revealed higher pull-out forces in SPI at all time points (p < 0.01). The presented findings demonstrate that a combination of a bioactive coating and the permanent chemical and structural modified interfacial composite layer can improve bone formation at the implant surface by creating a sustainable bone-implant interface. This might be a promising way to overcome the bioinert surface property of PEEK-based implants.

P131. Liposomal Bupivacaine does not decrease postoperative opioid use or length of hospital stay in patients undergoing anterior and posterior lumbar discectomy and fusion

<h3>BACKGROUND CONTEXT</h3> Patients undergoing lumbar spinal surgery often report significant postoperative pain, necessitating increased postoperative analgesia and prolonging hospital stay. Liposomal bupivacaine (LB) is a novel local anesthetic encapsulated in a lipid bilayer, resulting in sustained-release analgesia, that is believed to decrease postoperative pain. While the efficacy of perioperative LB infiltration has been demonstrated in various orthopedic procedures, there has been little evidence for its use in patients undergoing lumbar spinal surgery. <h3>PURPOSE</h3> The aim of this paper was to evaluate the efficacy of liposomal bupivacaine for lowering postoperative opiate usage and length of hospital stay in the management of anterior and posterior lumbar decompression and fusion. <h3>STUDY DESIGN/SETTING</h3> A retrospective study consisting of 107 patients who underwent lumbar spinal surgery performed by a single surgeon (R.V.) from 2016 to 2019. <h3>PATIENT SAMPLE</h3> A total of 107 patients included in analysis were those who underwent anterior or posterior decompression and fusion for lumbar spondylolisthesis and stenosis. <h3>OUTCOME MEASURES</h3> Postoperative opiate use in morphine equivalents (mEq) and hospital length of stay (LOS). <h3>METHODS</h3> Demographic information, postoperative opiate use and length of hospital stay were obtained through in-depth review of electronic medical records (EMR). Data were analyzed using independent t-tests and multiple linear regression. <h3>RESULTS</h3> There were 51 (47.6%) patients who received LB, while 56 patients did not receive any perioperative local anesthetic. Patients who received LB did not have significantly lower postoperative opiate usage on postoperative day (POD) 0, POD1, POD2, or total per LOS (p=0.861, 0.602, 0.721, 0.974 respectively). Multivariate analysis showed age significantly predicted postoperative opiate usage on POD 0 (p=0.044) and total per LOS (p=0.035), while LB did not. Patients that received LB had a longer LOS with a mean of 5.45 days compared to 4.7 days for patients that did not receive LB, although significance was not reached (p=0.235). <h3>CONCLUSIONS</h3> Local anesthetics are often employed by surgeons to improve postoperative pain control. LB did not significantly decrease postoperative opiate use or shorten LOS. At this time LB was not shown to be clinically effective in patients undergoing anterior or posterior discectomy and fusion, though further evaluation is required. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

71. Long-term follow-up of a consecutive series with prodisc C Nova at a single institution

<h3>BACKGROUND CONTEXT</h3> Cervical total disc replacement surgery has more than two decades of experience. Device designs that feature a ball and socket mechanism with central keels, such as the original prodisc C, have been shown to perform favorably. However, a tall central keel can potentially be less than optimal for patients with shorter vertebral bodies or in multi-level cases. A variation of the prodisc C design was subsequently created, keeping the original mechanism of action but changing to shorter, tri-keel fixation. prodisc C Nova (Centinel Spine, West Chester, PA), which has one central keel cranially and two lateral keels caudally, was developed and released in Europe in 2010. <h3>PURPOSE</h3> The primary objective of this study was to evaluate the long-term clinical and radiographic outcomes. <h3>STUDY DESIGN/SETTING</h3> Prospective, consecutive series. <h3>PATIENT SAMPLE</h3> Fifty-six patients (37 Female, 19 Male) underwent total disc replacement surgery for symptomatic cervical disc disease at a single level. <h3>OUTCOME MEASURES</h3> Evaluation at each visit included patient self-assessments, eg, visual analog scale (VAS) pain and satisfaction, walking, physical and neurological examination, and radiographic evaluation. Radiographic evaluation was performed by an independent radiologic group (Medical Metrics, Houston, Texas). <h3>METHODS</h3> After failing conservative therapy, patients were evaluated for their suitability for surgical intervention of their symptomatic cervical disc degeneration. Patients underwent an anterior discectomy and total disc replacement. The clinical status of each patient was evaluated pre- and postoperatively at 6 weeks, 3 months, 6 months, 1 year and annually thereafter. <h3>RESULTS</h3> Patients were followed through 9 years postoperatively. At baseline, the average age was 48.22 ± 8.98 years and an average BMI 27.68 ± 4.78 kg/m2. VAS neck and VAS arm pain both showed statistically significant reduction from baseline by 6 weeks postop and were maintained through 9 years. VAS neck was 6.67 ±2.29 mm at baseline and 3.25 ± 3.59 mm at 9 years. VAS arm was 6.02 ±2.59 mm preoperatively and 4.00 ± 3.65 mm at 9 years. Patients reported high satisfaction and willingness to have operation again at all time points. Patients walking frequency increased by month 3 and was maintained in ≥ 75% of patients at all timepoints out to 9 years. Radiographic results showed no migration or protrusions through 9 years follow-up. One case of minor subsidence was measured after 5 years but did not require surgical intervention and had satisfactory results. One patient required reoperation at 10 months for persistent pain and required facet denervation at both cranial and caudal adjacent levels as well as index level. The disc remained intact and had good follow-up. There were no device failures. <h3>CONCLUSIONS</h3> Long-term follow-up shows that prodisc C Nova has patient-reported outcomes and radiographic results comparable to that published with prodisc C. Patients reported consistent and sustained improvement through 9 years of follow-up. Not only was pain relief achieved but functional improvement through walking was sustained. There were also no adjacent level surgeries over the 9 years, showing that maintaining motion has other potential clinical benefits beyond the index level. The change in keel fixation design did not affect patient outcomes, providing another option for some patients. <h3>FDA DEVICE/DRUG STATUS</h3> prodisc C Nova (Investigational/Not approved)

Cervical disc arthroplasty at C2-3: illustrative case.

BACKGROUNDSince the beginning of the 21st century, cervical disc arthroplasty (CDA) has been accepted as an alternative to anterior cervical discectomy and fusion for surgical management of disc problems. The published clinical trials of CDA have included patients with radiculopathy or myelopathy caused by one- or two-level disc herniation at C3–7. However, it remains uncertain whether CDA is a viable option for C2–3 disc herniation.OBSERVATIONSIn this report, a 52-year-old man presented with hand numbness, arm pain, and myelopathic symptoms that were refractory to medical treatment for more than 6 months. The magnetic resonance images demonstrated herniated discs at C2–3, C3–4, and C4–5, causing stenosis. There was no ossification of posterior longitudinal ligament and the spine was mobile, so he received anterior discectomies with artificial disc replacement at each of the C2–3, C3–4, and C4–5 levels. The surgery went smoothly, and his neurological symptoms were promptly relieved. The postoperative radiographs at 24 months demonstrated a preserved range of motion at each level.LESSONSTo date, this was the first report of CDA performed at C2–3, which also involved three consecutive levels of disc replacement. The report suggested that both C2–3 and three-consecutive-level CDA may be a viable option for cervical disc disease.

The aiming device for cervical distractor pin insertion: a proof-of-concept, feasibility study

BackgroundRestoration of cervical lordosis after anterior discectomy and fusion is a desirable goal. Proper insertion of the vertebral distraction or Caspar pin can assist lordotic restoration by either putting the tips divergently or parallel to the index vertebral endplates. With inexperienced surgeons, the traditional free-hand technique for Caspar pin insertion may require multiple insertion attempts that may compromise the vertebral body and increase radiation exposure during pin localization. Our purpose is to perform a proof-of-concept, feasibility study to evaluate the effectiveness of a pin insertion aiming device for vertebral distraction pin insertion.MethodsA Smith-Robinson approach and anterior cervical discectomy were performed from C3 to C7 in 10 human cadaveric specimens. Caspar pins were inserted using a novel pin insertion aiming device at C3-4, C4-5, C5-6, and C6-7. The angles between the cervical endplate slope and Caspar pin alignment were measured with lateral cervical imaging.ResultsThe average Superior Endplate-to-Caspar Pin angle (SE-CP) and the average Inferior Endplate-to-Caspar Pin angle (IE-CP) were 6.2 ± 2.0° and 6.3 ± 2.2° respectively. For the proximal pins, the SE-CP and the IE-CP were 4.0 ± 1.1°and 5.2 ± 2.4° respectively. For the distal pins, the SE-CP and the IE-CP were 7.7 ± 1.4° and 6.2 ± 2.0° respectively. No cervical endplate violations occurred.ConclusionThe novel Caspar pin insertion aiming device can control the pin entry points and pin direction with the average SE-CP and average IE-CP of 6.2 ± 2.0° and 6.3 ± 2.2°, respectively. The study shows that the average different angles between the Caspar pin and cervical endplate are less than 7°.

Pronostics Factors of Csm; Experience of Military Hospital of Rabat/Maroc about 107 Cases

Background: The surgery outcome of cervical spondylotic myelopathy (CSM) for some authors depend to the clinical signs (obesity, smoking, sex, age, patient’s activity, and the surgery delays). Nevertheless, for others authors it’s depending to the chirurgical approach (anterior or posterior or the levels number of decompression in the cervical spine). There is no consensus although some arguments prevail over to others in the literature. Our study purpose was to determine the important clinical factors predictors of surgical outcome in patients with CSM. It’s a retrospective study of 107 patients admitted to the Mohamed V hospital in Rabat over 06 years from January 2013 to December 2018 for cervical spondylotic myelopathy (CSM) operated and were followed up for 1year. Their neurological status pre and postoperative was assessed using the Japan Orthopedic Association (JOA) score and others prognostics factors such as sex, age, duration of symptoms, Cobbs angle, number of discs compressed, MODIC class signal and, (P&lt;0.05) was statistically significant. Patients were classified into 02 groups, youngers patients in group 1 = G1 (&lt;60 years of age; n = 70) and an elderly patients group = G2 (&gt;/=60 years of age; n = 37). The mean age = 52.72 years [42.27-63.16], male 64.5% against 35.5% of women, a sex ratio = 2/1 in favor of men. In G1, mean age X1= 45.6 years. In G 2, mean age X2 = 61.85 years. The average delays for surgery = 11.28 months [6-18.19]. In G1 it was 10.30 months and 16.34 months in G2. The pre operatory JOA score (JOA PREO) = 9.87 +/- 2.033. JOA PREO score was 11 and 7 respectively in G1 and G2. The prevalence of MODIC (MC) = 52.23% and type 2 of MC was predominant in both groups, with p&gt; 0.05. G1 patients underwent an ACDF in 82% and laminectomy in 18%. In G 2 laminectomy was performed in 50% and the anterior discectomy in 21.73%, corporectomy in 28.27%. After surgery, JOA score passed to severe to moderate 13.48 and 13.27 after 1year of follow-up in G1 and G2. In conclusion those factors such as sex, number of discs involved, and Cobbs angle on prognosis were not statistically significant (P&gt;0.05) but patient’s age and duration of symptoms &lt; 1 year predict to have more neurologic improvement (P&lt;0.05) according to the JOA score.

Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom.

BackgroundPreviously, dual-energy computed tomography (DECT) has been established for imaging spinal fractures as an alternative modality to magnetic resonance imaging (MRI).PurposeTo analyze the diagnostic accuracy of DECT in visualizing intervertebral disc (IVD) damage.Material and MethodsThe lumbar spine of a Great Dane dog was used as an ex vivo biophantom. DECT was performed as sequential volume technique on a single-source CT scanner. IVDs were imaged before and after an injection of sodium chloride solution and after anterior discectomy in single-source sequential volume DECT technique using 80 and 135 kVp. Chondroitin/Collagen maps (cMaps) were reconstructed at 1 mm and compared with standard CT. Standardized regions of interest (ROI) were placed in the anterior anulus fibrosus, nucleus pulposus, and other sites. Three blinded readers classified all images as intact disc, nucleus lesion, or anulus lesion. Additionally, clinical examples from patients with IVD lesions were retrospectively identified from the radiological database.ResultsInterrater reliability was almost perfect with a Fleiss kappa of 0.833 (95% confidence interval [CI] 0.83–0.835) for DECT, compared with 0.780 (95% CI 0.778–0.782) for standard CT. For overall detection accuracy of IVD, DECT achieved 91.0% sensitivity (95% CI 83.6–95.8) and 92.0% specificity (95% CI 80.8–97.8). Standard CT showed 91.0% sensitivity (95% CI 83.6–95.8) and 78.0% specificity (95% CI 64.0–88.5).ConclusionDECT reliably identified IVD damage in an ex vivo biophantom. Clinical examples of patients with different lesions illustrate the accurate depiction of IVD microstructure. These data emphasize the diagnostic potential of DECT cMaps.

Single-Level Cervical Arthroplasty with a Keel-less Prosthesis: Results in a Series of 35 Patients Operated on for Soft Disk Herniation with a Minimum of 3 Years of Follow-Up.

Cervical arthroplasty with artificial cervical disks has gained popularity as an alternative to anterior discectomy and fusion. The main advantages of disk arthroplasty include maintenance of the range of movement, restitution of disk height and spinal alignment, and reduction of adjacent segment degeneration (ASD). In this article, we aimed to assess the outcomes of the use of a keel-less prosthesis. We included all the patients who underwent single-level cervical arthroplasties with the Discocerv Cervidisc Evolution for "soft" disk herniation. Clinical assessment included Neck Disability Index (NDI) and visual analog scale (VAS) for neck and arm pain. Radiologic studies investigated the occurrence of ASD and system failure or subsidence. The reoperation rate was also recorded. The study included 35 patients (14 men and 21 women; mean age: 42.5 years; mean follow-up: 57.8 months). There was a significant decrease in VAS neck and VAS arm scores, which went from 7.2 and 6.9 preoperatively to 2.2 and 1.7 postoperatively, 2.2 and 1.6 at 6 months, 2.0 and 1.8 at 1 year, and 2.1 and 1.3 at the last follow-up, respectively. The mean NDI score was 58.0 preoperatively, 19.4 postoperatively, 17.0 at 6 months, 16.1 at 1 year, and 16.2 at the last follow-up. Radiologic studies revealed a preserved range of motion in 33 of 35 patients. No ASD occurred and no reoperation was required. Cervical disk arthroplasty with a keel-less prosthesis can be a safe and effective alternative to fusion for degenerative disk disease in selected patients, with a possible reduction of ASD.

About the surgical treatment of discogenic compressions of neural elements of the cervical spine

According to the literature, the successful results of surgical treatment of patients operated on for compression of the spinal cord and cervical spine roots vary within a fairly wide range - from 55% to 96%. It seemed important to us in the early stages after surgical treatment to assess in the age aspect its effectiveness, the dynamics of clinical symptoms and general physical condition of patients, their satisfaction with the results of the operation. We analyzed the results of surgical treatment of 44 patients suffering from a herniated disc of the cervical spine. Patients underwent surgical treatment, including discectomy (7), laminectomy (2), corporectomy and anterior corporodesis (1), discectomy and autoplasty (7), discectomy and cage placement (27). The performed surgical treatment led to the achievement of stabilization of the spine and regression of the neurological status, including the absence of pain, an increase in the volume and strength of active movements in the limbs, restoration of the functions of the pelvic organs, and improvement of sensitivity.

Association Between C5 Palsy and the Anterior Decompression Procedures, Corpectomy and Discectomy.

This is a retrospective study. The aim was to evaluate the influence of various decompression procedures on the incidence of C5 palsy (C5P). C5P is a well-known but unsolved complication of cervical spine surgery. Among anterior cervical decompressive procedures, both corpectomy and discectomy are important surgical methods, whose effects on the incidence of C5P are unknown. We retrospectively analyzed 818 patients (529 men; mean age: 59.2±11.6 y) who underwent anterior cervical decompression and fusion. The surgical choice to use corpectomy, discectomy, or hybrid decompression was based on standard treatment strategies depending on local compressive pathology and presenting clinical symptoms. We introduced an original "decompression combination score" as a means of quantifying the effects of the procedures on the development of C5P. The scores were based on the relative severity of various risk factors associated with the eventual development of C5P and were assigned as follows: C4 corpectomy, 1 point; C5 corpectomy, 1 point; C3 corpectomy successive to C4 corpectomy, 0.5 point; C6 or C7 corpectomy successive to C5 corpectomy, 0.5 point; C4/5 discectomy, 0.5 point; discectomy at another segment, 0 point. Each patient's decompression combination score was then comprised of the sum of these points. C5P occurred in 55 (47 men, mean age: 65.7±8.7 y) of the 818 (6.7%) patients. A larger number of operated disc segments was significantly associated with C5P. Higher decompression combination score was significantly associated with C5P. Multivariate analysis revealed that male sex, higher decompression combination score, and older age were significant risk factors. Corpectomy increased the incidence of C5P, while discectomy decreased the risk. The lower incidence of postoperative C5P after discectomy may be because of minimizing tethering effect to the C5 nerve root. As a preventive measure against C5P, corpectomy should be avoided, while discectomy is recommended as much as possible. Levels of Evidence: Step IV-Oxford Center for Evidence-Based Medicine 2011.

Biomechanical Study of Cervical Disc Arthroplasty Devices Using Finite Element Modeling.

Many artificial discs for have been introduced to overcome the disadvantages of conventional anterior discectomy and fusion. The purpose of this study was to evaluate the performance of different U.S. Food and Drug Administration (FDA)-approved cervical disc arthroplasty (CDA) on the range of motion (ROM), intradiscal pressure, and facet force variables under physiological loading. A validated three-dimensional finite element model of the human intact cervical spine (C2-T1) was used. The intact spine was modified to simulate CDAs at C5-C6. Hybrid loading with a follower load of 75 N and moments under flexion, extension, and lateral bending of 2 N·m each were applied to intact and CDA spines. From this work, it was found that at the index level, all CDAs except the Bryan disc increased ROM, and at the adjacent levels, motion decreased in all modes. The largest increase occurred under the lateral bending mode. The Bryan disc had compensatory motion increases at the adjacent levels. Intradiscal pressure reduced at the adjacent levels with Mobi-C and Secure-C. Facet force increased at the index level in all CDAs, with the highest force with the Mobi-C. The force generally decreased at the adjacent levels, except for the Bryan disc and Prestige LP in lateral bending. This study demonstrates the influence of different CDA designs on the anterior and posterior loading patterns at the index and adjacent levels with head supported mass type loadings. The study validates key clinical observations: CDA procedure is contraindicated in cases of facet arthroplasty and may be protective against adjacent segment degeneration.

Local Retropharyngeal Space Anesthetic for Dysphagia Reduction after Anterior Cervical Discectomy and Fusion Surgery: A Single-Center, Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

The main objective of this study was to analyze the ability of local anesthetic instillation into the retropharyngeal space to reduce dysphagia symptoms and occurrence rates in patients undergoing anterior cervical discectomy and fusion (ACDF) procedures. A single-center, prospective, randomized, double-blinded, and placebo-controlled clinical study was performed. We enrolled patients undergoing one- or two-level ACDF procedures for cervical degenerative disc disease with disc herniation, radiculopathy and/or myelopathy symptoms. The patients were randomly assigned (1:1 ratio) to receive either 0.5% bupivacaine hydrochloride or 0.9% NaCl solution. Forty-three (74%) and 41 (77%) of patients reported dysphagia symptoms at the time of discharge in the investigational and control groups, respectively. There were no statistically significant differences in duration of dysphagia symptoms, Swallowing-Quality of Life (SWAL-QOL) survey or pain scores between the investigational and control patient groups at any of the follow-up time points. Controlling for independent variables, only younger age significantly predicted dysphagia symptoms at discharge, 2-week, and 3-month follow-ups (P ≤ 0.03; R ≥ -0.038; OR 0.96, 95% CI 0.93-0.99. Female sex was associated with lower SWAL-QOL scores at discharge (P= 0.046; R= 0.87; OR 2.38, 95% CI 1.02-5.56). A total of 8 (13.8%) and 6 (11.3%) patients in the investigational and control groups, respectively, were referred to a specialist or underwent speech therapy for their dysphagia symptoms. There were no adverse reactions to the study drug observed. Local retropharyngeal space anesthetic instillation did not reduce dysphagia symptoms or occurrence rates in patients undergoing anterior discectomy and fusion surgeries.

Association of Duration of Preoperative Opioid Use with Reoperation After One-level Anterior Cervical Discectomy and Fusion in Nonmyelopathic Patients.

Retrospective cohort study. The aim of this study was to determine that rates of preoperative opioid use in patients undergoing single-level anterior discectomy and fusion (ACDF) without myelopathy and determine the association with reoperations over 5 years. Preoperative opioid use before cervical spine surgery has been linked to worse postoperative outcomes. However, no studies have determined the association of duration and type of opioid used with reoperations after ACDF. Patients undergoing single-level ACDF without myelopathy between 2007 and 2016 with at least 5-year follow-up were identified in one private insurance administrative database. Preoperative opiate use was divided into acute (within 3 months), subacute (acute use and use between 3 and 6 months), and chronic (subacute use and use before 6 months) and by the opiate medication prescribed (tramadol, oxycodone, and hydrocodone). Postoperative rates of additional cervical spine surgery were determined at 5 years and multivariate logistic regression was used to determine the association of preoperative opiates with additional surgery. Of 445 patients undergoing single-level ACDF without myelopathy, 66.3% were taking opioid medications before surgery. The most commonly used preoperative opioid was hydrocodone (50.3% acute use, 24.7% chronic use). Opioid-naïve patients had a 5-year reoperation rate of 4.7%, compared to 25.0%, 15.5%, and 23.3% with chronic preoperative use of tramadol, hydrocodone, and oxycodone. In multivariate analysis, controlling for age, sex, and Charlson Comorbidity Index, chronic use of hydrocodone (odds ratio [OR] = 2.08, P = 0.05), oxycodone (OR = 4.46, P < 0.01), and tramadol (OR = 4.01, P = 0.01) were all associated with increased reoperations. However, acute use of hydrocodone, oxycodone, and tramadol was not associated with reoperations (P > 0.05). Both subacute and chronic use of common lower-dose opioid medications is associated with increased reoperations after single-level ACDF in nonmyelopathic patients. This information is critical when counseling patients preoperatively and developing preoperative opioid cessation programs.Level of Evidence: 3.

The Effect of Percutaneous Nucleoplasty vs Anterior Discectomy in Patients with Cervical Radicular Pain due to a Single-Level Contained Soft-Disc Herniation: A Randomized Controlled Trial

Background Cervical radicular pain (CRP) is a common problem in the adult population. When conservative treatment fails and the severe pain persist, surgical treatment is considered. However, surgery is associated with some serious risks. To reduce these risks, new minimally invasive techniques have been developed, such as percutaneous nucleoplasty. Several studies have shown that percutaneous nucleoplasty is a safe and effective technique for the treatment of CRP, but until now no randomized controlled trials have been conducted that compare percutaneous cervical nucleoplasty (PCN) to anterior cervical discectomy (ACD) in patients with a single-level contained soft-disc herniation. Objectives To compare the effects of PCN and ACD in a group of patients with CRP caused by a single-level contained soft-disc herniation. Study design A randomized, controlled, multi-center trial. Setting Medical University Center and local hospitals. Methods Forty-eight patients with CRP as a result of a single-level contained soft-disc herniation were randomized to one of the following 2 treatments: PCN or ACD. The primary outcome measure was arm pain intensity, measured with a Visual Analog Scale (VAS). Secondary outcomes were arm pain intensity during heavy effort, neck pain, global perceived effect, Neck Disability Index (NDI), and the patients' general health (Short Form Generated Health Survey [SF-36]). All parameters were measured at baseline (T0), 3 months after intervention (T2), and one year after intervention (T3). One week after the intervention (T1), an intermediate assessment of arm pain, arm pain during heavy effort, neck pain, satisfaction, and improvement were performed. Results At 3 months, the intention to treat analyses revealed a statistical significant interaction between the groups on the primary outcome, arm pain intensity, and on the secondary outcome of the SF-36 item pain, in favor of the ACD group. On the other secondary outcomes, no statistical significant differences were found between the groups over time. At 12 months, there was a trend for more improvement of arm pain in favor of the ACD group and no statistical interactions were found on the secondary outcomes. Limitations Firstly, the inclusion by the participating hospitals was limited. Secondly, the trial was ended before reaching the required sample size. Thirdly, at baseline, after the inclusion by the neurosurgeon, 13 patients scored less than 50.0 mm on the VAS. Fourthly, the withdrawal of the physiotherapy (PT) group and finally, the patients and interventionists could not be blinded for the treatment. Conclusions At 3 months, the ACD group performed significantly better on arm pain reduction than the PCN group in patients with CRP as a result of a single-level contained soft-disc hernia. However, the clinical relevancy of this treatment effect can be debated. For all parameters, after one year, no significant differences between the groups were found. When it comes to the longer-term effectiveness, we conclude that PCN can be a good alternative for ACD.

Efficacy of anterior and posterior multilevel vertebrotomy in adolescents with Lenke type 1 and 2 idiopathic scoliosis operated on using pedicle screw fixation with various implant density

Objective. To analyze the efficacy of posterior and anterior multilevel vertebrotomy in adolescents with Lenke type 1 and 2 idiopathic scoliosis operated on using pedicle screw and hybrid instrumentation with varying implant density (ID). Material and Methods. The immediate and long-term results of surgical treatment of 271 adolescents with Lenke type 1 or 2 idiopathic scoliosis (with primary thoracic curve) operated on using one of three surgical techniques: instrumental correction and posterior fusion (n = 212), the same technique supplemented with discectomy and interbody fusion (n = 30), and that with posterior vertebrotomy (n = 29). In all three groups, the relationship between age, initial Cobb angle, mobility, ID, and treatment outcomes assessed using X-ray data and SRS-24 questionnaire was studied, including the construction of linear regression models. Results. In all groups, significant predictors of deformity correction were initial Cobb angle and ID, while the indicators of mobility and age did not demonstrate significance. The study showed no effect of anterior and posterior vertebrotomy on the magnitude of correction and its maintenance in the long-term period, as well as on the patient-reported outcomes (SRS-24). The combination of all indicators in the model explains 51 % to 74 % of the achieved correction variability. The explanatory power of the ID for the achieved correction is at least three times less than the explanatory power of the initial Cobb angle. Conclusion. Anterior discectomy with interbody fusion and posterior vertebrotomy as methods of spine release in surgery for adolescent idiopathic scoliosis do not provide additional correction of the thoracic scoliosis. Herein, the number of anchoring elements used for polysegmental fixation (implant density) does not play a role in maintaining the corrective effect.

P22. Local retropharyngeal space anesthetic for dysphagia reduction after anterior cervical discectomy and fusion surgery: a single-center, prospective, randomized, double-blinded, placebo-controlled clinical trial

BACKGROUND CONTEXT We hypothesized that a local anesthetic, bupivacaine hydrochloride, may facilitate the sympathetic blockade of the intraoperative stimulation, stabilize the hemodynamic profile and therefore reduce postoperative inflammation and swelling of the esophago-pharyngeal area. PURPOSE The main objective of this study was to analyze the ability of local anesthetic instillation into the retropharyngeal space to reduce dysphagia symptoms and occurrence rates in patients undergoing anterior cervical discectomy and fusion (ACDF) procedures. STUDY DESIGN/SETTING A single-center, prospective, randomized, double-blinded, and placebo-controlled clinical study was performed. PATIENT SAMPLE We enrolled 120 patients undergoing one- or two-level ACDF procedures for cervical degenerative disc disease with disc herniation, radiculopathy and/or myelopathy symptoms. OUTCOME MEASURES Swallowing-Quality of Life (SWAL-QOL) survey, occurrence rates, and duration of dysphagia symptoms. METHODS The patients were randomly assigned (1:1 ratio) to receive either 0.5% bupivacaine hydrochloride or 0.9% NaCl solution. RESULTS Twenty-seven (23.7%) patients reported no dysphagia symptoms: 15 (25.9%) in the investigational and 12 (22.6%) in the control groups. There were no statistically significant differences in duration of dysphagia symptoms, Swallowing-Quality of Life (SWAL-QOL) survey or pain scores between the investigational or control patient groups at any of the follow-up time points. Controlling for independent variables, only younger age significantly predicted dysphagia symptoms at discharge, 2-week, and 3-month follow-ups (p -0.038; OR=0.96, 95% CI 0.93 – 0.99. Female gender was associated with lower SWAL-QOL scores at discharge (p=0.046; R=0.87; OR=2.38, 95% CI 1.02-5.56). A total of eight (13.8%) and six (11.3%) patients in the investigational and control groups, respectively, were referred to a specialist or underwent speech therapy for their dysphagia symptoms. There were no adverse reactions to the study drug observed. CONCLUSIONS Local retropharyngeal space anesthetic instillation did not reduce dysphagia symptoms or occurrence rates in patients undergoing anterior discectomy and fusion surgeries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Recurrent Laryngeal Nerve Palsy after Anterior Cervical Discectomy and Fusion - Prevalence and Risk Factors.

Recurrent laryngeal nerve palsy (RLNP) is a potential complication of anterior discectomy and fusion (ACDF). There still is substantial disagreement on the actual prevalence of RLNP after ACDF as well as on risk factors for postoperative RLNP. The aim of this study was to describe the prevalence of postoperative RLNP in a cohort of consecutive cases of ACDF and to examine potential risk factors. This retrospective study included patients who underwent ACDF between 2005 and 2019 at a single neurosurgical center. As part of clinical routine, RLNP was examined prior to and after surgery by independent otorhinolaryngologists using endoscopic laryngoscopy. As potential risk factors for postoperative RLNP, we examined patient's age, sex, body mass index, multilevel surgery, and the duration of surgery. 214 consecutive cases were included. The prevalence of preoperative RLNP was 1.4% (3/214) and the prevalence of postoperative RLNP was 9% (19/211). The number of operated levels was 1 in 73.5% (155/211), 2 in 24.2% (51/211), and 3 or more in 2.4% (5/211) of cases. Of all cases, 4.7% (10/211) were repeat surgeries. There was no difference in the prevalence of RLNP between the primary surgery group (9.0%, 18/183) versus the repeat surgery group (10.0%, 1/10; p = 0.91). Also, there was no difference in any characteristics between subjects with postoperative RLNP compared with those without postoperative RLNP. We found no association between postoperative RLNP and patient's age, sex, body mass index, duration of surgery, or number of levels (odds ratios between 0.24 and 1.05; p values between 0.20 and 0.97). In our cohort, the prevalence of postoperative RLNP after ACDF was 9.0%. The fact that none of the examined variables was associated with the occurrence of RLNP supports the view that postoperative RLNP may depend more on direct mechanical manipulation during surgery than on specific patient or surgical characteristics.